snakebite

Snakebite: Short overview

• What to do with a snake bite? Soothe the affected person, immobilize him, if necessary, take care of the wound and remove jewelry / clothing, take him to the hospital or call the rescue service.
• Snakebite risks: Nervous and muscle damage, blood clotting disorders, circulatory problems, allergic reactions (itching, nausea, drop in blood pressure, etc.), serum sickness (when administering antivenom)
• When to the doctor? Always! Every snakebite is an emergency, as the danger posed by them usually can not be assessed on the spot.

Watch out:

• Some snakes are dead in danger! In addition, even dead snakes and even severed snake heads can still snap shut! Therefore, you should not touch a (supposedly) dead snake (without protective measures) or take a close-up photograph.
• Even if it is often done in movies – a snakebite wound should neither be ligated nor sucked out, burned out or cut out. Such measures will do more harm than good.
• Through fear and movement, snake venom spreads faster in the body. Therefore, you should absolutely ensure that the person concerned stays as calm as possible and keeps quiet.

Snakebite: What to do?

In the case of a snake bite, first aid aims first and foremost at delaying possible toxic effects until the patient can be treated. It’s also about reducing the patient’s pain and anxiety. In detail, the first aid for snakebites looks like this:

• soothe: After a snake bite many people are very scared. But restlessness and panic reactions accelerate the distribution of invading snake venom in the body. Therefore, you should calm the patient as much as possible.
• Quiet: Make sure that the patient immediately lies down (at a safe distance from the snake to avoid a second bite). He should move as little as possible in order to slow down the distribution of the poison in the body. If you have a bite in your arm or leg, you may seem to be stinging and tying the affected limb with it.
• If necessary, provide wound: Leave the bite wound as calm as possible. You should at most disinfect them and cover with a sterile or at least clean dressing. However, this must not be too narrow and affect the blood circulation!
• Remove jewelry and clothingIf you have a snake bite on your hand or arm, quickly remove rings, bracelets, watches, and constricting clothing before the fabric swells. If you have a snakebite on your leg, remove tight-fitting shoes and tight pants (cut open if necessary).
• Immediately to the doctor: Bring the patient to the nearest hospital as soon as possible. During transport, it should move little, if necessary, transport it lying. If possible, have the patient picked up by the ambulance service.
• if necessary take the dead snake with you: If it is safe – and only then! – you should kill the snake and take it to the clinic. If the doctor knows what poison he is dealing with, he can immediately initiate the right therapy. If it is not possible to safely carry the dead snake, you can alternatively memorize your appearance or possibly take pictures of it (from a safe distance). This makes it easier for doctors to identify.

What you should not do with a snakebite!

The measures that are taken in many movies after a snakebite are often anything but advisable. They may do more harm than good to them. You should therefore heed following a snake bite:

• Do not bind: Curing disrupts blood circulation, blocks nerves and enhances local toxicity. As a result, the tissue can swell extremely and even die off (necrosis). In addition, bleeding in the stagnant limb are possible.
• Do not burn out, cut in or out: Such measures can hardly reduce the amount of toxin in the body, but rather promote the spread of the poison (when larger vessels are destroyed). In addition, dangerous bleeding may occur (in case of disturbed blood coagulation).
• Do not suck: With the mouth, you can not generate sufficient negative pressure to suck enough snake venom out of a bite wound. In addition, you could poison yourself.

Experts also advise against the use of special equipment for first aid after a snake bite (poison extractors, electric shock devices).

Snake bite: risks

What a snake bite looks like, many people know thanks to it more or less characteristic bite mark at least roughly: The bite usually shows in the form of two adjacent punctual puncture sites. If a poisonous snake has bitten and actually injected poison, further symptoms develop – usually 15 to 30 minutes, but sometimes only a few hours after the snake bite.

snake venom

Snake venom is an aqueous secretion of special salivary glands from poisonous snakes. When biting it usually passes through a hollow anterior tooth in the upper jaw (in Trugnattern on fangs in the back of the throat) in the body of the victim – but not with every snake bite. There are also so-called “Dry” bitesin which a venomous snake bites, but does not inject poison into the skin of its victim.

Snake venom consists of various proteins (proteins) with toxic and enzymatic properties. They can cause various symptoms in the human body. For example, the so-called phospholipases break down the membranes of body cells and destroy so much tissue. The enzyme hyaluronidase relaxes the surrounding tissue so that the rest of the snake venom can spread quickly. They are very dangerous hemorrhagines, These are enzymes that interfere with blood clotting and damage the tiny vessels (capillaries).

Symptoms after snake bites

It depends essentially on the composition and dose of the injected poison mixture, what symptoms occur, how severe these are and how dangerous it can be for the patient. Essentially, there are five symptom complexes that can occur after snake bites:

Nerve damage (neurotoxic symptoms)

The venom injected with a snake bite can block the peripheral nervous system. Then paralysis of striated muscle occurs. One of the first signs is one Drooping of the upper eyelids (Ptosis) and Paralysis of the face and jaw muscles, In the further course the Paralysis on the respiratory muscles over, which can lead to suffocation.

For example, these neurotoxic snakebite symptoms are caused by Cobras, mambas, sea snakes and some rattlesnakes caused.

Muscle damage (myotoxic symptoms)

In some cases, snake venom has a toxic effect on the striated muscles and damages them. This results in some strong Muscle aches.

The destruction of muscle tissue is also noticeable by the fact that creatine kinase levels rise in the blood and myoglobin is detectable in the urine: both proteins are normally present inside the muscle cells and are released during cell destruction.

The released myoglobin colors the Urine dark brown, In addition, it can damage the tubule cells in the kidneys, causing damage kidney failure can lead.

Such myotoxic symptoms, for example, the bite some vipers, rattlesnakes, poison snakes and sea snakes entail.

bleeding disorder

Frequently, a snakebite triggers a blood coagulation disorder, up to the so-called consumption coagulopathy (disseminated intravascular coagulation): The poison first activates the coagulation system. This causes numerous small blood clots that can clog fine vessels. The clot formation also consumes as many substances that are necessary for coagulation (such as platelets, coagulation factors) that it comes to corresponding deficiencies. This can go so far that finally the blood can no longer coagulate. Unstable bleeding (such as bleeding from wounds, gum and nosebleeds) are the consequences. Also vomiting blood and bloody urine can occur.

Especially after one vipers-Schlangenbiss, but also after the bite of wore snakes (such as African tree snakes), such a severe coagulation disorder may develop.

Swelling (edema) around the bite site

When the tissue around the snake bite swells (edema), it indicates that poison has actually been injected. The edema can be massive and quickly spread to the whole arm or leg. If the bite is from a viper or rattlesnake, extensive bleeding of the skin (with blisters) forms around the bite site. In addition, surrounding tissue dies off (tissue necrosis).

Circulation problems

Occasionally, a snake bite triggers shock and circulatory problems, such as nausea, weakness and dizziness.

If someone develops vomiting, weakness, paleness, and sweats after a snakebite, snake venom does not necessarily have to be. Such symptoms can also be psychologically conditioned, that is triggered by the panic of the person concerned. Finally, a snakebite puts most people in great fear.

serum sickness

Patients who have received an antivenin after a snake bite can develop the so-called “serum sickness” after a few days. This refers to allergic late reactions such as hives, slight tissue swelling (edema) and joint pain. They can be treated with medication (with antihistamines and cortisone).

Other risks

Snake bites are usually sterile, so they usually do not introduce germs into the wound. This means that there are usually no primary infections. However, germs can subsequently invade and then trigger a so-called secondary infection. But that rarely happens.

A surviving snake bite usually has no lasting consequences – apart from possible tissue loss (by necrosis) and possibly an amputation. The latter may become necessary if the bite wound has been treated improperly.

Weeks or even months can pass until full recovery from snakebite.

Risk in this country: Kreuzotterbiss

Kreuzottern are among the vipers and are the most common poisonous snakes in German-speaking countries. If enough venom was injected in a nodular bite, a painful swelling quickly develops around the bite mark. This can turn bluish and spread to the entire extremity and even further. In addition, the lymph nodes in the affected body region often swell and the lymphatic vessels become inflamed (lymphangitis).

In addition, many patients after a Kreuzotterbiss sometimes violent panic reactions. General symptoms such as abdominal pain, nausea and vomiting are also sometimes observed.

Only in rare cases, severe symptoms of intoxication develop. For example, at the site of the bite, a bluish blister may form and tissues die off (necrosis). Even severe cardiovascular problems, hypotension and circulatory shock are the exception.

Occasionally swells as an allergic reaction to the Kreuzotterbiss the tissue in the area of ​​the eyes, the upper lip, the tongue and the larynx (angioneurotic edema). Quite seldom does an umbilical bite induce dizziness in children.

Snakebite: When to the doctor?

Basically every snake bite is a potential emergency and should be treated as such. This means: Always bring the person concerned to the doctor or call the rescue service.

The good news: About 50 percent of all snake bites (including venomous snakes) are “dry” or “empty” bites that have not been injected with poison. Although they leave a bite mark, but do not cause extensive symptoms of poisoning such as muscle or nerve damage. This also applies to a Kreuzotterbiss. Even if it was injected with poison, then often only so little that develop other than a local swelling at the bite site no further symptoms. Only rarely does an American Otterbite cause severe poisoning and deaths are even the absolute exception.

Since in individual cases, however, it is usually difficult to assess how dangerous the snakebite is, a doctor should always consult him.

Snake bite: examinations at the doctor

If you have been bitten by a snake, the ambulance will ask you or any escorts first for necessary information. Possible questions include:

• When and how did the snake bite come?
• How much time has passed since then?
• Do you know what type of snake has bitten you?

The doctor will then examine you immediately. He carefully inspects the bite, checks your vital signs (such as breathing and blood pressure), and takes blood and urine samples for analysis in the lab. He will then initiate a suitable therapy as soon as possible.

Snake bite: treatment by the doctor

The doctor will provide the bite wound sterile and watch closely the further course. He will monitor heart rate, blood pressure, breathing and neurological values.

In addition, he will treat the various symptoms as needed. If you have a lot of pain, you will be given painkillers (analgesics). Circulatory problems are likely to result in fluids and electrolytes (as an infusion) and possibly also in blood pressure-enhancing drugs. In case of breathing problems, artificial respiration may be necessary.

If it has come to a renal failure due to a myoglobin excretion with the urine, the doctor orders a blood wash (hemodialysis).

Gift of an antiserum

Against some snake venom an antidote (antiserum) is available. It is administered directly into a vein in severe poisoning symp- toms. This should only be done by a doctor because the patient may be allergic to it. In the worst case, there is a severe allergic shock (anaphylactic shock), which must be treated immediately!

An antivenin should always be administered as soon as possible after a snake bite. The more time that elapses, the higher the dose of the antiserum must be and the lower the chances of success of the treatment (exception: in case of a disturbance of the coagulation by the snake bite the administration of an antiserum is always helpful).

Other measures

If you are not vaccinated against tetanus (tetanus), the doctor will give you a tetanus syringe as a precautionary measure.

Dead (necrotic) tissue is usually removed only a few days after the snake bite. The resulting wound surface is optionally covered by a skin graft.

Prevent snake bite

To avoid a snake bite, you should follow the following advice – especially if you are in tropical-subtropical areas:

• Right clothes: When hiking in confusing terrain you should wear high, sturdy shoes and long pants, in very vulnerable areas may also special leggings.
• vibrations: Firm behavior, as well as the use of a walking stick, can banish snakes (they react to the vibrations).
• open eyes: Pay close attention to where you step out on the ground, sit down, and where you reach (for example, never blindfolded in bushes).
• Do not sleep directly on the floor: If possible, never set up your sleeping place directly on the floor.
• Be careful with leftovers: Dispose of scraps of food that could attract prey and snakes.
• retreatIf you meet a snake, you should retreat, ideally give it the opportunity to escape and never try to catch, scare or irritate the animal. Otherwise, you quickly lose a snakebite.