First State Management for Snake Bite
Reassuring, Immobilizing, and Getting to Hospital
Introduction
- Snake bite management requires prompt action
- First state management is crucial for patient safety
- Two scenarios: site and hospital
- Follow mnemonic 'Do it Right'
Reassuring the Victim
- Priority is to reassure the victim
- Ensure them that everything will be fine
- Stress that they will be taken to a hospital with snakebite facilities
- Provide reassurance and comfort
Immobilizing the Bitterness
- Immobilize the bitten limb to prevent further venom spread
- Apply a splint or wooden board if available
- Use a crepe bandage or clothing to secure the limb
- Bandage should be tight enough to occlude initial lymphatics
Getting to the Hospital
- Transport the victim immediately to a hospital with snakebite treatment facilities
- Ensure availability of antivenom at the hospital
- Inform the doctor about the signs and symptoms observed
- Prompt transfer is vital for timely treatment
Local Examination
- Look for fang marks or scratch marks as signs of snake bite
- Check for blister formation and swelling at the bite site
- Inspect for localized lymphadenopathy near the bite area
- Measure circumference of the limb for monitoring swelling
Systemic Examination
- Neurotoxic envenomation: look for diplopia and ptosis
- Hemotoxic envenomation: check for conjunctival hemorrhage and bleeding
- Monitor respiratory parameters and single breath count
- Assess for signs of impending respiratory failure
Investigations
- Perform 20 minutes whole blood clotting time test
- Consider point-of-care PT/INR testing if available
- Additional investigations: complete blood count, urine routine, renal function
- Assess for coagulation abnormalities and kidney injury
Indications for Antivenom
- Systemic indications: respiratory symptoms, bleeding, rapidly increasing swelling
- Positive 20 minutes whole blood clotting time or abnormal PT/INR
- Local indications: rapidly increasing swelling, lymphadenopathy
- Start antivenom with 6-10 vials at 1-2 ml per minute
Management in the Hospital
- Ensure airway, breathing, and circulation
- Monitor vital signs and respiratory parameters
- Repeat single breath count every 15-20 minutes
- Administer anti-allergic medication if needed
Additional Management
- Administer tetanus prophylaxis to all snake bite patients
- Prescribe antibiotics for coverage against gram-positive bacteria
- Observe patients for a minimum of 24 hours
- Address complications like compartment syndrome and renal failure
Conclusion
- First state management is vital for snake bite patients
- Reassure and immobilize the victim, get to hospital
- Conduct thorough local and systemic examinations
- Initiate antivenom and monitor closely in hospital