Management of Snake Bites in India
The immediate management of snake bites in India requires prompt activation of emergency services, rest and immobilization of the bitten extremity, removal of constricting objects, and rapid transport to a medical facility for definitive antivenom treatment. 1
First Aid Measures
- Immediately activate emergency services for any person bitten by a venomous or possibly venomous snake 2
- Rest and immobilize the bitten extremity to minimize venom absorption through the lymphatic system 2, 1
- Remove rings and other constricting objects from the bitten extremity to prevent damage from swelling 2, 1
- Transport the victim to a medical facility as quickly as possible, as definitive treatment (antivenom) is only available in healthcare settings 1
Harmful Practices to Avoid
- Do NOT apply ice to a snakebite wound as it has unproven benefits and may cause tissue injury 2, 1
- Do NOT use suction devices (with or without incision) as they are ineffective for venom removal and may cause tissue injury 2
- Do NOT apply electric shock as it is ineffective and potentially harmful 2, 1
- Do NOT apply tourniquets as they can worsen local tissue injury 2, 1
- Do NOT use pressure immobilization bandaging as it may worsen tissue injury with cytotoxic venoms 2, 1
Hospital Management
Anti-Snake Venom (ASV) Administration
- The recommended initial dose of ASV for treating a snake bite in India is 10 vials administered intravenously 3
- ASV should be administered after appropriate testing for hypersensitivity 3
- Have epinephrine readily available for treatment of anaphylactic reactions 3
ASV Dosing Protocols
- The Indian polyvalent antivenom is effective against the "Big Four" snakes: Spectacled cobra (Naja naja), Saw-scaled viper (Echis carinatus), Russell's viper (Daboia russelli), and Common krait (Bungarus caeruleus) 4
- Studies comparing different ASV dosing protocols have shown that lower doses may be as effective as higher doses, potentially reducing costs without compromising outcomes 5, 6
- In one study, a low-dose regimen (starting with 2 vials followed by 1 vial every 4 hours) was as effective as a high-dose regimen (starting with 2 vials followed by 2 vials every 4 hours) 6
Special Considerations for India
- India has the highest snake bite mortality rate globally, with approximately 58,000 deaths annually 4
- The "Big Four" snakes are responsible for the majority of deaths in India, but many other venomous species exist that may require specific management 4
- There is significant heterogeneity in venom composition across different regions of India, which can affect antivenom efficacy 4
- Medical education in India may not adequately prepare doctors to treat snake bites, particularly regarding appropriate ASV usage and management of adverse reactions 7, 8
Pitfalls to Avoid
- Delaying transport to a medical facility to attempt ineffective first aid measures 1
- Failing to remove constricting items like rings, which can lead to ischemic injury as swelling progresses 2, 1
- Excessive movement of the victim, which can increase venom absorption 2, 1
- Using inappropriate dosing protocols for ASV that may waste resources without improving outcomes 5, 6
- Inadequate preparation for managing adverse reactions to ASV, which can be life-threatening 7