Snake Bite: What to Do and What Never to Do

The immediate priorities

• Move the person away from the snake — do not attempt to catch or kill it
• Reassure and keep them still; panic and movement speed venom spread
• Remove rings, bangles, watches and tight clothing from the bitten limb before swelling starts
• Immobilise the limb with a splint, as you would a fracture, and keep it at or below heart level
• Transport to a hospital with anti-snake venom immediately — by vehicle, with the patient lying still
• Photograph the snake from a safe distance only if it can be done without delay or risk

What never to do

• Do not apply a tight tourniquet — it causes limb damage and does not stop venom
• Do not cut the wound or attempt to suck out venom
• Do not apply ice, chilli, kerosene, herbal pastes or cow dung
• Do not give alcohol, aspirin or painkillers of the NSAID class
• Do not wait to see whether symptoms develop before travelling
• Do not visit a traditional healer first — the delay is the commonest cause of death we see

Recognising envenomation

Not every bite injects venom; around half are 'dry bites'. But you cannot tell at the scene, and the patient must be observed in hospital for at least 24 hours regardless.

Cobra and krait bites affect the nervous system: drooping eyelids, double vision, difficulty swallowing or speaking, and eventually difficulty breathing. Krait bites are notoriously painless and often occur during sleep, with the patient waking with abdominal pain and progressive weakness. Viper bites cause severe local pain and swelling, bleeding from the gums or bite site, blood in urine, and kidney failure.

Prevention in rural Anantapur

• Use a torch when walking after dark, particularly on field bunds and near water
• Wear closed shoes and long trousers when working in fields
• Sleep on a cot rather than on the floor, and use a tucked-in mosquito net — this prevents the majority of krait bites
• Keep grain, firewood and rubble away from the house, since these attract rodents and therefore snakes
• Seal gaps under doors and repair cracks in walls
• Do not reach blindly into holes, stacked wood or grain sacks

What hospital treatment involves

Treatment is anti-snake venom given intravenously, with the dose determined by clinical features and clotting tests rather than by the size of the bite. Patients with neurological involvement may need ventilator support until the venom effect wears off, which is why bites should be taken to a hospital with intensive care rather than to a small clinic.

Repeat clotting tests, kidney function monitoring and, in viper bites, sometimes dialysis form part of the care. With prompt treatment, the great majority of patients recover completely.