1.      Focus on getting the victim to definite medical care.

2.      Light Tourniquet to occlude lymphatic flow if bite is on an extremely…….pulses must be felt (prevent ischemia). One should be able to insinuate a finger under the tourniquet. Prevent walking if lower limb bitten.

3.      Immobilisation of the limb, splinting.

4.      No cooling / incision at site bitten.

HOSPITAL MANAGEMENT:-

 ·       Quick history, brief but thorough examination

·       Vital signs, cardiac rhythm, oxygen saturation

·       IV Access.

·       Investigate…. Blood for grouping, cross match, CBC, peripheral blood smears, renal andhepatic functions, CT/ platelet/ PT/PTT (DIC state).

·       Urea, creat..potassium (ARF), Urine (microscopy).

·       In severe cases…….ABG, ECG, C Xray

·       Treat shock…..if volume resuscitation fails to bring up the BP try vasopressors.

·       Invasive hemodynamic monitoring (central line)

DRUG THERAPY:-

 ·       Tetanus immunoglobulin 250 U IV (avoid IM if clotting abnormality exists)

·       Anti snake venom: Be ready for anaphylaxis- Give slowly at first. If anaphylaxis occurs stop & treat promptly- skin tests for sensitivity are not useful as anaphylaxis can occur even after a negative skin test.

HIGH DOSE – Regimes are not followed.

LOW DOSE – 2 Ampoules of ASV diluted in 500 ml of 5% Dextrose over 1 hour, followed by 1 vialover 4 hours until clotting parameters normalized and then 1 vial as an infusion over 24 hours.

Regime followed in medical ICU :

·       2 ampoules ASV (diluted as above) in 1 hour

·       3 ampoules in 500 ml dextrose q 12 hours x 36 hours

·       1 ampoules in 500 ml dextrose X 24 hours

Local injection at the site of snake bite is not recommended.

MONITORING:-

Single breath count Chest expansion Clotting time, PT, PTT