What You Need To Know About Snake Bites – Dr Abdul Rahman Abdul Kadir

Important facts regarding snake bites and treatment procedures

1. Only 18 out of 140 snake species on land in Malaysia is venomous.
2. Snake bites do not necessarily be fatal because majority of it is ‘dry bites’ (bite and run).
3. In most cases, victims fail to recognise the species of the snake they were bitten by. There are many snake species which look venomous but are not.
4. Not all snake bites will be treated with antivenom.
5. Antivenoms have a very high allergy/anaphylaxis rate, which can cause death.
6. Administration of antivenom must fulfill the strict envenomation criteria set by specialists worldwide.
7. Each snake bite case will be referred to the Emergency Medicine Specialist on call for each state even if at a hospital in a remote area.
8. Patients will be under doctor’s observation to monitor for signs of poisoning in detail. The impression that only painkillers will be given and patients are neglected is not true and impossible as there is a specific protocol for every snake bite cases.
9. Most people only see that the patients are left alone and hospital staffs munching kuaci when in actuality, the patience have undergone all the listed procedures below:

1. Placed in the semi-critical or critical zone (depending on the seriousness of the bite) for assessment and treatment.
2. Seen by a doctor, monitored, and carefully checked to see if patients are having toxic manifestation of the nervous system (neurotoxicity), toxicity to the blood (hematoxicity) or toxicity to the muscle (myotoxicity) that may require aggressive treatment.
3. Blood samples have been taken and sent to the laboratory and serial repetition of tests will be carried out.
4. Bite marks have been cleansed and marked to observe if the inflammation continues to spread.
5. Direct consultation has been done with the Emergency Medicine Specialists through a phone call, and subsequent treatment strategies planned by the specialist to be carried out by the medical officer in a safe and systematic manner.
6. Antivenom treatment can be administered when there is a clear indication (systemic/entire body or on exposed area at a serious level) and the type of antivenom to be given will be determined by the Emergency Medicine Specialist very carefully. This is because antivenom treatments carry a very high risk of complications.

Response in the event of a snake bite

1. First, keep calm. Don’t panic. Get away from the snake and find a safe spot. DON’T PANIC. Only 18 out of 140 snake species in Malaysia is venomous. And if you happen to be bitten by a venomous snake, you won’t necessarily die because most snake bites are ‘dry bites’.
2. At the same time, try to remember the appearance, features, and colour of the snake for identification of species at the hospital later. Take a picture of the snake using your smartphone if possible.
3. Don’t emulate Hindi or Tamil films by cutting or sucking the snake bite. This will not help at all and will only make tissue injury worse. This can also cause the poison to spread more quickly in the body due to excessive pressure on it. The snake poison within the patient’s body immediately spreads to the lymph vessels which then makes it impossible for you to suck it out.
4. Get help immediately. You can make an emergency call to 999. If you have relatives or friends close by, and do not want to wait, go to the nearest hospital at once.
5. Reduce movement ofthe limb affected by the snake bite. Wearing a splint to restrict movement will be helpful.
6. Don’t tie or place tourniquet on the body part affected by the snake bite. It does not help slow down the spread of venom. It will only increase the pain and if left too long will damage the limb due to lack of blood supply.
7. Minimise movement of the victim as much as possible. Remain calm throughout the time. This is important because high heart rate and excessive body movement will cause the venom to spread faster and may cause systemic problems. For this reason, patients are prevented from drinking coffee, alcoholic drinks, and smoking.
8. Wash the area where the snake bit with clean water without scrubbing or rubbing the wound. The affected area may become swollen from the snake venom. Therefore, remove all rings, watches, bracelets, and other items that may become stuck due to excessive swelling. This would also restrict blood flow.
9. If the snake is killed, you can bring the body to the hospital for species identification. It is important to ensure that the correct antivenom is administered if needed. Remember to be careful while handling the body. We are still exposed to the dangers of the venom if the fingers are pricked with the fangs of the dead snake.
10. Follow up treatments will be provided by the Emergency Medicine Specialist at the hospital.
11. Not all snake bites require antivenom. TO BE BITTEN BY A SNAKE IS NOT PREREQUISITE FOR ANTIVENOM TREATMENT.
12. Antivenom should only be provided for cases which fulfills the strict criteria of envenomation (systemic/full body or onthe part exposed to serious levels). This is because the antivenom itself carries a risk of complications and side effects towards patients thus cannot be given liberally.
13. The decision to administer antivenom will only be made by the Emergency Medicine Specialist after detailed assessment based on their knowledge and experience in order to minimize the risk as much as possible for the snake bite victim.

Conclusion:

1. Do your best to keep calm in the event you are bitten by a snake.
2. Minimise movements as much as possible. Tie an arm sling if needed.
3. Get immediate help to get to the hospital. CALL 999 without feeling shy or embarrassed.
4. Please identify the appearance of snake for species identification purpose at the hospital to facilitate treatment strategies. Each emergency department will have an album with an image gallery of snakes to help patients figure out the type of snake which bit them.
5. The method for treating snake bites is the “wait and observe” approach. Observation for signs of envenomation in detail is very important. If you are waiting for a long while and require explanation, please ask the doctor or staff on duty.

Dr Abdul Rahman Abdul Kadir is an Emergency Medicine and Trauma Specialist at Hospital Melaka. This article is about snake bite cases with actual treatment procedures. Dr. Abdul Rahman emphasises the dissemination of authentic information to all patients and recommends the members of the public to find out first about something before trusting it especially tales on social media. This article is translated from the original at https://www.mmgazette.com/apa-yang-anda-harus-tahu-tentang-gigitan-ular-dr-abdul-rahman-abdul-kadir/ by Nur Nadhirah.

[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.] 

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