Snake bite -A review

Snake bite is a common but under-reported medical emergency accounting for 0.5% of all deaths with greater risk of fatal envenomation in children. In India, four species of venomous snake are most common but better classification of medically significant species is warranted. Snake venom is a mixture of peptides with enzymatic & toxic properties which mediate activation of cytokine cascades along with organ specific toxicities, manifesting into local and systemic symptoms. The syndromic approach of attributing a constellation of signs & symptoms to a particular family of venomous snake has clinical acceptance but overlaps exist. Management of snake bite victim starts with a first aid measures of reassurance, immobilization and quick transfer to hospital. Measures such as application of tourniquet, incision and suction are harmful & should not be done. On arrival at hospital, triage and stabilization of Airway, Breathing & Circulation (ABC) is done followed by a focused assessment to ascertain the severity of envenomation. Antivenom treatment is the mainstay of snake bite management. ASV should be started only when specific indications such as signs of neurotoxicity, coagulopathy, hypotension, hematuria are present. Indiscriminate use of ASV is strongly condemned. Currently 8-10 vials of ASV as initial dose with a maximum of 25 vials is recommended. There is no role of test dose of ASV. Measures to treat any ASV induced anaphylaxis should be ready prior to start of ASV treatment. Supportive treatment is as important in determining the final outcome of envenomation as ASV