What are the consequences of a viper bite for a person? How to provide first aid to a victim? What should the treatment be? You will find answers to these questions in the article.
general information
All representatives of the viper family are classified as poisonous snakes. The appearance is quite remarkable, although it is often confused with a snake. The color of this snake varies from black to brownish-gray. They live throughout Africa, Asia and Europe. In Russia, this species is found everywhere, with the only exception being Siberia. Here, scientists have identified approximately six types of common viper; Caucasian, Horned, Steppe and others are common. The common viper, the consequences of whose bite we will consider, is small in size, and the body length rarely reaches sixty centimeters.
Description
The viper can be easily identified by the dark stripe that runs along the entire ridge. Unlike snakes, which have a round head, vipers have a triangular head, with a pattern in the form of the letter X on the top of the head. Such snakes live for about fifteen years, preferring to live in one place. Vipers love damp and warm places. Old rat holes and cracks in rocks are often chosen for nesting. Human intervention or hunger can force her to leave her usual place.
Like other cold-blooded creatures, vipers love warmth. They go out in search of prey at night, hunting lizards, rodents, and small birds, but during the day they sit in the nest or bask in the sun. In winter, the animal hibernates, and awakens in early spring, when there is still snow. In the central zone of the Russian Federation, the wintering period takes about two hundred days, in the north 215. Males are the first to leave the shelter.
When is there danger?
Vipers feel great at a body temperature of nine to thirty degrees. If these indicators fall below or rise above these marks, the animal dies. This is why snakes have to hide in a shelter all day and crawl out only a few times a day to warm up. People often encounter them in the forest due to their own carelessness, receiving a poisonous bite. A person is not considered by this snake as a potential victim, they are afraid and do everything not to collide with him, and when they meet, they will never attack first.
You can only get a bite if there is a direct threat, if you step on the snake or pick it up. Before attacking, the snake will make a loud hissing sound. Another distinctive feature of vipers is poor hearing. They are not able to determine the approach of people by their steps, but are guided only by the shaking of the ground. In the case when the ground is too soft, the snake is unable to detect the presence of an outsider until the last moment.
Every year, doctors record several thousand cases. Thus far, no deaths have been reported, but this does not mean that snake venom is harmless. The consequences of bites are severe, this is often observed in patients with allergic reactions.
What does a bite look like?
After an unpleasant encounter with a snake, in the first minutes only two red dots will be visible on the affected area - marks left from the teeth. Since the poison has a strong hemolytic effect, which leads to an acceleration and increase in blood clotting, the wounds heal quite quickly. The blood bakes and a red spot appears around it. After a short period of time, swelling appears in the affected area, causing noticeable pain and spreading quite quickly, the skin begins to swell and becomes bluish in color. If the bite occurs on a limb, the person may experience numbness in the fingers. In the most dire situations, after bites, vascular thrombosis is observed, as well as hemorrhage of internal organs.
What does the danger depend on?
The consequences of a common viper bite will depend on the following points:
- Volumes of the snake. It was found that the more cold-blooded, the larger the glands that secrete poison; accordingly, its volume also increases.
- Height and weight of a person. The larger the creature that is bitten, the less impact the venom will have.
- Affected area. It is generally accepted that bites in the area of the shoulders, neck, and chest are extremely dangerous.
- General condition of the body. If there are heart problems, then there is a possibility of developing a state of shock.
Symptoms
It is extremely important to understand what the signs of a bite are in order to provide timely help if necessary. The first signal is severe pain at the site of the bite. Also, this area begins to swell, and the size of the limb can increase several times. The poison, which spreads through the bloodstream, causes hemorrhage, which causes a sharp decrease in blood pressure and swelling of the lymph nodes. Frequent symptoms are vomiting, nausea, high fever, migraine, general weakness.
Bite for an adult and a child - consequences
What consequences can there be after a viper bite? First of all, it all depends on the composition of the poison. The thing is that it is mostly considered hemo- and cytotoxic. This suggests that as a result of its exposure, the body undergoes a profound functional and structural change in the blood tissues or tissues, which leads to death. This effect is due to the composition of the poison, or rather the large number of necrotizing enzymes. At the same time, neurotoxins are not observed in the viper’s venom, and due to this, its effect on the nervous system is not observed. And the production of poison by this representative is not as critical as, for example, a pit snake or adders.
Despite this, for people who have suffered a viper bite, the consequences can be quite sad. This is especially true for those who have problems with the cardiovascular system, or who provided first aid incorrectly.
For a child, a viper bite has serious consequences. It can lead to low blood pressure, internal blood loss, general weakness and loss of consciousness. In difficult cases, convulsions and increased agitation are observed. Such complications can lead to the death of the child.
Photos of the consequences of a viper bite for a person are quite frightening, so for aesthetic reasons we did not place them in the article.
Dry bites
Perhaps the main role in the seriousness of the consequences of an encounter with a common or steppe viper is played by the amount of poison that it secretes. This is directly related to the hunting habits of the amphibian. Vipers hunt only small prey, doing it quickly, from cover, and then wait for the poison to take effect. It is also worth noting that the poison is used extremely carefully; the snake always tries to have a small amount in reserve. That is why, in some cases, the bite of a steppe viper may have no consequences. It may turn out to be completely harmless.
Emergency help
The first and most reliable aid for bites is a special drug that should be present in every clinic. This antidote is prepared based on snake venom. But, as often happens, victims of attacks are people going on vacation in nature, who do not have the opportunity to immediately go to the doctors. In addition, the serum must be administered intravenously, so not everyone will be able to carry out such treatment on a hike, even if the antidote is at hand. It is in such situations that you need to know how to provide first aid. Here the count is in minutes, but very often it happens that after being bitten people get lost and don’t understand how to act.
First you need to weaken the effects of the poison and call an ambulance. Before the doctors arrive, you should not remain idle; we carry out the following manipulations:
- The victim should be taken to a safe place and laid on the ground. Complete rest is extremely important for the patient; he should worry less and move around. This will help stop the rapid spread of poison.
- The wound needs to be opened. To do this, they press on its edges with their fingers, and for ten minutes the poison is sucked out of it with their mouth and spat out.
- Another requirement is to ensure you drink plenty of fluids (keep in mind that alcohol is prohibited). A small amount of toxins are removed with water. There are some actions that are prohibited. You should not try to cut or cauterize the wound with anything, cover it with earth, or tie everything with a tourniquet.
A bath diluted with milk or a steam bath copes well with weakness and eliminates residual signs. To reduce pain and relieve redness of the wound, juice extracted from plantain or horse sorrel root is applied to the affected area. As another natural antidote for severe wounds, you can use boiled vinegar, a tincture made from the roots of elecampane, St. John's wort or ginger. Spicy products relieve the effects extremely well.
Conclusion
So, if you are a fan of going into the forest to pick mushrooms or berries, then you have probably encountered this snake more than once. A meeting with a person usually ends tragically for a viper, because for many, killing a snake is a real feat. If you encounter this animal, you should not do anything rash, just give it the opportunity to move away. A snake bites only in the most desperate situations. When the viper hisses, you should not make sudden movements. Such actions do not mean that she will rush at a person. The opposite is true: the bite will occur silently only when there is no other option, or a person accidentally steps on it.
The bite of poisonous snakes is difficult to miss - after just a few minutes a person usually begins to experience quite severe pain. The symptoms of a viper bite differ little from the symptoms of the bites of other venomous snakes, but some differences still exist.
Viper snake bite – symptoms and signs
Symptoms of a viper bite in humans can vary and depend on the following indicators:
- The amount of poison injected. In 25% of cases, a person does not receive poison at all when bitten; in 60% of cases, the snake injects a rather small, non-life-threatening dose of the active substance.
- The age and health status of the person bitten. Old people and children usually tolerate the bite less well. Also at risk are those who are prone to cardiovascular and neurotic diseases, allergy sufferers, people who have recently undergone surgery and severe systemic diseases. Any chronic disease from snake venom can worsen.
- Bite sites. Damage to the limbs practically does not pose a serious threat to health. A bite to the neck, head, or abdomen requires immediate hospitalization.
Vipers are very cautious animals; they prefer to avoid contact with humans and almost never attack first. Because of this, most bites occur due to carelessness or inattention: in a situation where a person did not notice the snake and stepped on it in the tall grass, crushed the viper that had climbed into a backpack, or clothes folded on the ground. Symptoms after a viper bite primarily appear in the affected area:
- pricking sensation;
- reddish mark from 2 poisonous teeth (in difficult cases - 4);
- after 15 minutes – the appearance of severe pain at the site of the bite and around it;
- swelling;
- tissue redness;
- the appearance of bruises;
- After a few hours, bruises and blisters with pus may appear.
In addition, signs of toxic poisoning appear:
- weak rapid pulse;
- dizziness and nausea;
- spasms;
- temperature increase;
- enlarged and painful lymph nodes;
- breathing disorder, .
What are the symptoms of a viper bite in animals?
Many animals are not sensitive to snake venom at all, 
but there are also categories for which a viper bite is deadly. These are small rodents, dogs and cats. Symptoms in cattle when bitten by a steppe viper do not always appear due to the large mass of these animals. You shouldn't worry too much if your cow is bitten by a snake; most likely, the animal will make a full recovery within a couple of days. It may fall to its side for a while, but this does not always happen. But the goat may need a longer period. In general, with strong doses of poison, the manifestations of the bite will be the same as in humans. It is important to remember that milk from a bitten animal cannot be consumed, but it should be milked several times a day.
Update: October 2018
Just the sight of a crawling snake fills us with horror and fear. But, contrary to what many people think, even the most poisonous snake will never attack a person with the intention of deliberately biting. By attacking a person, the snake protects itself from danger. Only now a person rarely steps on a snake in order to crush it.
Thus, a person receives snake bites through negligence, accidentally stepping on an animal or disturbing its habitat, while the snake attacks a person because the natural instinct of self-preservation is triggered. This is another reason to be especially vigilant when visiting forests and swamps!
Statistical Facts About Snakes
How to distinguish the bite of a poisonous snake from a non-venomous one
On the left is a non-venomous snake, on the right is a poisonous one
Snakes are a suborder of reptiles that has many families, both venomous and non-venomous, with a variety of colors and patterns. In addition, there are melanistic (black) individuals. Therefore, sometimes it is not easy to distinguish a poisonous individual from a non-venomous one, for example, a melanistic viper from a melanistic snake, etc.
Few of us can quickly determine whether a snake is poisonous or not. When a person accidentally disturbs a snake, and it bites him in defense, often he does not even see it. And if she notices it, it is difficult to quickly determine whether its bite is dangerous or not. However, this can be recognized by the bite mark left behind:
- Poisonous snake bite - traces of its fangs are visible
- Non-venomous snake bite - 2 scratches or small thin stripes
If you manage to see the snake that bit you, try to remember its size, color, pattern, characteristic movements, etc., this may be useful for selecting the necessary serum.
Non-venomous snakes
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Poisonous snakes
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in the south of the European part of Russia, in the Caucasus, in the Kazakhstan steppes, floodplains of the Altai and Uzbekistan rivers, in the foothills of Kyrgyzstan |
in Azerbaijan, the steppes of Kyrgyzstan, Kazakhstan, the shores of the Aral Sea, the Caspian Sea, southern Siberia, Northern Uzbekistan |
in Central Asia (sandy areas) |
in the Caucasus, Central Asia and Transcaucasia |
in Southern Uzbekistan, Turkmenistan, Tajikistan |
Characteristics of bites from poisonous snakes in our latitudes
In our latitudes there are 14 species of poisonous snakes from the families of colubrids, vipers and aspides. The copperhead and snake snakes, representatives of already-like species, can bite a person, but their bite does not pose any danger; only the wound can fester. But the representatives of the two remaining families pose a real danger to their lives.
| Viperaceae - Common viper | Aspidae - Central Asian cobra | |
| Attack Features | When potential danger approaches, it tries to crawl away or lies quietly. Bites if stepped on, picked up or chased. | At the sight of danger, it takes a typical pose, hisses, and when a person approaches, it jumps forward, but does not always bite at this moment, it can simply hit its head with its jaws closed. |
| Venom components |
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| Where does the poison accumulate? | In the head of the snake there are special venom-bearing glands, the excretory ducts of which enter the fangs. The release of poison occurs due to contraction of the temporal muscles. | |
| Effect of poison | Destroys the walls of blood vessels, proteins, blood cells. Blood clots form inside the vessels, the function of the heart and liver is damaged, and the water-mineral balance is disrupted. | Causes disruption of reflex activity. Paralysis, paresis of the limbs, heart failure and circulatory disorders occur. |
Symptoms of a poisonous snake bite
After a snake bite, a certain symptom complex develops, directly related to the entry and spread of snake venom throughout the body. The consequences of a cobra attack are always more severe than those of a viper. The severity of the bite and, accordingly, the symptoms depend on several factors: 
- victim's body weight– the smaller it is, the more severe the intoxication;
- human health status– chronic diseases aggravate the course of intoxication;
- bite sites: the most dangerous are the head, neck and poison getting into a blood vessel;
- air temperature– the higher it is, the faster intoxication develops;
- the size of the snake - large individuals secrete more poison;
- the amount of poison that enters the body.
Surprisingly, a viper’s bite can be completely safe if it has recently used its venom - the deadly liquid is produced slowly.
Common viper
| Local | Are common | Symptoms of severe intoxication |
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Central Asian cobra
| Local symptoms | General symptoms |
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What not to do if you are bitten by a snake
- Apply a tourniquet - a sharp disruption of blood circulation increases the degree of tissue damage and intoxication.
- Cut the tissue at the site of the bite, supposedly to release blood with poison. This is fraught with infection in the wound, poison entering the vessels and damage to vital vessels and nerves.
- Cauterize the wound.
- Drink alcohol, which accelerates the spread of poison throughout the body.
- Inject the damaged area with anesthetics (novocaine, adrenaline).
First aid for a snake bite
If a person died from a poisonous snake bite, most likely it was due to untimely first aid. The first aid algorithm will help save a person from the serious consequences of a snake attack, and sometimes death:
- Call an ambulance. Even if a person objectively feels well, within a couple of minutes life-threatening conditions may arise, such as impaired cardiac and respiratory function.
- Suck the poison out of the wound as soon as possible (optimally - within 1-3 minutes after the bite):
- open the punctures from the teeth by lightly rubbing the damaged skin between the fingers;
- grab the tissue near the wounds with your teeth and suck out the poison, slightly pressing the surrounding tissue with your hands;
- the liquid that has been sucked out should be immediately spat out - the danger of poisoning from poison that has entered the stomach is minimal, but you should definitely not swallow a mixture of poison and blood;
- actions should be clear and quick, procedure time – 15-20 minutes
If you find yourself alone in such a situation, and it is physically impossible to suck out the poison yourself, try to at least squeeze out a little blood from the wound in the first minutes. But this should be done very carefully, pressing down the surrounding tissues, and not the wound itself.
- Disinfect the wound alcohol-free antiseptic (hydrogen peroxide, potassium permanganate solution, brilliant green) - gently wipe the wounded surface.
- Apply an aseptic bandage to the wound.
- Ensure rest of the limb and whole body– free the limb from clothes, watches, bracelets (if the bite was on the hand), fix the limb with splints and take a horizontal position.
- Apply a compression bandage to the limb– wrap loosely with an elastic bandage so that your finger can easily fit under the bandage.
- Apply cold to the bite site– ice in a towel, a heating pad with cold water.
- Take antihistamines:
- administer intramuscularly 1 ml of 1% solution of diphenhydramine, suprastin;
- or take an antihistamine orally (Suprastin, Loratadine, Fenkarol) and continue taking it as directed for 3-5 days;
- or (in case of a strong reaction) inject 30-60 mg of prednisolone intramuscularly or take 1 tablet of 5 mg orally.
- Relieve general intoxication:
- drink 3-5 liters of liquid per day;
- when bitten by a viper, a warm alkaline drink (still mineral water, soda solution 1 tsp per glass of water) in a volume of 1-2 liters is recommended;
- take vitamins C and P;
- intravenously: 400 ml of 5% glucose, 400 ml of rheopolyglucin.
- Stimulate cardiac and respiratory activity(if necessary and the presence of appropriate symptoms): chest compressions, artificial respiration.
- Administer the antidote. This event is carried out by a medical professional. Depending on what type of snake bit the person, Antigyurza or Anticobra serum is administered. The action of serums is based on the destruction of poison components. They are most effective when administered in the first hours after the bite; they should be administered no later than the first day.
Preventing snake bites
- Do not provoke the snake into active actions, do not scream, let it calmly crawl away and hide;
- Be careful in the forest and swamp, watch your step, do not walk in places where there is dead wood;
- When visiting forests, wear high boots and thick clothing;
- When moving through the forest, tap a long stick in front of you. When picking berries from a small bush, also run a stick along it, and only after a few minutes collect the berries;
- When spending the night in the forest, carefully check your tents and sleeping bags to see if a snake has crawled inside. Close tent doors tightly.
Spider bites
The likelihood of encountering spiders in nature is much higher than snakes. Spiders, as we know, do not attack humans; most often a person receives bites due to his own carelessness and reckless curiosity, catching spiders and putting them on his hand. Like any other living creature, a spider protects itself, so it can bite when a person disturbs an arthropod without noticing it, since their size is small.
Statistical facts:
- There are about 30,000 species of spiders in the world;
- Almost all of them are poisonous;
- The poison is produced by special glands and injected into the victim through fangs - chelicerae;
- The most poisonous poison for humans is produced by the female karakurt - the black widow;
- The larger the spider, the more venom it produces.
What does a spider bite look and feel like?
- The moment of the bite is similar to piercing the skin with a thin needle or is completely imperceptible;
- A white spot with pink or red edges appears at the site of damage;
- There is redness, numbness and tingling of the bite area;
- After some time, an ulcer may form at the site of the bite, the contents of which are gradually rejected;
- Symptoms of intoxication appear within 5-20 minutes;
- Common symptoms may develop: headache, muscle weakness, chills, convulsions, shortness of breath, increased heart rate, gastrointestinal spasms, urticaria.
 South Russian tarantulaLives in minks in arid areas in southern Russia. Habitat: steppes, deserts. The bite is a spherical swelling of a pale color with reddish edges, which bursts within 1-2 hours and turns into an ulcer. |
 Spider - recluseFound from the southern midwestern United States to the Gulf of Mexico. The bite is a blister with a bluish-purple, red or white border that looks like a target. Increases in size and bursts to form an ulcer |
 Karakurt - black widowLives in Kyrgyzstan, Central Asia, Astrakhan, Rostov, Volgograd, Saratov, the Azov and Black Sea regions, Altai Territory, even in Novosibirsk. They love the slopes of ravines, virgin wormwood, banks of irrigation ditches, and where there are hot summers and warm autumns. The bite is visually invisible - a small red spot may form that quickly disappears |
Black Widow
The phrase black widow is the second name of the female karakurt, since after mating she devours the male. This black spider is deadly to humans, and symptoms develop only after a few hours. When biting, a black widow brings discomfort to a person in the form of pain, but the wound itself is almost invisible on the skin.
Symptoms of a bite develop after 1-2 hours, subside within 1-3 days:
- Pain and erythema at the site of injury;
- Excitement, anxiety;
- Headache and dizziness;
- Sweating;
- Nausea and vomiting;
- Hypertension;
- Increased salivation;
- Erythematous rash, itching;
- Ptosis;
- Swelling of the extremities;
- Muscle spasms, cramps;
- Cramping pain in the abdomen.
Paresthesia, seizures, weakness and restlessness may persist for several weeks.
Fatalities are rare; children, the elderly and patients with chronic diseases are at risk. The most dangerous outcome is the development of DIC syndrome: disseminated intravascular coagulation of platelets, which quickly leads to death.
Tarantula
The tarantula lives in steppe and desert areas and hunts at night. The idea of the tarantula as a deadly arthropod is greatly exaggerated. The bite of this type of spider extremely rarely leads to the death of a person and only with the development of a severe allergy in the form of anaphylactic shock. A tarantula can bite a person, but it can also defend itself in another way - by shedding thin hairs that stick into the skin:
Tarantula
The tarantula, a colorful member of spiders, often becomes a pet and can bite its owner. They do not pose a mortal danger. When biting a person, it only damages the skin, but does not inject poison. Therefore, a typical swelling forms at the site of damage, which disappears after a few days. However, if the wound is not treated, infection and suppuration of the affected area may occur.
Recluse spider bite
The hermit is common in the USA and Australia. On the back of the arthropod there is a camouflage pattern in the shape of a violin, so it is difficult to notice it in places where it likes to hide - old boxes, cracks in walls and floors, niches under beds. The hermit’s bite is not noticeable to humans, and deadly symptoms develop only on the second day:
- severe itching, induration and swelling at the site of injury;
- ulceration of the skin at the site of the bite;
- tissue necrosis to the deep layers of the skin, difficult to treat;
- elevated temperature;
- muscle and joint pain;
- cough, runny nose.
A fatal outcome is possible with the development of severe intoxication - arachnosis: necrosis of the skin and nearby tissues, diffuse myalgia and convulsions, drop in blood pressure, hemolysis of red blood cells, depression of cardiac activity.
Cross spider and black house spider
- Cross spiders are the most common type of spider in our area. They weave their webs near a person’s home and even inside the house. Reach sizes up to 1-2 cm.
- The black house spider is smaller in size and lives both inside and outside the home.
A person is bitten only when they fall into his hands, and then only if they try to hold the spider. House spider bites do not pose a mortal danger. Epeirotoxin, the main component of the poison, can lead to cold-like symptoms - aching joints, weakness and headache, which lasts for about a day. A slight swelling forms at the site of damage.
What to do if you are bitten by a spider?
First aid helps to avoid unpleasant complications of a spider bite. If the damage does not cause concern, these measures are quite sufficient, but it will not be superfluous to play it safe and visit a doctor:
- Wash the bite area with cold water and soap, the sooner the better.
- Treat the wound with the available antiseptic: chlorhexidine, hydrogen peroxide, potassium permanganate solution.
- Immobilize the bitten limb.
- Bandage the limb with an elastic bandage above the injury site, tightly, but not too tightly.
- Apply cold to the bite site.
- Drink as much fluid as possible.
- With the development of general symptoms -.
- If a mild allergic reaction develops, take an antihistamine - Loratadine, Suprastin, Fenkarol.
When to see a doctor
If you suspect or you know for sure that you have been bitten by a spider, you need to consult a doctor. It is difficult for the average person to differentiate which type of spider attacked, but there is definitely no need to waste precious time.
If you experience the symptoms described below, you should not hesitate to call an ambulance:
- Rash all over the body;
- Numbness of the injured area;
- Muscle spasms and cramps;
- Pain in the right hypochondrium, similar to appendicitis;
- Hyperthermia;
- Headache;
- General weakness;
- Pink urine.
What to do if bitten by a poisonous spider?
In this case, you should immediately visit a doctor or call an ambulance. Of course, first aid measures will help reduce intoxication, but they should be performed on the way to the hospital or while waiting for an ambulance, i.e. You can't do this without medical help.
- Black widow bites treated with the introduction of a special serum and antihistamine therapy. In severe cases, intravenous infusion of cardiac drugs, respiratory analeptics, muscle relaxants is carried out, and hormonal therapy is indicated.
- Hermit bites treatment takes a long time due to the development of specific tissue necrosis. Dead skin and tissue are surgically removed, and hormonal and antibacterial therapy is prescribed.
- Detoxification therapy in the form of intravenous administration of saline solutions and glucose helps to cope with the general symptoms of a spider bite.
Prevention of spider bites
- Do not pick up or try to catch spiders - active human actions provoke spiders to attack. This recommendation also applies to domestic spiders, especially exotic ones, which have become fashionable to breed in apartments.
- Exercise caution when visiting attics, street buildings, or dismantling old things.
- Avoid creating conditions favorable for spiders to settle: carry out cleaning in a timely manner, especially in hard-to-reach places: under and behind cabinets, behind curtain rods, etc.
- When visiting areas where poisonous spiders are found, wear thick shoes and closed clothing.
- Try not to show excessive curiosity and not to stick your hands into cracks, under stones, etc., teach this to your children too!
- Every year in the world, more than 2 million people suffer from the bite of poisonous snakes, of whom about 120 thousand die.
- The aggressiveness of snakes increases during their molting and mating season.
- Most often, a snake attacks a person only in case of self-defense.
- The snake's speed during an attack can reach 3.5 meters per second. During the throw, the snake covers a distance of up to 1/3 of its length.
- In 70% of cases, snake bites occur on the lower limbs of a person.
- The most severe bites from venomous snakes occur in women, children and people under the influence of alcohol.
Types of poisonous snakes
In Russia, there are 14 species of poisonous snakes; most often, people suffer from bites from reptiles of three families: 1) the colubrid family, 2) the viper family, 3) the aspid family.Family of already-like
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Common copperhead
The bites of these snakes do not pose a threat to health or life. However, the bite is accompanied by painful sensations and suppuration of the wound may develop.
Viper family
The viper's head is shaped like the tip of a spear. The scutes covering the head are small and practically do not differ from those on the body. The eyes are small in size, with a small ridge protruding above them. The head is separated from the body by a sharp cervical interception. The body is short and thick. The tail is blunt and short. The snake is quite peaceful and bites only if it is pursued, grabbed or stepped on. At the sight of a person, the viper always hurries to crawl away, hide, or lies quietly.
The mortality rate after being bitten by a common viper is about 1%. This is due to the fact that the viper injects a small amount of poison into the victim. She saves it, since the production of poison is a very energy-intensive process and takes a lot of strength from the snake.
Poison injection mechanism
The viper has hollow large fangs with a deep groove. The snake injects venom into the victim thanks to a reflex contraction of the temporal muscles that surround the venom-carrying glands.
When bitten, the poison can get under the skin, into muscle tissue or into the lumen of a victim’s vessel. A bite into the lumen of a vessel is more severe due to the fact that the poison spreads faster throughout the body causing various disorders. There may be cases when the bite occurs with one fang, as a result of which a smaller dose of poison is injected and the poisoning proceeds more easily.
Components of poison and their effects on the body
The main components of the poison are enzymes that break down various types of tissue (hyalorunidase, phospholipase, proteases), as well as toxic amino acids, proteins and carbohydrates.
- Hyaluronidase– breaks down connective tissue, destroys the walls of small capillaries, increases the permeability of tissues to water and ions.
- Phospholipase– splitting the lipid layer of red blood cells leads to their destruction (red blood cell hemolysis).
Viper venom - contains hyaluronidase and phospholipase and destroys the walls of blood vessels, red blood cells, proteins, forms blood clots inside the vessels, leading to circulatory disorders. In addition, the poison disrupts cardiac and liver function, and also disrupts water-mineral balance.
The poison spreads throughout the body primarily through the lymphatic vessels, less through the bloodstream and nerve fibers.
The poison is eliminated through the mucous membrane of the gastrointestinal tract, the exocrine glands (mammary glands) and the kidneys.
How does a viper attack?
Symptoms of a poisonous snake bite
Most often, bites from non-venomous snakes leave only small scratches on the body. The bite of a poisonous snake leaves deep punctures from the teeth, through which the poison is injected.
Local symptoms of a viper bite
- 1 or 2 punctures from snake teeth in the form of small dots
- Relatively mild pain at the bite site
- Burning
- Redness
- Swelling after 10-30 minutes, sometimes significant
- Possible presence of pinpoint hemorrhages, bloody blisters
- Possible areas of skin dying
- The skin becomes purple-bluish in color
- Nausea
- Drowsiness
- Dizziness
- Heartbeat
- Decreased body temperature
In case of severe intoxication:
- Confusion
- Weakness
- Pale skin
- Dizziness
- Nausea
- Sweating
- Cold extremities
- As symptoms increase, the following appears: fever, shortness of breath, possible loss of consciousness, and the development of renal failure.
3. Adder family
- Central Asian cobra
Description: the color of the upper body is from light olive to brown, the abdomen is light, yellowish. The pupil is large. Transverse stripes, the younger the snake, the brighter they are; with age, the stripes on the abdomen disappear. The snake's scales are smooth. The cobra warns of an attack: it expands its neck, makes a loud hiss, and raises the front part of its body. Often the cobra will perform a feint attack without using a bite. In such an attack, the cobra only hits the enemy with its head with its mouth closed, thereby protecting the poisonous teeth from possible breakage and preserving the poison.
Components of the poison and their effects on the body:
- The main toxins: neurotoxin - acting on nerve cells, as well as a toxin acting on the heart muscle - cardiotoxin;
- Damaging enzymes: phospholipase, hyaluronidase, cholinesterase.
Local symptoms:
- Burning pain in the bite area (subsides within a few hours)
- Swelling (not as severe as swelling from a viper bite)
- The color of the skin in the area of the bite is not changed
- Bloody fluid oozes from the wound for some time.
- The functions of the affected limb are impaired, paralysis develops, which begins to spread upward, involving the muscles of the torso and face, the eyelids and lower jaw droop, and the movement of the eyeballs is impaired.
- Intoxication develops quickly, almost immediately after the bite
- Weakness
- Vague concern
- Loss of coordination, unsteady gait
- Difficulty breathing
- Nausea
- Hiccups
- Vomit
- Swallowing disorder
- Salivation
- Speech is impaired, becoming slurred and silent.
- Cardiac activity weakens
- Possible involuntary urination and defecation
- Death can occur from respiratory arrest after 2-7 hours
What determines the severity of the bite?
- The body weight of the victim, the smaller the weight, the more severe the reaction to the bite. Snake bites are especially difficult for small children.
- State of health (presence of concomitant diseases);
- Place of the bite (bites on the neck and head are more dangerous, as well as when the bite falls on a blood vessel);
- The higher the air temperature, the faster the symptoms of intoxication develop;
- Size of the snake (the larger the snake, the more venom it has);
- The amount of poison injected. Sometimes it happens that a bite can be completely harmless and contain no poison. This situation can occur if the snake has recently used poison and it has not yet had time to develop. The viper's venom accumulates gradually.
How to assess the severity of poisoning?
| Snakes | Degree gravity poisoning | Pain | Edema | Bloody bubbles | Tissue destruction (necrosis) | Muscle twitching | General signs |
| Vipers and pit vipers | Lightweight | Local and only in the first hours after the bite | Slight in the bite area | No | No | No | In rare cases, slight shortness of breath and palpitations in the first hours after the bite |
| Average | Burning | expressed | Rarely. When applying a tourniquet - often; | rarely | No | Shortness of breath, palpitations, rarely nausea and fever, circulatory disorders | |
| Heavy | Burning with spread | Sharply expressed, extends to the entire limb or part of the body | often | often | No | Drowsiness in the first hours, shortness of breath, palpitations, nausea, vomiting, impaired liver and kidney function, severe circulatory disorders. | |
| Adders and sea snakes | Lightweight | Local pain 1-2 hours after the bite. | rarely | No | No | No | A short-term feeling of stiffness and loss of sensitivity in the affected limb. |
| Average | Same | rarely | No | No | Weak, quickly passing, tremor of the eyelids and fingers | General weakness, feeling of numbness and stiffness of the affected limb, dysfunction of the lower limbs. | |
| Heavy | Uncertain in nature with distribution throughout the body. | minor | No | No | Severe, especially in the extremities, muscle spasms of the fingers | Lethargy, drowsiness, dizziness, nausea, vomiting, difficulty breathing, paresis and paralysis of the limbs, lips, tongue, blurred vision. | |
First aid for a snake bite
What should you not do if you are bitten by a snake?
- Apply a tourniquet. The tourniquet sharply disrupts blood circulation in the bite area and significantly increases the degree of tissue damage. Applying a tourniquet for 20-30 minutes sharply worsens the general condition of the patient.
- Making cuts to allow “poisoned blood” to flow out has a high probability of damaging a nerve, vessel or tendon, as well as causing an infection.
- Cauterize the bite site.
- You should not drink alcohol, it only accelerates the spread of poison.
- Injecting the bite site with novocaine or adrenaline impairs local blood supply and aggravates tissue damage.
What to do, step by step guide
| Step by step guide: | How? | For what? |
 |
| After a bite, the poison instantly begins to spread through the vessels of the lymphatic and circulatory system. By slightly opening the punctures made by the snake's teeth, the efficiency of venom extraction increases. The fact that poison can enter the body from the oral cavity and cause poisoning, especially with wounds or diseased teeth, is only a theory that is not confirmed in practice. Thousands of professional snake catchers use this technique, and there have never been any reported cases of poisoning. Timely sucking out of the venom saves lives and reduces the number of complications after a bite. Timely initiation of poison suction can remove up to 50% of the injected poison. |
 | Any antiseptic will do, but it is better not to use alcohol or alcohol solutions, since alcohol accelerates the penetration of poison into the body:
| Disinfection of the wound is performed to prevent infection and the development of a suppurative process. Viper venom has an antimicrobial effect, so the wound should be disinfected only if the venom has been suctioned out. |
 | After a bite, completely limit movement in the bitten limb. Install the tire. If possible, take a horizontal position, maintaining complete peace and tranquility. Remove rings and bracelets if the bite is on your hand. | Any movements in the limb accelerate the movement of blood and lymph through the vessels, which accelerates the spread of poison throughout the body. Rings and bracelets can make swelling worse. |
 | The entire limb where the bite occurred should be wrapped. The bandage should comfortably compress the limb without causing discomfort, so that the finger can easily penetrate under the bandage. On the upper limb, the pressure of the bandage should be 40-70 mmHg. and 55-70 for the lower limb. | A moderately tight bandage compresses the lymphatic vessels and superficial veins, which slows down the spread of poison throughout the body and does not disrupt tissue nutrition, which is carried out by the deep veins and arteries. However, excessive pressure from the bandage can cause local tissue damage due to the complete lack of blood circulation in the area. |
 | You can use ice, but be sure to wrap it in a towel or other cloth. Beware of frostbite; as soon as you feel discomfort, take it off for a while (5-7 minutes). | Cold applied to the bite area slows down the spread of poison and the development of the inflammatory reaction, reduces swelling and pain. |
| Take antihistamines: Suprastin, diphenhydramine, pipolfen - administered intramuscularly 1 ml 1% or orally suprastin: 2 tablets. 3 r. per day, Loratadine: 1 tab. in a day; Levocetirizine: 1 tablet. in a day; If possible, administer glucocorticoid drugs:
| Antihistamines block the action of histamine, one of the main substances in inflammation and allergic reactions. Hormonal agents such as prednisolone have powerful anti-inflammatory, anti-allergic and anti-shock effects. |
|
| A large amount of fluid taken accelerates the removal of toxins from the body. Alkaline drinking reduces the toxicity of viper venom. Vitamins accelerate the metabolic processes of neutralizing toxins. |
 |
| Cordiamine– stimulates respiratory and cardiovascular function. Ephedrine- increases the strength and frequency of heart contractions, constricts blood vessels, reduces swelling, increases blood pressure, dilates the bronchi, stimulates the central nervous system. Caffeine– stimulates the respiratory and vasomotor center, increases the strength and frequency of heart contractions, increases blood pressure, dilates the bronchi, increases the formation and excretion of urine. |
 |
To prevent anaphylactic shock, serum is administered according to certain rules. At the beginning, 0.1 ml of serum is administered, after 10-15 minutes 0.25 ml, if it does not cause a reaction, the rest of the serum is administered. The serum can also be used for cobra, karakurt and scorpion bites.
| The serum binds the components of the poison and eliminates the destructive effect of the poison on the body. A timely administered serum will save lives! The serum is most effective in the first hours of intoxication. |
Forecast
With modern treatment, the prognosis for bites from venomous snakes is favorable. Deaths occur rarely, more often due to delayed treatment or severe concomitant diseases of the victim.Prevention
- Don't provoke the snake! The snake is a peace-loving animal and will never attack itself.
- Don't step on the snake, be careful and watch your step.
- When you see a snake, do not scream or make sudden movements.
- When entering a potentially hazardous area, wear high boots and thick clothing.
- Before walking through thick, tall grass, make sure there are no snakes there. Use a stick or other available means.
- Choose a suitable place to stay overnight. It is better if it is a hill with sparse and low vegetation, away from rocks and holes.
- Don't leave tents open.
- Before getting into your sleeping bag, check for snakes.
Of the 3,000 species of snakes found around the world, only 15% are widespread, and in the United States, 20% are dangerous due to venom or toxic secretions contained in the saliva (Table 347-1). At least one species of venomous snake is found in every state except Alaska, Maine and Hawaii. These are almost all crotalids (also called pit vipers due to the pit-shaped depressions on each side of the head that are heat-sensitive organs):
- rattlesnakes;
- Cottonmouths;
- water muzzles (moccassins).
About 45,000 snakebites (of which 7,000-8,000 are venomous) occur annually in the United States. The majority of bites are from rattlesnakes, and nearly all are fatal. The remaining venomous bites are caused by copperhead snakes and, to a lesser extent, moccassin snakes. Coral snakes (elapids) and imported species (in zoos, snake farms, and professional and amateur collections) commit<1% всех укусов. Большинство пациентов являются мужчинами в возрасте 17-27 лет, 50% из них были в состоянии алкогольного опьянения и намеренно ловили или убивали змею. Большинство укусов происходило в верхние конечности. В США происходит 5-6 смертей в год. Факторами риска смерти, включая экстремальные ситуации возрастного характера,являются неосторожное обращение с пойманными змеями (чаще, чем случайные встречи), несвоевременное обращение за помощью и неправильное лечение.
Outside the United States, fatal snakebites are more common and cause >100,000 deaths annually.
Pathogenesis
Snake venoms are complex substances, mainly proteins with enzymatic activity. Although enzymes play an important role, the lethal properties of the venom are caused by certain smaller polypeptides. Most venom components exhibit binding to multiple physiological receptors, and attempts to classify venoms by toxicity to any particular system are misleading and may lead to errors in clinical assessment.
Pit snakes. The complex venom of most North American pit snakes produces local effects as well as systemic effects such as coagulopathy.
Effects may include:
- damage to local tissues;
- vascular damage;
- hemolysis;
- DIC or defibrillation syndrome;
The poison disrupts the permeability of capillary membranes, causing extravasation of electrolytes, albumin and red blood cells through the walls of blood vessels into the poisoned area. Common clinical syndromes following severe pit viper envenomation include:
- Edema. Initially, edema, hypoalbunemia, and blood thickening develop.
- Hypovolemia. Following this, the deposition of blood and fluids in the peripheral vascular bed develops, causing a decrease in pressure, lactic acidosis, shock and, in severe cases, multiple organ failure.
- Bleeding. Thrombocytopenia, which usually develops in cases of severe rattlesnake bites, is clinically significant and can occur alone or together with other manifestations of coagulopathy. Intravascular coagulation due to the venom can trigger a DIC-like syndrome, leading to bleeding.
- Renal Failure: Renal failure may occur due to a severe drop in blood pressure, hemolysis, rhabdomyolysis, nephrotoxicity of the venom, or disseminated intravascular coagulation. Proteinuria, hemoglobinuria, and myoglobinuria may occur due to a severe reaction to a rattlesnake bite.
Coral snakes. The venom of these snakes contains mainly neurotoxic components that cause presynaptic neuromuscular blockade, which can cause respiratory paralysis. Due to insufficient activity of an important proteolytic enzyme, symptoms and signs at the site of the snake bite are minor.
Snake bite: symptoms
Pain is noted at the site of the bite, swelling, redness, hemorrhage, and tenderness of the regional lymph nodes occur.
The systemic effect of snake venom on the body leads to the development of hypotension and syncope, laryngeal edema, colic-type abdominal pain, diarrhea and vomiting, coagulopathy and spontaneous bleeding, ECG changes, shock, ARDS, rhabdomyolysis and renal failure. However, the bite of a viper (Vipera benus) in adults rarely leads to death.
The bite of a poisonous or non-venomous snake usually causes horror, the manifestations of which often do not depend on the type of snake (nausea, vomiting, tachycardia, diarrhea, profuse sweating) and which can hardly be distinguished from the characteristic signs of poisoning.
Symptoms and signs of poisoning may be local, systemic, or combined, depending on the severity of the poisoning and the type of snake. Anaphylactic shock may develop, especially in people who keep snakes and have previously been sensitized to snake venom.
Pit vipers. About 25% of pit viper bites are characterized as dry (no venom is released) and symptoms of systemic damage do not develop.
Local changes include scratches caused by one or more teeth. If poisoning occurs, swelling and erythema on the surrounding tissue develop at the site of the bite, usually after 50-60 minutes. Swelling can progress rapidly and involve the entire limb within a few hours. Lymphagitis, enlargement and tenderness of regional lymph nodes may develop; the temperature at the site of the bite rises. In moderate to severe poisoning, subcutaneous hemorrhages usually appear around the bite site within 5-6 hours. Bleeding is especially severe after bites from eastern and western diamondback snakes, water snakes, and prairie, Pacific, and timber rattlesnakes. Bruising is less common after being bitten by moccasin snakes and Mojave rattlesnakes. The skin around the bite is tense and pale. Blisters, serous, hemorrhagic, or both, appear at the bite site within 8 hours. Necrosis around the bite site is usually observed in rattlesnake lesions. In most cases, the effect of soft tissue damage reaches its maximum within 2-4 days.
Systemic manifestations of poisoning may include nausea, vomiting, profuse sweating, restlessness, confusion, spontaneous bleeding, fever, hypotension and shock. The venom of most North American pit vipers causes mild neuromuscular disturbances, including general weakness, paresthesias, and muscle fasciculations. Some patients develop mental disorders. The venom of the Mojave and eastern diamondback rattlesnake can cause serious neurological disorders, including respiratory failure. Rattlesnake venom can cause a variety of coagulation abnormalities, including thrombocytopenia, increased prothrombin time (measured by MHO) or activated aPTT, hypofibrinogenemia, elevated levels of fibrin breakdown products, or a combination of these abnormalities resembling DIC. Thrombocytopenia is usually the first manifestation and may not be clinically manifested or, as part of a multicomponent coagulopathy, cause spontaneous bleeding. Patients with coagulopathy have characteristic bleeding from the bite site or from the site of venipuncture or mucous membranes with epistaxis, from the gums, with hematemesis, bloody stools, hematuria, or a combination of these. An increase in hematocrit is the earliest sign due to swelling and thickening of the blood. Subsequently, a decrease in hematocrit is observed due to fluid redistribution and blood loss during the development of DIC syndrome. In severe cases, hemolysis can cause a rapid drop in hematocrit. Anaphylactic shock can cause immediate development of symptoms of systemic damage.
Coral snakes. Pain and swelling may be minimal or absent and are often transient. Systemic neuromuscular manifestations may develop after 12 hours and include weakness and lethargy, altered consciousness (euphoria, drowsiness), cranial nerve palsy causing ptosis, double vision, blurred vision, dysarthria and difficulty swallowing, increased salivation, muscle weakness and impairment or respiratory paralysis. Developed toxic damage to the nervous system is difficult to recover and can last from 3 to 6 days. If left untreated, paralysis of the respiratory muscles can be fatal.
Diagnostics
- Snake identification.
- Determining the severity of poisoning.
To clarify the diagnosis, it is necessary to determine the type of snake and identify the clinical picture of poisoning. The medical history should contain information about the time of the bite, a description of the type of snake, assistance provided at the scene (in the field), highlighting some medical data: the presence of allergies to serums made using material from horses and sheep, and information about bites of venomous snakes and previous treatment received. A complete physical examination should be performed.
Snake bites should be considered poisonous until proven otherwise after precise identification of the species of snake or a specified period of observation of the patient.
Snake identification. Patients often cannot remember details of the snake's appearance, but pit vipers are different from non-venomous snakes. In such cases, consultation with zoo, aquarium, or poison control centers can help determine the species of snake.
Coral snakes in the United States are distinguished by their round pupils, black faces, and lack of pits on their heads. They have blunt or cigar-shaped heads and alternating rings of red, yellow and black, which is why they are often mistaken for the common non-venomous scarlet kingsnake, which has alternating rings of red, black and yellow. A distinctive feature of the coral snake is that the red rings are adjacent only to the yellow ones, and not to the black ones (the sign is used: “red to yellow kills, red to black is not poisonous”). Coral snakes have short, immobile, venomous teeth and inject venom with repeated chewing movements.
Teeth marks are indicative, but not decisive for identifying the type of snake. However, the quantity
The teeth markings at the bite site may vary because... a snake can strike and bite many times.
A dry pit viper bite is confirmed if no symptoms or signs of poisoning appear after 8 hours.
Severity of poisoning. The severity of poisoning depends on the following:
- the size and type of snake (the rattlesnake is larger than the copperhead, which is larger);
- the amount of poison injected during one bite (it is not possible to determine from the medical history);
- number of bites;
- localization and depth of the bite;
- age, body weight and health status of the patient;
- time elapsed before the start of treatment;
- the patient's sensitivity to the poison, manifested by its response.
Poisoning can be classified by severity as mild, moderate and severe depending on local manifestations, systemic symptoms and clinical signs, coagulation parameters and the results of other laboratory tests. Severity should be determined by the most severe symptom, clinical sign, or laboratory finding.
Poisoning can progress quickly from mild to severe, so constant monitoring of the patient and reassessment of severity are necessary.
The immediate development of systemic symptoms should be regarded as anaphylactic shock.
Snake bite: treatment
- First aid.
- Symptomatic therapy.
- Antidote.
- Treatment of the wound.
General principles. Treatment should begin immediately, even before transporting the patient to a medical facility.
In the field (at the scene of an incident), the patient should move away or be moved to a distance out of reach of the attacking snake. He must be calmed and avoid tension, kept warm and quickly taken to the nearest medical facility. The use of pressure immobilization to delay systemic absorption of venom (bandaging the limb with a wide elastic bandage or other tissue) may be appropriate for coral snake bites, but is not recommended in the United States, where most bites are committed by pit snakes, because pressure can cause arterial disruption of the limb and necrosis. First aid is the need to maintain the airway and breathing, give O 2 and ensure the possibility of intravenous administration in an uninjured limb during transport of the patient. All other prehospital interventions (tourniquets, topical medications, suction of venom from the wound by mouth or other device after making an incision or without making an incision, use of cold or electric shock) have not been proven to be beneficial and may be harmful and delay adequate treatment. However, previously applied tourniquets, despite the risk of limb ischemia, should remain in place until the patient is admitted to the hospital, poisoning has been ruled out, or effective treatment has begun.
Serial clinical and laboratory evaluation and testing begins in the emergency department. Limb circumference is measured upon arrival and every 15-20 minutes until local progression subsides; outline the boundaries of local edema with a special marker to assess the progression of local poisoning. All pit viper bites require a basic clinical blood test, including platelets, coagulation profile (PT - prothrombin time, MHO, fibrinogen), determination of fibrin breakdown products and urinalysis, as well as plasma electrolytes, urea and creatinine. For moderate and severe poisoning, patients require blood typing and compatibility testing, ECG, chest x-ray and creatine kinase tests according to the patient's condition, performed every 4 hours for the first 12 hours, and then daily. In coral snake bites, the neurotoxic venom requires monitoring of O2 saturation as well as baseline and serial pulmonary function tests.
The duration of close observation for all patients bitten by pit viper should be >8 hours in the emergency department or emergency department. Patients without obvious signs of poisoning can be sent home 8 hours after appropriate wound treatment. Patients with coral snake bites should be monitored for at least 12 hours in intensive care units due to the risk of developing respiratory paralysis. Poisoning that is initially assessed as mild can progress to severe within hours.
Symptomatic treatment may include respiratory support, benzodiazepines for sedation for anxiety, opioids for pain, fluid resuscitation, and vasopressors for shock. Transfusions may be required, but should not be started until the patient has received the required amount of neutralizing antivenom, since most coagulopathies are treatable only if sufficient amounts of neutralizing antivenom are administered. If anaphylaxis (immediate development of systemic symptoms) is suspected, standard treatment is carried out, including epinephrine. In case of trismus, laryngospasm, hypersalivation, tracheostomy may be required.
Antidote. Along with intensive supportive care, antivenom remains the mainstay of treatment for patients with moderate to severe poisoning.
In cases of pit viper poisoning, horse anti-snake serum is largely replaced by polyvalent anti-crotalide immune FAb serum produced from sheep material. The effectiveness of antivenom made from horse serum depends on time and dose; it is most effective within 4 hours after the bite and less effective after 12 hours, although it may reverse the development of coagulopathy after 24 hours. Clinical experience suggests that the effectiveness of anticrotalide polyvalent immune FAb serum may not decrease over time, it is effective even after 24 h after the bite. Anticrotalide polyvalent immune FAb serum is also safer than equine serum, although it can still cause acute (allergic or anaphylactic) reactions and delayed reactions associated with hypersensitivity. A loading dose of 4-6 vials of a suspension of anticrotalide polyvalent immune FAb serum diluted in 250 ml of saline should be administered slowly at a rate of 20-50 ml per hour during the first 10 minutes; then, if no negative reaction occurs, the remainder is administered within an hour. The same dose can be repeated 2 times if necessary to control symptoms, reverse the development of coagulopathy and normalize physiological parameters. In children, the dose is not reduced (ie, based on weight and height).
Individual species of pit vipers may influence the required dose of antivenom. Smaller doses may be required for the aquatic moth. Antivenom is not usually needed for moccasin (copperhead) and pygmy rattlesnake bites, except for children, the elderly, and patients with various medical problems (diabetes, coronary artery disease).
Horse serum may cause hypersensitivity reactions and serum sickness. The need to conduct a skin test for sensitivity to equine anti-snake serum if its administration is necessary is controversial. The skin test does not predict the development of an acute reaction due to hypersensitivity, and a negative test result does not completely exclude the development of an immediate reaction due to hypersensitivity. However, if the skin test is positive and the poisoning is life- or limb-threatening, the H1 and H2 blockers available in the anaphylactic shock emergency kit should be given before administering the antidote. Early anaphylactoid reactions to serum are known and usually result from too rapid infusion; To stop them, the administration of serum is temporarily stopped and therapy is carried out with epinephrine, Hj- and H2-blockers and intravenous fluid administration, depending on the severity of the reaction. Typically, the antivenom is restarted after dilution and the infusion is given at a slower rate. Serum sickness is common and manifests 7 to 21 days after treatment as fever, rash, discomfort, urticaria, arthralgia, and lymphadenopathy. Treatment includes H2 blockers and a course of oral corticosteroids.
Additional therapeutic measures. Patients should receive tetanus prophylaxis (toxoid or sometimes immunoglobulin) according to the medical history. Snake bites rarely become infected, and antibiotics are only indicated when there are clinical signs of infection. If necessary, a first-generation cephalosporin (oral cephalexin, intravenous cefazolin) or broad-spectrum penicillin may be an alternative.
Treatment for bite wounds is the same as for other puncture wounds. The wound area is cleaned and bandaged. When biting a limb, it is splinted in a functional position and given an elevated position. The wound should be inspected and cleaned daily and bandaged with sterile material. Blisters, blood vesicles and superficial necrosis should be surgically removed from the 3rd to the 10th day, if necessary in several stages. Physiotherapeutic treatment, including a sterile whirlpool bath, can be used to debride the wound. The need for fasciotomy for compartment syndrome is rare, but is the method of choice when the increase in compression is >30 mmHg. Art. for 1 hour, which leads to severe circulatory impairment in the limb, and its elevated position, intravenous administration of mannitol at a dose of 1-2 g/kg and antidote are no longer sufficient. Joint mobility, muscle strength, sensitivity and volume of the limb should begin to be assessed within 2 days after the bite, no later. The development of contractures can be avoided by intermittent immobilization.
Regional poison control centers and zoos have excellent information resources for snake bite cases, including snakes from other regions.
Poisonous snake bites: first aid
- Transport immobilization is carried out and, if possible, the part of the body where the bite was located is located below the level of the heart.
- Immediately after the bite, apply a pressure bandage (tourniquet) over the bite, while avoiding compression of the arteries.
- An incision and suction of venom from a wound is permissible only immediately after a bite in cases where the snake is large and resembles a poisonous snake in appearance, the victim is a child or an elderly person, and the anti-snake serum may not be administered immediately.
- The patient must be reassured and, if necessary, sedated to prevent tachycardia and vasodilation, which will increase the absorption of the poison from the tissues.
Hospital stage
- Patients with a poisonous snake bite must be hospitalized.
- They provide venous access and send blood for the study of OAK, coagulogram, urea, electrolytes, and blood group. Examine urine for the content of myoglobin and hemoglobin.
- Hypotension and shock are treated.
- The patient may develop compartment syndrome, the signs of which must be identified early.
- If you are bitten by a snake, you need to take a culture from the wound and prescribe antibiotics. Some experts recommend administering high-dose hydrocortisone and antihistamines to reduce local and systemic inflammatory responses.
- Indications for prescribing antisnake serum are the presence of systemic manifestations, coagulopathy, neutrophilic leukocytosis, as well as the spread of edema to the wrist or ankle area, to the hand or foot, respectively.
- Contact the regional poison control center and consult on the choice of type and dose of anti-snake serum. General events. For all bites, it is necessary to take a smear and culture from the wound for microscopy and bacteriological examination.
BITES OF OTHER REPTILES
Other reptiles whose bites are significant include venomous lizards, alligators, crocodiles and iguanas.
Poisonous lizards. These lizards include the following:
- gnawing lizard;
- bearded lizard, tolahini and escorpion lizard (Heloderma horridum), found in Mexico.
The complex venom of these lizards contains serotonin, arginine esterase, hyaluronidase, phospholipase A2, and ≥1 salivary kallikreins, but there are no neurotoxic components and coagulopathic enzymes. Bites are rarely fatal. When a venomous lizard bites, it holds on tightly and injects the venom with chewing movements.
Symptoms include severe pain, swelling, bruising, lymphangitis and lymphadenopathy. Systemic manifestations, including weakness, sweating, thirst, headache. Cardiovascular collapse is rare. The clinical course is the same as for mild to moderate poisoning from the venom of most rattlesnakes.
When providing assistance at the scene, remove the lizard's jaws using forceps, holding a fire to the lizard's chin, or submerging the animal completely under water. In the hospital, treatment is symptomatic, the same as for pit viper bites; There is no antidote serum. The wound is examined with a fine needle for any remaining broken or lost teeth and then cleaned. If the wound is deep, an x-ray may be ordered to rule out a foreign body or bone fragment. Antibiotics for prophylactic purposes are not recommended.
Alligators and crocodiles. Bites usually occur when animals are handled in captivity. The bites are not poisonous, but soft tissue infection by Aeromonas species often occurs and is usually treated as a major injury.
The wounds are washed and cleaned; then delayed primary wound closure is performed or the wound is allowed to heal by secondary intention. Patients are given preventive clindamycin and trimethoprim+sulfamethoxazole-biseptol (preferred choice) or tetracycline.
Iguanas. Bites and claw wounds have become more common since iguanas were kept as pets. The wounds are superficial, local treatment. Soft tissue infection is rare, but when it occurs, the most common pathogen is Salmonella; Fluoroquinolones are used for treatment.
