Signs and symptoms of venomous snakebite may include

a visible bite on the skin (possibly no more than a local discoloration);

pain and swelling in the bite area (may develop slowly, from 30 minutes to several hours);
continued bleeding from site of bite (often seen with viper bites);
rapid pulse;
labored breathing;
progressive weakness;
dim or blurred vision;
nausea and vomiting;
seizures; or
drowsiness (or loss of consciousness).
Usually enough symptoms present themselves within an hour of a poisonous snakebite to erase any doubt as to the victim's having been envenomated or

Figure 5-4.-Corals, cobras, kraits, and mambas.

not. The victim's condition provides the best information as to the seriousness of the situation.

The aims of first aid for envenomated snakebites are to reduce-not stop-the circulation of blood through the bite area, delay absorption of venom, prevent aggravation of the local wound, maintain vital signs, and transport the victim as soon as possible to an MTF with minimum movement.

TREATMENT OF SNAKEBITES.-The proper steps in the treatment of snakebites are listed below.

1. Try to identify the snake. Positive identification is important to selecting the correct antivenom for the treatment of the patient.

NOTE: Do not risk further injury by trying to kill the snake.

2. Certain suction extractors have benefit (for example, the Sawyer extractor), especially if used within the first 3 minutes. If available immediately, use the extractor and leave it on for 30 minutes. The cups may fill up. Empty and re-use them as necessary.

3. GENTLY wash the wound with soap and water (it may remove some of the venom). Do NOT rub vigorously, as it may cause the venom to be absorbed more rapidly.

4. Place the victim in a comfortable position.
5. Tell the patient to remove any jewelry (especially rings and bracelets, as these may impede blood flow if there is swelling of the extremities). Assist, if necessary.

6. Start an IV line.
7. Monitor vital signs (including ABC+D&Es) closely, responding appropriately as necessary.

8. Until evacuation or treatment is possible, ensure the victim lies quietly and does not move any more than necessary.

9. Do not allow the victim to smoke, eat, or drink any fluids. (Water is permissible if you anticipate more than several hours will pass before arriving at a hospital and being able to establish an IV line.)

10. Transport the victim to a hospital or other appropriate facility.

11. Place a lymphatic (light) constriction on the extremity (if the bite is on an extremity). The goal is to obstruct lymphatic-not blood-flow. (See instructions below.) DO NOT USE A TOURNIQUET!

12. Splint the extremity at the level of the body (heart). DO NOT ELEVATE THE EXTREMITY!

13. Hospitalize and observe all snakebites for at least 24 hours.

In the case of spitting cobras (found in Africa, Thailand, Malaysia, Indonesia, and the Philippines), which attempt to spray venom into victims' eyes, rinse the eyes with large volumes of water (neither a blast nor a trickle, and not with hot water). Apply yes"> antibacterial (tetracycline or chloramphenicol) eye ointment, and apply a patch with just enough pressure to keep the eyelid from blinking.)

Other aid will be mainly supportive:

Check pulse and respiration frequently. Give artificial ventilation, if necessary.

Treat for shock, including IV fluids (normal saline or lactated Ringer's solution).
When possible, clean the area of the bite with soap and water, and cover the wound to prevent further contamination.