How and what to do in dealing with snakebites

By Donya Betancourt

SANUR, Bali (JP): A constant concern for families with children in Southeast Asia are snakebites.

There are at least 3,000 species of snakes, most of which are nonvenomous (nonpoisonous). Some snakes have special salivary glands which produce venom. Venom has several functions, including the rapid immobilization and predigesting of prey.

In Asia, snakebites are a hazard. The mortality and morbidity rate depends on the type and density of the snakes in each area. Venomous species are confined to four groups in Asia.

1. Cobras are often quite toxic and are common in Asia. They are a major cause of death in the Philippines, Thailand, Myanmar, Sri Lanka and India.

2. Sea snakes are closely related to the cobras. Being bitten by a sea snake is also a danger for fisherfolk in Malaysia and Indonesia.

3. Vipers are a responsible for numerous snakebites in the Americas, Africa, Europe and Asia (especially in Malaysia and Indonesia).

4. Colubrid, of which only a few can cause significant injury to human.

In Indonesia, most snakebites are the work of pit vipers and sea snakes. In most areas of Asia, medical treatment for snakebites is delayed because of a shortage of specific antivenoms, a lack of transportation to hospitals and a belief in traditional treatments.

The facts also show that venomous snakebites are uncommon and few physicians have extensive experience in treating such cases. Usually, the physician simply does not know how much venom is introduced in an individual case, how deeply and whether the bite is subcutaneous (under the skin), intramuscular (in the muscle) or intravenous (into the blood vessel).

Generally, physicians can determine the severity of snakebites by clinical observation and the appearance of the wound.

Now how can you determine if the snake is poisonous? It is helpful to determine the type of snake, for example by being aware that a snake with a large lance-shaped head is likely to be a venomous viper. If the snake is unknown, consider a scratch to be nonvenomous and a puncture wound to be venomous.

With a venomous snakebite, the fang marks on the skin will begin to burn and hurt within five minutes and swell within 30 minutes; there may be a blood blister, bleeding or purple spots in the area where the bite occurred. A child may develop one of the following symptoms -- nausea, vomiting, gradually increasing drowsiness, slurred speech, droopy eyelids, weakness and shortness of breath -- within six hours of being bitten.

What should you do?

The priority is to transfer the victim to a medical facility.

In most cases, no other first aid measures are necessary other than the immobilization of the bitten extremity. All snakebite victims should be kept quite.

If you are far from a medical facility or more than 60 minutes from the hospital, are sure the snake was poisonous and the fang marks begin to swell or hurt, the cut-and-suck technique can be used.

First, use a knife or razor blade which has been cleaned with flame or alcohol. Then cut the skin over the fang mark lengthwise (do not make cross incisions), about 0.6 to one centimeter long and deep enough to go through the skin to the depth of the bite mark, or around 0.3 centimeters. After that, squeeze out the venom for one to two minutes, then begin suction of the venom- containing tissue fluid with either a commercially available extractor or your mouth (make sure you have no oral sores). Continue the suction for at least five minutes.

After suction, wash the incision thoroughly with soap and water. But first, remove any rings or bracelets and avoid using a tourniquet unless you are more than two hours away from the hospital. If you can reach a hospital in less than two hours, you can place a tourniquet between the bite and the heart, at least two inches above the bite. Make it tight enough to stop lymph flow through the lymph vessels, but not so tight as to stop blood flow in the veins or arteries. If the veins stand out, the tourniquet is too tight.

If the bitten extremity turns white or the pulse disappears, the tourniquet is much too tight. Do not remove the tourniquet until after an antivenom has been given. And never apply ice because ice can cause frostbite damage to the skin. When you are at the hospital, ask for a tetanus booster if your child has not had one in more than five years and the skin has been punctured.

One thing to remember concerning snakes is that they typically prefers to be left alone, so if you see a snake head the other way as avoiding contact is the best way to prevent snakebites.

The writer is a pediatrician based in Sanur, Bali. If you have any questions, please feel free to write to her. Her email address is drdonya@hotmail.com.