Treatment for Cobra Bite
The definitive treatment for a cobra bite is antivenom, which should be administered as soon as possible after emergency services have been activated. 1, 2, 3
Immediate First Aid Measures
- Activate emergency medical services immediately for any person bitten by a venomous or possibly venomous snake 1, 3
- Rest and immobilize the bitten extremity to minimize venom absorption through the lymphatic system 1, 3
- Remove rings and other constricting objects from the bitten extremity before swelling develops 1, 2
- Keep the victim calm and minimize movement/exertion 1, 3
Harmful Practices to Avoid
- Do NOT apply tourniquets as they can worsen local tissue injury 1, 2
- Do NOT apply ice to the bite wound as it may cause additional tissue injury 1, 2
- Do NOT use suction as it removes very little venom (only about 0.04%) and may increase tissue damage 1, 2
- Do NOT apply electric shock as it is ineffective and potentially harmful 1, 2
- Do NOT use pressure immobilization bandaging as it may be potentially harmful 1
Medical Management
- Antivenom is the cornerstone of treatment and should be administered as soon as possible in a medical facility 1, 2, 3
- Ensure airway management and ventilatory support if needed, particularly important for cobra bites which can cause respiratory paralysis 2, 4
- Establish intravenous access before antivenom administration 2
- For neurotoxic envenomations like cobra bites, respiratory support may be required for several days 5, 4
Clinical Manifestations and Monitoring
- Cobra envenomations can cause progressive neurotoxicity leading to bulbar and respiratory paralysis requiring mechanical ventilation 4, 6
- Patients may develop areflexic flaccid paralysis requiring ventilation within hours after the bite 5
- Monitor for cardiovascular manifestations, though these are less common with cobra bites 4
- Mechanical ventilation may be required for extended periods (ranging from 9 hours to 7 days in reported cases) 5, 4, 7
Antivenom Administration
- Specific cobra antivenom should be used when available 8, 6
- Antivenom is most effective when administered before the onset of paralysis 5
- Some cases may require large doses of antivenom for complete reversal of symptoms 8
- If the specific species is unknown, polyvalent antivenom may be used 5
Special Considerations
- In cases where specific antivenom is not immediately available, contact regional poison control centers or local zoos for assistance in acquiring exotic antivenins 6
- Cholinesterase inhibitors (like prostigmine) may have limited effect on the neuromuscular blockade caused by cobra venom 5, 4
- Complete recovery is expected with proper supportive care and antivenom administration 5, 6