Treatment for Krait and Cobra Bites
For krait or cobra bites, immediate activation of emergency services and rapid transport to a medical facility for antivenom administration is essential, as this is the definitive treatment that can prevent mortality and reduce morbidity. 1, 2
Immediate First Aid Measures
- Activate emergency services immediately for any person bitten by a venomous or possibly venomous snake 1
- Rest and immobilize the bitten extremity to minimize venom absorption through the lymphatic system 1, 2
- Remove rings and other constricting objects from the bitten extremity to prevent damage from progressive swelling 1, 2
- Minimize physical exertion by the victim to reduce systemic absorption of venom 1
- Transport the victim to a medical facility as quickly as possible for definitive treatment (antivenom) 1, 2
Harmful Practices to Avoid
- Do NOT apply ice to the snakebite wound as it has unproven benefits and may cause tissue injury 1
- Do NOT use suction devices (with or without incision) as they are ineffective for venom removal and may cause additional tissue damage 1
- Do NOT apply electric shock as it is ineffective and potentially harmful 1
- Do NOT apply tourniquets as they can worsen local tissue injury 1, 3
- Do NOT use pressure immobilization bandaging for North American snake bites as it may worsen tissue injury with cytotoxic venoms 1, 2
Medical Management
- Antivenom is the cornerstone of treatment for both krait and cobra bites 2, 4, 5
- Krait bites may require high doses of antivenom for reversal of neurological manifestations 4
- For cobra bites, early administration of antivenom can prevent respiratory paralysis 5, 6
- Anticholinesterase agents may help reverse neuromuscular dysfunction caused by elapid envenoming 6
- Respiratory support including intubation and mechanical ventilation may be necessary for patients with respiratory insufficiency 6, 7
Clinical Manifestations
Krait Bites
- Often occur while victims are asleep 7
- Minimal local signs at bite site 7
- Progressive neurotoxic symptoms including paralysis, muscle pain, and abdominal pain 7
- Possible myoglobinaemia (muscle breakdown) 7
- May require prolonged respiratory support 4, 7
Cobra Bites
- Significant local tissue swelling and potential necrosis 5, 7
- Neurotoxic effects leading to respiratory paralysis 5, 6
- Response to antivenom may not be immediate but is essential 5
Pitfalls to Avoid
- Delaying transport to a medical facility to attempt ineffective first aid measures 1, 2
- Failing to monitor for recurrent neurotoxicity even after initial antivenom administration 4, 7
- Sudden release of tourniquets (if already applied) which can cause rapid systemic envenomation and respiratory arrest 3
- Underestimating the need for respiratory support in neurotoxic envenomation 6
- Inadequate antivenom dosing, particularly for krait bites which may require higher doses 4