What is the treatment for a 30-year-old female with a snake bite in India?

Treatment of Snake Bite in a 30-Year-Old Female in India

Immediately activate emergency medical services and transport the patient to a hospital facility for antivenom administration, which is the cornerstone of definitive treatment and must be given as soon as possible. 1, 2, 3

Immediate First Aid at the Scene

Critical Actions:

• Rest and immobilize the bitten extremity completely to minimize venom absorption through the lymphatic system 1, 2, 3
• Remove all rings, jewelry, and constricting objects from the affected limb before swelling develops to prevent ischemic injury 1, 2, 3
• Keep the victim calm and minimize all movement and exertion, as walking increases systemic venom absorption 1, 3
• Transport to the nearest medical facility immediately—do not delay for any first aid measures 2, 3

Harmful Practices That Must Be Avoided

Do NOT perform the following interventions, as they are ineffective and potentially harmful:

• Do NOT apply tourniquets—they worsen local tissue injury 2, 3
• Do NOT apply ice to the bite wound—it causes additional tissue damage 2, 3
• Do NOT use suction devices (removes only 0.04% of venom and increases tissue damage) 4, 2, 3
• Do NOT apply electric shock therapy—it is completely ineffective 2, 3
• Do NOT use pressure immobilization bandaging in India for most snake species, as it may worsen tissue injury with cytotoxic venoms 2, 3

Note: While the American Heart Association suggests pressure immobilization bandaging (40-70 mm Hg) may be reasonable for certain neurotoxic snake bites 4, this technique is not recommended for the cytotoxic venoms common in India and requires specialized training that is often poorly retained. 4

Hospital-Based Definitive Management

Antivenom Administration:

• Antivenom is the only definitive treatment and should be administered as soon as possible in a medical facility 1, 2, 3
• Establish intravenous access before antivenom administration 2
• In India, the average antivenom dose ranges from 20-320 ml depending on the snake species and severity of envenomation 5
• Antivenom is most effective when given within four hours of the bite 6
• Have epinephrine readily available for potential anaphylactic reactions to antivenom 1

Species-Specific Considerations in India:

• Saw-scaled viper (Echis carinatus) causes 64% of envenomations in rural Maharashtra and produces cytotoxic effects with bleeding and tissue injury, requiring 20-250 ml of antivenom 5
• Cobra bites (16.6% of cases) cause neurotoxic effects including descending paralysis, ptosis, dysphagia, and respiratory compromise, requiring 40-320 ml of antivenom and potential ventilatory support 7, 5
• Krait bites (9.8% of cases) produce neurotoxic symptoms, with 75% of elapid bites requiring assisted ventilation 7, 5
• Russell's viper (9.4% of cases) causes both cytotoxic and hemotoxic effects 5

Critical Monitoring and Complications

Watch for these life-threatening complications:

• Acute renal failure (occurs in approximately 19% of cases) 7
• Respiratory failure requiring mechanical ventilation (75% of elapid bites) 7
• Rare but serious complications include cerebrovascular accident, angle-closure glaucoma, and arterial thrombosis 8
• Coagulopathy and bleeding disorders with viper bites 7, 5

Common Pitfalls to Avoid

• Delaying hospital transport to attempt ineffective first aid measures—this is the most critical error 2, 3
• Failing to remove constricting items before swelling progresses, leading to compartment syndrome 1, 3
• Allowing excessive patient movement during transport, which increases venom absorption 1, 3
• Inadequate antivenom dosing or delayed administration beyond the 4-hour window 6

Context-Specific Considerations for India

• Snake bites in India show a 4.7% mortality rate when properly managed, with most deaths preventable through early antivenom administration 5
• 68.9% of bites occur between May and November (monsoon season) 5
• 60.6% of bites occur while the victim is sleeping 7
• Primary healthcare centers in rural India can successfully manage snake bites with appropriate antivenom availability and basic supportive care 9, 5
• The median time to hospital arrival is often 9 hours in rural areas, emphasizing the critical need for immediate transport 7