Dealing with Snakebites in India

22 09 2007

INDIA’S “BIG FOUR

The Russell’s Viper (Top two pics)

Echis carinatus – the Saw Scaled Viper
Notice how variable the colouring can be.

(the three pics below)

Saranya, my 19-year-old daughter, just recovered from a snakebite last month.

I haven’t really kept myself very up-to-date on the developments in

mirror, mirror
mirror, mirror

treating snakebites for the last couple of years as my snake rescue work has almost been non-existent of late. It’s very good to see that the next generation is showing an interest in preserving these wonderful, though somewhat dangerous creatures! Naja naja, the Spectacled Cobra

Now that I’ve had to brush-up, I thought I would take the opportunity to summarise the steps to be taken

when bitten by an Indian snake…

The Common Krait Bungarus caeruleus

First and foremost, no snakebite should be ignored. Most bites may be from nonpoisonous snakes and sometimes even venomous snakes do not

deliver enough venom when biting to prove dangerous, but that is no excuse not to go to the nearest emergency room, get evaluated, and if necessary, have treatment started. Early treatment is the key to preventing complications, and to saving lives, limbs and kidneys!

In India, it is conservatively estimated that up to 20,000 people die annually from snakebites. Morbidity is also significant. These are not small numbers, and there seems to have been little improvement in reducing the fatalities over the years in spite of now having good supplies of polyvalent antisnakevenom available in all population centers. The major reason for the high mortality rate (about 5% to 10% of all those reporting bites) is the delay in getting the victim to a well-equipped casualty treatment facility fast enough.

About 80% of the venomous snakebites in India come from the saw scaled viper (Echis carinatus) and this little fellow can cause problems perhaps a little more slowly than the others of the “big four” (cobra, krait and Russel’s viper) so it’s probably true that a lot of the fatalities that do occur are in fact preventable.

FIRST AID:
In the absence of a nearby doctor, those accompanying the bitten one need to first calm the victim down and then immobilise the affected limb (if it is a limb). Tourniquets, applying any sort of chemicals or external medicines, and cutting into the site of the bite to suck out the venom (all of which were the mainstays of first aid in my heyday) seem to have fallen out of favour.

The use of pressure bandaging is controversial but if done with something like crepe bandage and not too tightly, perhaps combined with a simple splint or sling, it may help to slow the spread of venom through the lymphatic system. Blood supply must NOT be cut off! On the whole, perhaps if the bitten one will be getting to a HOSPITAL within 3 0r 4 hours, it may be better not to attempt any pressure bandaging but advice on this point varies.

Try to remove any jewelery worn on the affected limb like rings, bangles, bracelets, anklets, or metti (toe rings) as these may cause problems if there is swelling or edema associated with the bite.

Next, get the person to the nearest good hospital as fast as possible. Walking and running for the victim are best avoided as is movement of the affected limb. Try to carry the person at least on a pallet or makeshift stretcher if no vehicles are available.

Giving anything by mouth is best avoided except if dehydration is a risk, in which case oral rehydration fluids (clean water mixed with a little salt and sugar will do OK).

Some poisonous snakes have cardiotoxins (poisons that can slow or stop the heart) so if possible try to keep the affected limb below the level of the heart. The victim should be encouraged to breathe deeply and evenly to bring the pulse rate to a steady state.

Particularly as you move towards the closest hospital, keep a watch on breathing and on keeping airways clear. If the person has difficulty breathing first see that there is nothing blocking the airway (like the tongue, secretions, or vomit) and if necessary be prepared to help the person to breathe by doing mouth to mouth. Rarely will the heart be affected so full scale CPR may not be needed.

Those having cell phones should call ahead so that even if antivenom is not available, it will be made available by the time the patient arrives. remember that 5, 10, or even more vials of antivenom may be needed, so ask whoever is at the other end to ensure an adequate supply, OR in the absence of definite knowledge, try to take the victim to a hospital that is large enough to be likely to have stock of the antivenin. In Tamil Nadu, the government hospitals are expected to have stock of antivenom

Observe the snakebite victim carefully while taking them to the hospital. Note the time and location of the bite and try to get as much accurate information on the appearance and size of the snake. Any symptoms such as discolouration at the site or of the affected limb, swelling, changes in eyes (e.g. droopy lids), eyesight, speech, breathing, sweating, unusual eye movements, bleeding, lowered level of consciousness or other difficulties should be noted.

If the snakebite victim happens to faint the most important thing is to make sure that they are able to breathe. If possible lean the head backward and depress the tongue to keep the throat open. Do not waste time trying to make them recover from the faint. Make sure that they are breathing and concentrate on getting to the hospital fast. If as you move towards the hospital, you do have access to a phone or mobile, ask the doctors who are waiting for you for advice perticularly in case of fainting as sometimes this may indicate that a medical condition called “shock” is setting in and that is potentially more dangerous than even the effects of snake venom!

Try to get information on what snake it was, appearance, size, etc. but please don’t waste time on this! Getting the person to a competent hospital is the only major priority!

TREATMENT:
Mostly, if there are symptoms, the doctors will immediately do a spot test dose in the skin to check for allergies to the antivenom. Depending on the symptoms, they may then start the antivenom treatment and then one will most profitably spend one’s time praying that there will be no complications.

On admission, and at relevant intervals afterwards, doctors will probably check on how well the blood is clotting (bleeding time, clotting time, and sometimes tests like PT and aPTT), kidney function (urine output, blood urea, creatinine and electrolyte levels), and of course the vital signs – pulse, breathing, temperature, blood pressure and the amount of oxygen in the blood (pO2). They may also keep tabs on the patient’s haemoglobin, blood cell counts, and perhaps the blood gases too.

Sometimes, even after a day or two, things can go wrong with the patient starting bleeding, kidney failure, or even the heart could be affected, so keeping the victim under medical observation even after the antivenom has been administered is important. Most of the time, alert medical staff will successfully deal with the crises as they arise.

Saranya (my daughter) was probably bitten by the Saw Scaled Viper (Echis, see above), but sometimes a non-big-four candidate can cause trouble. In our our area of South India, especially in hilly areas, we do run into bites from the Hump-nosed Pit Viper (Hypnale hypnale pic. above))

or the Bamboo Pit Viper Trimeresurus gramineus

and very, very rarely,

the King Cobra (Ophiophagus hannah).

There have been so many hits on this article as well as requests for more information that I thought I would share some of the resources that I found most helpful:

Snakebite Envenomation in India: A Rural Medical Emergency
Indian Pediatrics 2006; 43:553-554

http://www.indianpediatrics.net/june2006/june-553-554.htm

Kraits deliver some powerful neurotoxins that cause few initial symptoms at the site of the bite but can be deadly within a couple of hours.
Detailed Instructions for Krait bites can be found here:
http://www-surgery.ucsd.edu/ent/DAVIDSON/Snake/Bungarus.htm *Note that Indian polyvalent antivenom is effective against Krait venom also.
The University of Adelaide’s toxinology resources website has an excellent database of information on most of the poisonous snakes in the world, first aid, treatment, and antivenins. Use the search engine to find the information you need: http://www.toxinology.com/fusebox.cfm?fuseaction=main.snakes.results&Common_Names_term=&Family_term=&Genus_term=Daboia&Species_term=&countries_terms=®ion_terms=

Snakebite Research Unit, Little Flower Hospital
Angamaly, Kerala
First Aid

http://www.lfsru.org/firstaid.htm

A helpful interview with Romulus Whittaker in The Hindu: http://www.hindu.com/mag/2004/06/13/stories/2004061300400200.htm
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16 responses

20 12 2007
Maximus

I would like to see a continuation of the topic

23 12 2007
ponnvandu

Well Maximus, there is a dearth of scientific data on the many other poisonous snakes that can and sometimes do bite people in India. It is now known that most of the collubrid snakes (world over) do have ‘venom’ and that sometimes this venom can affect humans, though very often it does not.

Bites from the Russel’s Viper (Kannadi virrian in Tamil) are notiorious for the amount of ulceration that they cause. Once the venom has been neutralised in the blood, these ulcers will be the biggest cause of concern and can cause huge extents of tissue death.

If there was more data available I would be happy to write it up but as of now the important thing to know is that bites from ‘the big four’ can be effectively treated with the polyvalent anivenom that is also readily available (though not cheap!). Please do let me know if you run into any interesting and reliable information on the treatment of snakebites.

9 10 2008
man from mars

I recently came across a tv episode in animal planet/discovery/national geographic describing a new deadly species encountered during the flowering of Bamboo in North east India. Apparently, the flowering increases the rat population in the forest which then attack the nearby fields and the snakes follow them. Is it possible to provide more info on this new species. It is a pit viper but not the Bamboo pit viper or the Hump-nosed pit viper pictured in this article.

28 05 2009
Capt Suresh Sharma

Excellent information and photos of snakes of India.

16 06 2009
ponnvandu

Thanks, Captain. I’m hoping that some of my readers may contribute their knowledge so I can keep this up to date. It is a lifesaving subject…

30 01 2010
Buvannesswari Devi

I wanna know more and more about snakes and also i want someone to suggest a very good book on snakes. i wanna learn more about its species and sub species and it’s venom creation and all other fascinatins stuff

8 08 2010
bikash

every one is talking about vnomous snake .hope any body cangive information about non venomous snake also

10 06 2011
jai

my mom in position of coma , because of snak bite, last 1 month , please wat can i do?

10 06 2011
Capt Suresh Sharma

Jai, only the doctors can deal with it. Please ask them what is the reason. It must be multi organ failure.

12 06 2011
ponnvandu

Jai, I’m sure the medical professionals are doing their best. If you could give me as much information as you do have, I can ask some experts here for advice. Also, your location and where your mom is now being treated. my email address is samlcarr at gmail.com. We will be praying for your mom’s safe recovery.

3 07 2011
geetu

hello,
i read the complete article and got a lot of information.I am living in maharashtra and its a mine area wid lush green forests all around. Recently there hav been two cases of snake bites in our mines. Both the victims were in teens and died before they reached the city hospitals,due to lack of knowledge about how to treat a snake bite. The local mine level hospitals do not hav a single vial of ASV. I came to kno recently that asv is supplied by the gov. free. please guide as to wat shud b done,as m very concerned about all of us and want to kno how to approach and whom to approach?

2 10 2011
Das, Austin Steeven

For poisonous snakes, prevention is the cure. Better we stay away from them. Better we never try to handle(stone, thrash etc.) If we must undertake dangerous field works, we must use impenetrable gloves, gum-boots etc. for everybody’s safety. Lastly, snake-proofing our houses with net-mesh, 45 degree parapet walls of about 3 feet height, guarding our water inlet/outlet etc. could save everybody’s anxiety and life. Safe day to everyone.
Austin SteevenDas, Western Ghats

18 11 2011
SD

The following comment is an excellent example of the kind of nonsense that people believe and then have to die for believing. Please don’t even be tempted to follow such idiotic advice. Get treated. Read the blog, save your life!
Dear Sir,
It is miracle unbelievable. By the grace of God Lord SIVA, since 28 years(1983) I am serving/curing snake bite victims in Orissa India and also abroad with 100% honest either in physical or over Mobile Phone. 99% of victims have not seen. It is very simple, only victim’s name is required. Then Mantra will be applied in his/her name immediately. Within few minutes he/she will cure wherever he/she may be. I refer every body to go for medical treatment first. After blood investigation, no poison will be found. Thousands of victims have been cured. Only two to five minutes is required, no need any delay for hospitalization. While I was 18 years, my father gave this Mantra at his eleventh moment at SCB Medical College Hospital, Orissa in Nov 1983 who died in Cancer disease. Since then I have dedicated my life towards this noble service to the human being with free of cost. Though I am a science Graduate a Govt. employee in Orissa myself also surprised what is behind it. My Mobile Phone Number is XXXXXXXXXX. I am sure, yes there is a existence of God. In this scientific age it is really very surprise.

With regards
(edited)
Cuttack, Orissa, India
Mobile No.xxxxxxxxx

I am posting this as an edited comment. Take my advice, get the antivenin in if the doctors diagnose poisonous snakebite. You can in addition say any mantras on the way to the hospital, during treatment, and afterwards too.

14 01 2012
Ajay

Mr.SD,
Your comment is nothing more than nonsense without any authenticity. If that is the case ask Drs,scientists to watch/observe your so called victims of snakebite to prove your case and then serve humanity. To me you are nothing but twisted, and cripple minded person. One more thing quit doing treatment and become a good fiction writer. You will make alot of mony and those hapless person would be spared from you. And will live to see this beautiful world.

29 01 2014
drug rehab Cincinnati

We absolutely love your blog and find almost all of your post’s to be what precisely I’m
looking for. can you offer guest writers to write content for you personally?
I wouldn’t mind writing a post or elaborating on some of the subjects you write with regards
to here. Again, awesome web site!

29 01 2014
ponnvandu

Thanks for liking my blog! I certainly would not mind getting good content for this blog, if the topic and content are appropriate. Please send your email id to samlcarr at gmail dot com and we can talk about it…

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