It is important that every snake bite victim receive first aid treatment as soon as possible. The patient must not exert himself by running, because increased circulation brought on by such physical activity will speed up absorption of the poison. For the same reason, the use of whiskey or other stimulants should be avoided.
The victim’s state of mind is important; he must promptly be convinced that his chances for recovery are good—and, indeed, they are. He should not be terrified by the thought that every snake bite means certain death. Actually, a survey of case histories shows that with prompt and proper treatment, only about one or two per cent of all snake bites in this country are fatal.
There is a considerable difference of opinion about the correct first aid treatment for poisonous snake bite. The Division of Medical Sciences of the National Research Council, a section of the National Academy of Sciences, recently made a study to determine the most effective method of such treatment. It recommended immobilization of the bitten limb, application of a constricting band, and prompt incision and suction.
Based on these recommendations, the following first aid treatment for poisonous snake bite is suggested:
1. IMMOBILIZE THE AFFECTED ARM OR LEG whenever possible. Where this is not practicable, keep movement of the bitten limb to a minimum. Muscular activity helps increase the spread of venom. Whenever feasible, transport the victim by litter to further medical aid.
2. APPLY A CONSTRICTING BAND from two to four inches above the bite, between the wound and the heart. This will help to limit the spread of venom until it can be removed by incision and suction or neutralized by antivenin. A piece of rubber tubing or a strap tourniquet, included with every snake bite kit, is best for this purpose. When these are not available, items of clothing may be used. A shoe lace, neckerchief or a strip of clothing torn from shirt or trousers will do. The poison, unless injected directly into a major blood vessel or deeply into a muscle, is absorbed slowly by the lymphatics below the skin. Therefore, do not restrict the deeper blood circulation by applying the constricting band too tightly. It should be loose enough for a finger to be slipped under it with little difficulty. Remember that during first aid treatment the constricting band must be loosened every 15 minutes for about two minutes. This precaution may prevent gangrene. If the bite is on the hand or forearm, take off rings, bracelets or other jewelry because subsequent swelling may make their removal difficult.
3. MAKE INCISIONS after sterilizing the cutting instrument and the bite area with iodine or alcohol. If no antiseptic is available, the blade of the cutting instrument can be sterilized by holding it over a flame (a match will do). Make one cut over each fang mark parallel with the long axis of the bitten limb, not across it. Incisions should be one-quarter inch long and one-eighth to one-quarter inch deep, but definitely no longer than the diameter of the suction apparatus being used. This would allow air to enter the suction bulb from the outside and the device would then be unable to work. Incisions are of the utmost importance to first aid treatment; without them little or no poison can be withdrawn from the wound by suction. However, making even a small incision involves some risk and this operation should be done with considerable care. Improper or carelessly applied first aid may actually do more harm than good. Although a physician may later decide to make additional incisions to relieve the pressure of swelling, only the cuts over the fang marks are recommended for first aid.
4. APPLY SUCTION to the cuts. This can best be done with one of the suction devices manufactured for that purpose but, if none is available, suction can be applied by mouth. There is little danger in oral suction unless the lips or inside of the mouth have cuts or abrasions. Contrary to popular opinion, a tooth cavity will not permit passage of venom into the blood. Moreover, snake venom is destroyed by the stomach’s digestive juices, so if some is accidentally swallowed, there is little need to worry if you have a healthy system. Only during the first 30 minutes following the bite can much venom be removed by incision and suction.
5. GET TO MEDICAL AID as soon as possible—but keep in mind that unnecessary physical exertion is harmful.
Antivenom may be administered soon after first aid has been started, but this is best left to a doctor. The North American Antisnakebite Serum made by Wyeth, Inc., of Philadelphia 3, Pennsylvania, is effective against pit viper bites but is of less value in the treatment of coral snake poisoning. Because coral snakes cause so few bites in the United States, no serum to neutralize their venom is prepared in this country. In South America, where these snakes are common and may reach a length of five feet, a serum to neutralize the poison is being produced by the Instituto Butantan at Sao Paulo, Brazil. It and other foreign snake bite serums often are available at larger zoos where exotic poisonous species are exhibited.
SUGGESTIONS TO PHYSICIANS
In most areas of Texas, snake bite is an uncommon medical emergency, and one with which few doctors have had experience. For this reason, the following recommendations by the National Research Council’s Division of Medical Sciences are included for the benefit of the physician.