Respected All,

In continuation to our last post on “snakebite and their types”, today we will discuss snakebite’s management protocol exercised in Exploration and Production (E&P) Companies. I am not sure about this but I have never heard in my brief professional experience that snakes are not hazards at any location within Pakistan. They are everywhere where we lead for search of resources. Snakes are remarkable animals, successful on land (on-shore) and sea (off-shore), forest, grassland, lakes, and desert. In Punjab they approach us from nearby fields and in remaining three provinces they have majority of families.

In our today’s post we will share with you reactive snakebite management protocol instead of proactive and preventive plans. But before going into the details of management plan, lets know something in more details about them.

• Snakes are almost always more scared of you than you of them.
• They don’t respect boundaries and in search of food they move a lot and often come into our camp areas.
• They catch prey, which includes insects, birds, small mammals and other reptiles, including sometimes other snakes (giving us some relief too).
• They are cold-blooded that is the reason we don’t see them when it is cold outside.
• Snakes that inject venom use glands, which are actually modified salivary glands and leaves marks of their fang.
• A snakebite should always be considered as a medical emergency, a life threatening emergency.

As we told in the last article that there are 4 types of common poisonous snakes in Pakistan and also 4 categories venom.

There are 4 types of poisonous snakes in Pakistan.

1) Common Cobra (Naja Naja)

2) Common Krait (Bungarus caeruleus)

3) Russell’s Viper (Lundi)

4) Saw Scaled Viper

4 Categories of Venom:

1) Cytotoxins: This causes local tissue damage.

2) Hematoxins: This causes internal bleeding.

3) Neurotoxins: This affects the nervous system.

4) Cardiotoxins: This type of venom affects directly on the heart and choking it to death within minutes.

The findings following a venomous snakebite can be misleading. AND it is the PANIC which leads to rush of blood, anxiety and suffocation and ends up in death. Bites by venomous snakes result in a wide range of effects, from simple puncture wounds, swelling, redness, mild or acute pain, itching, suffocation, bleeding etc to life threatening illness and death.

At first we should look for signs and symptoms of snakebite and reassure and calm the patient to help you slowing the absorption of venom (in case of confirmed snakebite) into the body and quickly preparing for medical evacuation and immobilization.

In case of venomous snakebite the speed of action of the venom results in many doctors not being confident to treat such bites at remote locations and with a lack of specialist knowledge and training; most victims are referred to hospitals for confirmation of venom and/or detailed clinical management. Signs and symptoms of snake poisoning cab be broken down into few major categories to make quick guess and lay base for evacuation.

Local effects: Bites of venomous snakes are painful and tender to touch. They can be swell, bleed and blister.

Internal Bleeding: Check for shock and bleeding of internal organs. A victim may bleed from the bite site or bleed spontaneously from the mouth or old wounds. Unchecked bleeding can cause shock or even death.

Nervous System: Assess for nervous system. The victim may have vision problems, trouble speaking, breathing and numbness.

Muscle death: Russel’s venom can directly cause extended muscle destruction. The debris from dead muscle cells can clog up the kidneys and lead to kidney failure.

Eyes: Spitting cobras can actually spit out their venom quite accurately into the eyes of their victims, resulting in severe pain and possible blindness.

Blood Clogging Test: If internal bleeding has started then no need to do this test and often this test is not performed at remote locations due to possibility if it is the case of venomous snake then the bleeding may not stop at (remote) location with minimum resources, where there is no resource of blood is available.

Specific First Aid Tips for Snakebite:

1. Keep the victim calm and prevent unnecessary movement. Reassure and try to keep him calm.
2. Lay the casualty down and immobilize the bitten limb if possible with a sling or splint, but don’t elevate it.
3. Restrict the victim’s physical activity to a minimum. Muscular contraction accelerates the absorption of venom.
4. Identification of the snake can help the medical authorities determine whether it was venomous or not but don’t endanger yourself trying to capture or kill the snake.
5. Remove bracelets, rings or other constrictive objects from the bitten limb. Don’t give anything to drink or eat.
6. Wrap the pressure bandage around the bite site.
7. Immobilize the extremity.
8. Check to make sure toes and fingers are still pink and warm, that the limb is not going numb, and that pain is not getting worse.
9. Safely and rapidly transport the victim to an emergency medical facility.
10. CPR: In rare or advanced cases where the victim becomes unconscious, open the airway and check breathing. This is where the basics of first aid come in handy. Place the person on the side in a recovery position if breathing is normal and, in cases where breathing has stopped, mouth to mouth resuscitation will be necessary. Cardiac arrest can occur in very rare cases requiring cardiopulmonary resuscitation (CPR).

In our next post we will share some of the precautions to be considered in snakebite cases. Also, we will highlight the changes incorporated in 2010 guidelines for First Aid and ECC on immobilization, pressure bandages, and tourniquets.

To Your Health, Safety and Prosperity,

Faisal Javed Mir & First Aid to Save a Life Pakistan

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