Treatment of Venomous Snake Bites

Identification of Bite Marks

• Venomous Snake Bite: Usually shows two distinct fang marks. Multiple bites may show 4 or more marks, sometimes accompanied by additional smaller tooth marks.
• Non-Venomous Snake Bite: Typically displays rows of small, shallow, serrated tooth marks. Local symptoms are mild pain and slight bleeding, which usually subside quickly without systemic poisoning symptoms.

Immediate First Aid Steps

1. Calm the Victim:
   • Keep the patient as calm and still as possible to slow the spread of venom.
2. Positioning:
   • Keep the affected limb immobilized and at or below the level of the heart to reduce the spread of venom.
3. Clean the Wound:
   • Remove any venom sacs or broken fangs from the wound.
4. Cutting, Washing, and Squeezing Out Venom:
   • Disinfection: Disinfect the area around the bite.
   • Incision: Make a longitudinal cut (1-1.5 cm long) along the fang marks or a cross-shaped incision to reach beneath the skin, avoiding veins. This method is generally not recommended for bites from highly hemotoxic snakes like pit vipers due to the risk of excessive bleeding.
   • Negative Pressure: Use suction methods like cupping (or a commercial snakebite suction device) to draw out venom.
   • Washing and Squeezing: Flush the wound with a 1/5000 potassium permanganate solution, 5% sodium EDTA, or hydrogen peroxide while gently squeezing the area from the proximal end towards the bite to encourage venom expulsion. Continue this process for 20-30 minutes.
5. Dressing the Wound:
   • After washing, cover the wound with sterile gauze and keep the limb in a lowered position to promote venom drainage.
6. Alternative Fluids:
   • If clean water is not available, urine can be used for rinsing, but avoid alcohol or spirits.

Local Injection Treatments

1. Enzyme Injection:
   • Inject 2000-4000 units of crystalline trypsin dissolved in 10-60 ml of 0.25%-0.5% procaine around the wound and into the swollen area. Repeat as necessary.
2. Potassium Permanganate Injection:
   • Inject 5-10 ml of 0.5% potassium permanganate solution around the wound. Note that potassium permanganate can cause severe tissue damage and pain and should not be overused or mixed with procaine.

Herbal Treatments

1. Topical Applications:
   • Mix “Xionghuang (realgar) garlic paste” with saliva to form a paste and apply it to the bite.
   • Use “Xionghuang (realgar) coal” to create smoke and apply it to the bite until purple-black liquid oozes out, indicating the removal of toxins.

General Recommendations

• Seek Medical Attention Immediately:
  • Always get the victim to a hospital as quickly as possible for professional medical treatment, including antivenom administration.
• Avoid Harmful Practices:
  • Do not use ice on the bite.
  • Do not use tourniquets, as they can cause more harm than good.
  • Do not cut the bite site if bitten by highly hemotoxic snakes to avoid excessive bleeding.
• Monitor the Victim:
  • Keep monitoring the patient’s vital signs and be prepared to perform CPR if necessary.

By following these guidelines, immediate and effective treatment can be administered to a person bitten by a venomous snake, potentially saving their life and preventing severe complications.