Makindo Medical Notes

⚠️ Most snake bites in the UK are not serious, but ALL snake bites must be checked by a doctor. 👉 Useful guideline link: Snakebite Treatment Resources

🌍 About

• Worldwide, ~5.4 million people are bitten by snakes each year, with up to 2.7 million envenomings.
• Most bites occur in Africa, Asia, and Latin America, where snakes and humans are in closer contact.

🐍 Snake Bites in the UK

• The European Adder is the only venomous snake in the UK.
• Adders are grey or reddish-brown with a distinctive dark zig-zag stripe along the back.
• Although bites are rarely fatal, always seek hospital care.

🌎 Dangerous Snakes Worldwide

Some of the world’s most dangerous snakes include:

🐍 Snake	Where Found	⚡ Danger	Notes
King Cobra	Southeast Asia, India	Neurotoxic – respiratory failure	Largest venomous snake, intimidating hood.
Inland Taipan	Australia	Most toxic venom worldwide	"Fierce snake" – rarely bites humans.
Russell’s Viper	South Asia	Haemotoxic – bleeding, renal failure	Responsible for many deaths in Asia.
Black Mamba	Sub-Saharan Africa	Rapidly fatal neurotoxin	Fast, aggressive, highly feared.
Fer-de-Lance	Central & South America	Haemotoxic – severe necrosis	Commonest fatal snake in Central America.

🧪 Clinical Effects by Venom Type

Venom Type	Features	Management
🩸 Haemotoxic (Vipers)	Pain, swelling, bruising, bleeding, shock	Immobilize limb, antivenom, fluids, blood products
🧠 Neurotoxic (Cobras, Kraits, Mambas)	Ptosis, paralysis, respiratory failure	Antivenom + respiratory support (ventilation if needed)
💪 Myotoxic (Sea Snakes)	Muscle pain, dark urine, renal failure	Antivenom + aggressive IV fluids, monitor electrolytes
❤️ Cardiotoxic (Mambas, Elapids)	Arrhythmias, cardiac arrest	Antivenom, cardiac monitoring, ACLS if arrest
🦵 Local Tissue Damage	Swelling, necrosis, blistering	Wound care, tetanus, antibiotics, debridement if needed

⚠️ Complications

• 🧠 Paralysis
• 🩸 Disseminated intravascular coagulation (DIC)
• 🚰 Acute kidney injury (AKI)
• ✂️ Amputation due to necrosis
• 💀 Multiorgan failure

🚑 First Aid & Emergency Management

• ✅ Ensure safety – move away from snake.
• ✅ Keep patient calm & limb immobilized (at or below heart level).
• ✅ Call for emergency help – transfer to hospital quickly.
• ✅ Apply a pressure immobilization bandage (for neurotoxic bites e.g., cobra, mamba).
• ❌ Do NOT use a tourniquet, cut, suck, or apply ice.
• ✅ Monitor vitals (breathing, BP, HR).
• 💉 Give antivenom at hospital – definitive treatment.
• 🧴 Supportive care: IV fluids, analgesia, treat shock, seizures, or respiratory failure.
• 💉 Give tetanus prophylaxis if not up-to-date.

🏥 In-Hospital Care

• Most patients admitted for at least **24h monitoring**.
• Wound cleaned, bandaged, supportive care provided.
• Antivenom used if confirmed or suspected envenomation.

📚 References

• Snakebite Treatment Foundation

Cases — Snake Bites 🐍

• Case 1 — Neurotoxic Snakebite (Cobra) 🧠: A 25-year-old farmer in India presents 2 hours after a bite to the leg. He has drooping eyelids, slurred speech, and difficulty swallowing. Exam: bilateral ptosis, shallow respirations, O₂ sats 84% RA. Diagnosis: Neurotoxic envenomation (cobra). Management: Airway support, early antivenom, ICU monitoring, ventilatory support if needed.
• Case 2 — Haemotoxic Snakebite (Viper) 🩸: A 40-year-old man develops swelling, bleeding gums, and haematuria after a viper bite. Exam: hypotension, oozing from venepuncture sites. Coagulation screen: prolonged PT, low fibrinogen, thrombocytopenia. Diagnosis: Haemotoxic envenomation causing DIC. Management: Antivenom, blood products (FFP, cryoprecipitate), IV fluids, renal monitoring.
• Case 3 — Cytotoxic Snakebite (Puff Adder) 🦵: A 33-year-old safari worker is bitten on the ankle by a puff adder. Rapidly progressive swelling, blistering, and necrosis develop around the wound. Exam: severe pain, compartment syndrome signs. Diagnosis: Cytotoxic envenomation. Management: Antivenom, analgesia, wound care, fasciotomy if compartment syndrome, possible grafting later.
• Case 4 — Allergic Reaction to Snakebite 🫁: A 29-year-old man is bitten by a non-venomous snake but develops sudden urticaria, wheeze, and hypotension minutes later. Diagnosis: Anaphylaxis to snake venom proteins. Management: IM adrenaline, IV fluids, antihistamines, steroids, airway support.
• Case 5 — “Dry Bite” (No Envenomation) ✅: A 21-year-old tourist in Africa is bitten by a snake on the calf. Minimal local pain and swelling; no systemic features after 12 hours observation. Coagulation normal. Diagnosis: Dry bite (no venom injected). Management: Wound cleaning, tetanus prophylaxis, observation; reassurance and discharge if stable.

Teaching Commentary 🧠

Snakebites cause different clinical syndromes depending on venom: - Neurotoxic → paralysis (cobra, krait). - Haemotoxic → bleeding/DIC (vipers). - Cytotoxic → local necrosis, compartment syndrome (puff adder). - Allergic → anaphylaxis. - Dry bite → no venom, just local effects. Management priorities: 1️⃣ First aid: immobilise limb, no tourniquets/cutting. 2️⃣ Hospital: airway, breathing, circulation. 3️⃣ Give antivenom if systemic features or severe local swelling. 4️⃣ Supportive: fluids, blood products, analgesia, wound care. ⚠️ Always monitor for late complications: renal failure (haemotoxic), neuropathy (neurotoxic), tissue loss (cytotoxic).