Dealing with Snakebites in India

22 09 2007


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.

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!

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

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: *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:®ion_terms=

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

A helpful interview with Romulus Whittaker in The Hindu:

Birds and Elephants at Topslip

24 02 2007

Do you know that India boasts over 1,400 of the world’s 10,000 species of birds! Of these fully 260 species can be seen in the Indira Gandhi Wildlife Sanctuary – one small 500 sq km patch of forest? Serious birders from all over the world visit here every year to enjoy the myriad and unique birds found only in the various remaining small patches of shola forest.

Ponnvandu (our little trust) organised 15 volunteers from our college student work to participate in this year’s elephant and bird counts. It was an exciting two days. Most of our kids are getting into the forest on foot for the very first time! Some are so city bred that they have never even seen the milky way before…

We were blessed with lovely weather. Five of our volunteers were needed for the elephant census and the rest were assigned to enumerate the bird species. Only four of us are decent birders so we decided to form three teams and divided the sholas amongst the three for two days of morning and evening counts. It is exciting work! The forest department lorry drops us at specific points in the forest and from then on we work with the local tribal guides and forest guards to complete routes of 7 to 10 km each in the early morning and then starting again in the late afternoon.

The five that went for elephant counting saw a total of 39 elephants, which is quite encouraging given that this is a dry season census and most elephants are known to head deep into the forest in search of perennial streams and lakes (few and far between). A number of calves and juveniles were counted in the family groups. One young man found himself just feet away from a late foraging sloth bear while he was absorbed in observing a mother and calf elephant. Luckily these bears are very short sighted and it went harmlessly on its way.

Our budding birders quickly got the hang of things, started recognising bird song and we came up with a very encouraging 87 species including many of the rarer birds. The group that first went into the Karian Shola were able to see two nesting Malabar Pied Hornbills (Anthracoceros coronatus) and one male actually feeding the ensconced female – a very very rare treat indeed. They also spotted the very hard to find Ceylon Frogmouth (Batrachostomus moniliger) on this hike. One group came across the ‘dreaded’ king cobra up close (a 4 meter/13 footer, about medium sized). This is one species that eats only other snakes. The king cobras come to the bamboo breaks and near spots of water for their breeding season and they can get quite aggressive if someone is found near their nests!

On the second day we were joined by the world famous bird guide (now a forest dept guard) Mr. Natarajan. He is amazing and being a local tribal, knows both these forests and the resident wildlife intimately. Articulate and a wonderful teacher, the lucky five kids that spent the day with him really got a grand education in censusing, bird identification and generally how the whole ecosystem works.

Having these young people from the Sri Krishna College of Arts and Sciences (SKCAS) enthusiastically participating in very rigorous census work was perhaps the most exciting part. They learned a tremendous amount, but more than that they got the feel of what biodiversity means, how fragile these ecosystems are and the crying need for more involvement in conservation work.

One of the saddest findings was that many areas of shola are being invaded by coffee plants. Coffee seeds from the surrounding private coffee plantations are being effectively dispersed into these sholas and one can see that the shola forests are under a very severe threat from this new invasion. Sometime soon I will do a post on what shola forest is, but so far the main point is that we don’t have any idea how to regenerate a shola, so once gone, gone forever.