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Poisonous animals
Cnidarians (Jellyfish, Corals and Anemones)
Venomous fish
Hymenopterans (Bees, Wasps and Ants)
Sea snakes
Terrestrial snakes
Miscellaneous animals
North America
Mexico and Central America
South America and the West Indies
North Africa, Near and Middle East
Central and Southern Africa
The Far East
Indian Subcontinent and Southeast Asia
Australia and the Pacific Islands

Diagnosis & Treatment — First aid / lay people


General observations

This Diagnosis & Treatment section is based on analysis of envenoming caused by V. aspis and V. berus and to a small extent by V. ammodytes (see the Biomedical database entry for Vipera sp. (European vipers)). Documented cases of envenoming due to V. latasti, V. kaznakovi, V. lebetina, V. seonaei and V. ursini are rare or simply not available. See also Diagnosis & Treatment: Terrestrial snakes: North Africa, Near and Middle East and the Biomedical database entry. The signs and symptoms of envenoming caused by V. ammodytes, V. aspis, V. berus, V. latasti and V. ursini are described as being similar with the exception of V.berus, V.ammodytes and in particular V.aspis in which neurotoxic effects are observed in certain geograpgical areas (Warrell 2010). Envenoming due to colubrids and the pitviper Gloydius halys in Europe is similarly poorly documented or not at all.

General problems

  • Fear,
  • collapse, loss of consciousness.
F  First Aid
  • Calm the patient.
  • Place the patient in a stable lateral position, or possibly the Trendelenburg position (shock position).
C  Comments

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.

Early anaphylactoid signs and symptoms

Nausea, vomiting, abdominal colic, diarrhoea, incondinence of urine and faeces, sweating, hives, swelling of the face, lips, gums, tnogue, throat, breathing difficulties, collapse, loss of consciousness (within five minutes to hours after the bite).

F  First Aid

Early anaphylactoid signs and symptoms can be treated with an oral or parenteral H1 blocker or adrenaline (epinephrine) (Epi-Pen), depending on severity (Warrell 2005).

How can absorption and circulation of the venom be delayed?

F  First Aid
  • 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.
C  Comments

With European viper bites, all forms of tourniquets and compression bandages are problematic and may even be dangerous. The marked local effects of the venom lead rapidly to swelling of the bitten extremity, such that arterial occlusion pressures may be reached or exceeded, with consequent ischaemic damage distal to the tourniquet. Furthermore, the local effects of the venom are intensified by confinement of the venom to a small volume of tissue.

Average time between the bite and death

34 h (mean) (6–60 h) (Warrell 1987).

However, death may also occur within minutes after the bite due to autopharmacological effects of the venom.