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Bites of poisonous snakes: emergency medical care
Last reviewed: 23.04.2024
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According to WHO, poisoning with snake venom is recorded annually in 500 000 people, among them 6-8% of cases - with a fatal outcome. Representatives of four families are considered to be the most poisonous for humans:
- aspides (cobra);
- viper (adder, efa, gyurza and rattlesnake);
- yamkogolovye (shchitomornik);
- sea snakes (pelimida).
There are two main groups of poisonous snakes: with a "short tooth" (aspides and some yamkogolovye) and "long tooth" (viper, shtomurtniki). The first contain a neurotoxin blocking the pain and causing a stop in breathing and circulation. The latter secrete a hematotoxin that causes local necrosis, severe pain, and an ICE syndrome. Some types of pits (cascavela, massasauga) contain both toxins.
The most severe poisoning occurs when a snake bites the head and neck, or when a poison enters the blood directly. With the bite of aspidids and sea snakes, pain is often absent, but within 20-30 minutes the condition deteriorates sharply, weakness, numbness in the face and trunk region, and collapse due to histamine release develop. In the future, paralysis and peripheral paresis, including diaphragms, may develop, which can lead to asphyxia and circulatory arrest.
When biting viper and yamkogolovyh snakes is characterized by the emergence of acute pain in the place of bite, a pronounced local reaction, serous hemorrhagic edema of the limb with the transition to the trunk. The DIC-syndrome develops, a shock.
Emergency medical assistance with snake bites
Venous tourniquet or a pressure bandage is applied for 30 minutes only with a bite of aspids and sea snakes. With bites viper and shchitomordnik plaque can not be imposed, as this leads to a sharp deterioration of blood circulation in the limb. The injured person should be put in the shade with raised legs, squeezed and removed the poison, treated with ethanol, brilliant green, but not potassium permanganate, as oxidants strengthen the damaging effect of the poison, it is also necessary to provide immobilization of the extremities, and introduce antihistamines. Anesthesia is carried out by non-narcotic analgesics (rarely drugs).
When snake bites can not cauterize the wound, apply cold, cut and cut the place of bite with any drugs, as this leads to additional infection of the wound, strengthening the resorptive action of the poison. Do not recommend the suction of poison by mouth due to the risk of poisoning through microtraumas of the oral cavity of the rescuer.
With the bite of aspidic, in particular cobra, monovalent antitoxic horse purified concentrated concentrated liquid whey against cobra venom is used, and with the bite of vipers and shield-moss, it is necessary to use polyvalent horse purified concentrated serum against snake venom, epha, cobra, or if there is reliable information about the form snakes, - monovalent serums. Initially, the serum is injected in a 1: 100 dilution intradermally in an amount of 0.1 ml, then in the absence of an allergic reaction of 0.1 ml in undiluted form subcutaneously and after 30 minutes the whole dose of 10-50 ml is injected intramuscularly into the scapular region (serum administration according to the method of Bezredki ). According to vital indications, antiserum serum is administered intravenously from 10-20 ml (500-1000 ED) to 70-80 ml after preliminary intravenous, intramuscular injection of 1% solution of diphenhydramine (dimedrol) 1 mg / kg and prednisolone at a dose of 5 mg per 1 kg of body weight body.
The introduction of serum is provided for signs of systemic action of venom, the development of DIC syndrome and a severe increasing "upward" edema. With a mild poisoning without obvious somatic reactions, it is undesirable to administer serum, because of the high risk of developing severe allergic reactions, up to anaphylactic shock. When breathing and circulatory disturbances as a result of a snake bite, ventilation and cardiopulmonary resuscitation, treatment of hypovolemic shock and DIC syndrome are shown.
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