Bit of a long topic and my typing skills are just great, so hang in there...will post in instalments
1.Snake bite kit-should be part of your FA kit
DO NOT USE ANY TOURNIQUET
Newer, highly effective technique is to use the aussie wrap-using a crepe bandage or dupatta or any suitable cloth.Wrapping the bandage from bitten part upto the armpit or groin, assuming the bite has been on an extremity.
Snake anti venom -lyophilised , powder form vial-2 (can keep in sun , desert wherever and is effective even years after expiry date!Do not buy Bharat Serums liquid ASV-needs refrigeration!!)
from Haffekine Lab or Indian Serum Research Institute, Kasauli-about Rs.450ea -2
Inj. Adrenaline 1:1000-2
Inj/Tab Rantac -2
Tab.Avil or Claridin or Allegra 180mg-2
Tab.Medrol 8 mg -2
Alcohol wipes or small bottle of surgical spirit
Betadine oint-15g small-1
Surgipad 10x10 sterile dressings-2
1/2 inch paper plaster-1 MICROPORE is common brand
Sterile Water for Injection-10 ml x 2
Scalp vein needle sets:
In the event of an actual or probable bite from an Indian or Common Cobra, execute the following first aid measures without delay.
Make sure that the responsible snake or snakes have been appropriately and safely contained, and are out of danger of inflicting any additional bites.
Immediately call for transportation.
Keep the victim calm and reassured. Allow him or her to lie flat and avoid as much movement as possible. If possible, allow the bitten limb to rest at a level lower than the victim's heart.
Immediately wrap a large crepe bandage snugly around the bitten limb starting at the site of the bite and working proximally up the limb (the full length if possible). The bandage should be as tight as one might bind a sprained ankle
Secure a splint to the bandaged limb to keep the limb as rigid and unmoving as possible. Avoid bending or moving the limb exessively while applying the splint.
DO NOT remove the splint or bandages until the victim has reached the hospital and is receiving Antivenom.
Have the Haffkine Bio-Pharmaceutical Corp. Polyvalent Antivenom ready for the victim.
DO NOT cut or incise the bite site
DO NOT apply ice to the bite site
DO NOT apply Suction devices from OTC/Sawyer snake bite kits
Kit is common to all the big 4 of India,as snake antivenom is POLYVALENT.
How to use.
Shoo the snake away, worse case scenario, kill it!
apply surgical spirit to bite, over this TRY to apply little betadine ointment and strap , using the surgipad and plaster.
Then apply the crepe bandage as described and transport teh patient ASAP.
If you have recognised the snake to be a venomous one, please also pop the following tabs:
Avil or Claridin or Allegra 180mg-1
When you reach the hospital, tell the physician the history/background and be prepared for an IV line.
Snake antivenom is made from Horse serum and can cause bad allergic reactions, upto and including death! thats why you have taken the pills mentioned above.Incidently, the same pill regimen can be used for a bad allergic attack , with nbreathing difficulty...
Before starting ASV therapy, I give the patient 0.3 ml lof adrenaline -(epinephrine, aka epipen-a preloaded injectible pen, abt 55 USD, 10 rupees if you mix your own!)
DEEP IM.So, if your doc hasnt had experience in handling snake bites, tell him to do this before starting ASV intravenously-If you are a heart patient then 1/2 this dose, repeat again in 15-20 min.It causes shivering and tremors and kicks up heart rate, but will prevent a ANAPHYLACTIC REACTION to horse based ASV
OBSERVE PATIENT CLOSELY for signs and symptoms of envenomation which usually manifest between 15 minutes and two hours following the bite.
If NO signs or symptoms have been noted after TWO hours, there is the possibility that the patient received a dry bite (no venom injected).
VERY SLOWLY begin to remove the bandages and splint watching carefully for any changes in the patient's status. If any changes occur, assume the patient has been envenomed and prepare to give antivenom immediately (as directed below).
If signs and symptoms still fail to manifest, continue CLOSE observation of the patient for an additional 24 hours.
IF ANY SIGN OR SYMPTOM becomes apparent or has been noted during the course of evaluation, begin Antivenom Therapy as follows:
Each vial of Haffkine Institute Polyvalent Antivenom is packaged as a lyophilized dry preparation in a glass vial with an accompanying vial of sterile water (to reconstitute the antivenom). It is preferable to reconstitute the antivenom in Lactated Ringers Solution. The contents of TWO vials of antivenom are to be used as the Initial dose. Withdraw 20 ml of room temperature Lactated Ringers Solution into a sterile syringe, and then transfer 10 ml to each antivenom vial.
Carefully mix and reconstitute the antivenom in each vial by covering the open ends with several thicknesses of sterile gauze sponges and then shaking each vial vigorously for one minute. Allow the vials to stand still for one minute to clear. Withdraw the CLEAR solution into a clean sterile syringe (leaving froth and undissolved particles behind), and prepare to transfer to IV Fluid bottle.
Administer the reconstituted Antivenom intravenously over a period of 20 minutes at a rate of 1 vial per 10 minutes (i.e., 1.0 mls per minute).
Should any signs of ALLERGY/ANAPHYLAXIS -This is reaction to the snake antivenom (e.g., coughing, dyspnea, urticaria, itching, increased oral secretions, etc.) develop, immediately discontinue the administration of antivenom, and treat symptoms with epinephrine, steroids and antihistamines.
As soon as the patient is stabilized, continue the antivenom infusion at a slower rate.
After the first two vials of antivenom has been administered, the splint and the bandages may be removed. This should be done VERY SLOWLY over a FIVE minute period to prevent a bolus release of venom. If the patient's condition worsens:
Reapply the crepe bandage. Prepare a third vial of antivenom (1 vial in 10 mls of Lactated Ringers Solution) immediately as directed above.
Infuse this dose at 1.0 ml per minute for 10 minutes.
Release the bandage again slowly over 5 minutes.
In any case, an additional vial of antivenom should be prepared and allowed to dissolve fully. Anticipate giving this next dose approximately Two hours after the first two vials has been delivered. If the patient's symptoms should persist or worsen, administer this dose 60 or 90 minutes following the first dose or doses.
ANTIVENOM THERAPY IS THE MAINSTAY OF TREATMENT FOR COBRA/KRAIT ENVENOMATION.
Many of the symptoms are ameliorated or entirely eliminated by the antivenom alone. Other symptoms will require additional modalities of therapy to correct. Local symptoms may take several days to weeks to completely resolve; their progression, however, may be treated with antivenom therapy.
Neurological Symptoms (especially respiratory obstruction or failure) are usually the most immediate cause of dangerous problems. Often, these are improved by the antivenom. If breathing becomes impaired, provide respiratory assistance.
If severe muscle paralysis develops and persists, administer 0.6 mg of Atropine IV. Follow by giving 0.5 mg of Neostigmine IV every 30 minutes for a maximum of FIVE doses. (This is real despo scenario, if you are far from medical help, but the AUSSIE WRAP bandage has been proved to delay venom spread for upto 8 -10 hrs, however, do not test this!)
It is important to keep venom neutralization current and continuous. The best method to accomplish this is to keep a close watch on the patient's status. If the present condition does not improve, or should it worsen for any reason, additional antivenom should be administered. The antivenom should ideally be diluted 1 to 10 in Lactated Ringers Solution, and always given by intravenous infusion at a rate of One vial per 10 minutes (1.0 mls per min). Give all additional antivenom in one vial doses. One should anticipate using Three to Five vials for a minor bite. Ten to Fifteen may be necessary for moderate or severe bites.
Stay safe and God Bless
Last edited by eljefe on Wed Jul 19, 2006 12:06 pm, edited 1 time in total.