Diagnosis & Treatment — First aid / lay people
- collapse, loss of consciousness.
- Calm the patient.
- Place the patient in a stable lateral position, or possibly the Trendelenburg position (shock position).
Anxiety (fear of death) plays an important role following accidents with venomous animals and has an additional negative influence on the clinical course after an accident.
Loss of consciousness after an accident with a venomous animal can have many causes. It is important to place the patient in a stable lateral position to avoid aspiration. If peripheral circulatory failure is present, the shock position may improve the patient's condition. If resuscitation is necessary, it is only in exceptional cases that lay people will be sufficiently well trained to be able to intervene.
How can absorption and circulation of the venom be delayed?
Elapids (Cobras, Kraits):
- Compression-immobilisation method or comparable methods and splinting of the bitten extremity.
- Avoid pressure points when applying the splint (padding).
- Transport the patient.
Viperids, crotalids, colubrids:
- Immobilisation of the bitten extremity using a splint (piece of wood or something similar).
- Avoid pressure points when applying the splint (padding). Transport the patient.
The risks of the compression-immobilisation method or comparable methods limit their use to elapid bites (Cobra, Kraits). Following Cobra bites, local swelling begins after an average delay of 2–3 h (Reid 1964), but following Krait bites there is no local swelling at all. The compression-immobilisation method or comparable methods are justified with elapid bites, as the neurotoxic effects of the venom begin rapidly, and there is a risk of respiratory failure occurring before medical facilities can be reached.
Exposure of the eyes or mucous membranes to venom
Eye irrigation/thorough washing of the mucous membranes with water.
Average time between the bite and death
- Asiatic Cobras: on average 8 h (12 min–120 h).
- Bungarus caeruleus: on average 18 h (3–63 h).
- Daboia russelli: on average 3 days (15 min–264 h).
- Echis sp.: on average 5 days (25 h–41 days). These data are from E. ocellatus bites (Nigeria)!
This information makes it possible to assess the probability of reaching medical facilities in time and, barring other circumstances (see above), justifies the use of a tourniquet for elapid bites (see above).