Snake Bites

In the UK approximately 100 people are envenomated by a snake each year.

So what do you need to do if your patient has received a venomous bite from a snake? (not the classic UK cocktail).

Symptoms/signs

70% patients have LOCAL symptoms only:
- Pain – immediate sharp pain (can take unto 30min to develop)
- Tingling/Paraesthesia – can develop later
- Swelling/Inflammation – local and regional lymph nodes
  - This may be mistaken for cellulitis initially
  - Over 24hrs, may develop bruising, erythema alone lymphatics, whole limb swelling (possibly whole body)
30% patient have SYSTEMIC symptoms:
- Severe Anaphylactoid reaction – often within 5min of bite (but may be delayed by hours)
  - Angioedema, bronchospasm, tachycardia, lsweating/fever, light headed, D+V, abdo pain
  - Can fluctuate over 48hr
- Generalised Oedema – can be fatal, affecting, airway, lungs, brain etc..
- Hypotension – can be life threatening, will normally develop within 2hrs
- Bleeding – Unusual but can be fatal (may present with bleeding gums, wounds, lungs, GIT)
- Acute Kidney Injury – especially children
- Rhabdomyolysis
- Decending paralysis – can start with ptosis and progressing to respiratory muscle paralysis
Deaths – in the UK its not likely 14 deaths since 1876, and last death 1975

Often present with local sharp pain, and swelling
Look for tooth fragment
Remember Snakes have significant material load (so antibiotic and tetanus cover)

They will need some information to aid their decision making (call early):

Snake species – Ideally latin name (english names can cover several species) – Can send a photo to NPIS if you have one
History/Exam – time, site, local and systemic signs/symps, lymph node involvement
Investigations – FBC, Blood Film, Coat Screen, D-Dimer, U&E, CK, Urine dip, ECG

DON’T CUT & SUCK!!!
ABC’s
Analgesia
Treat Anaphylaxis – Treat early
Ventilation – intubate early if developing depending paralysis
Beware Surgeons! – you can be misled into a diagnosis of compartment syndrome. Beware, on measuring pressures are often normal, and fasciotomy prior to correction of coagulation may be fatal.
Tetanus IgG
Antibiotic cover
Look for tooth fragments
Admit – for at least 24hr

UK snakes – wildlife trust
- Remember the Slow Worm – wildlife trust
Exotic Snakes – the owner will often know the name
- If you have a photo you can send to NPIS/Toxbase
  - If NO photo NPIS/Toxbase may be able to suggest good resources
- common pet snakes