Snakebite

Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

A snakebite can cause various symptoms of poisoning after a poisonous snake snaps. In this country, for example, an adder bite can trigger symptoms of poisoning, while a grass snake bite is non-toxic. Read here which first aid measures you should take if you have a snakebite, what is not advisable and how you can avoid a snakebite!

Snake bite: quick reference

What to do if you get a snake bite Calm down those affected, keep them calm, if necessary treat the wound and remove jewelry / clothing, bring them to the hospital or call the emergency services.
Snake bite risks: nerve and muscle damage, blood clotting disorders, circulatory problems, allergic reactions (itching, nausea, drop in blood pressure, etc.), serum sickness (when administering an antidote)
When to the doctor Always! Every snake bite is an emergency, as the danger they pose cannot usually be assessed on site.

Attention:

Some snakes pretend to be dead in case of danger! In addition, dead snakes and even severed snake heads can snap shut reflexively! Therefore, you should not touch a (supposedly) dead snake (without protective measures) or take photos of it up close.
Even if it is often done in films - a snakebite wound should not be tied, sucked out, burned out or cut out. Such measures do more harm than good.
Snake venom spreads faster in the body through fear and movement. Therefore, you should make absolutely sure that the person concerned remains as calm as possible and keeps himself calm.

Snakebite: what to do

In the case of a snakebite, first aid is primarily aimed at delaying any toxic effects until the patient can be treated by a doctor. It is also about reducing the patient's pain and anxiety. In detail, first aid for snake bites looks like this:

Calm down: After a snake bite, many people are very scared. But restlessness and panic reactions accelerate the distribution of snake venom that has entered the body. Therefore, you should calm the patient down as much as possible.
Resting: Make sure that the patient lies down immediately (a safe distance from the snake to avoid a second bite). He should move as little as possible in order to slow down the distribution of the poison in the body. If you have a bite in your arm or leg, you can splint the affected limb with sticks and bandages to immobilize it.
If necessary, treat the wound: If possible, leave the bite wound alone. At most, you should disinfect them and cover them with a sterile or at least clean bandage. However, this must not be too narrow and impair the blood circulation!
Remove jewelry and clothing: If you get a snakebite on your hand or arm, remove rings, bracelets, watches, and restrictive clothing quickly before the tissue swells. If you have a snakebite on your leg, remove tight-fitting shoes and tight pants (cut open if necessary).
See a doctor immediately: take the patient to the nearest hospital as soon as possible. It should move little during transport, if necessary transport it lying down. If possible, have the patient picked up by the ambulance service.
if necessary take the dead snake with you: if it is safe to do so - and only then! - you should kill the snake and take it to the clinic. If the doctor knows what poison he is dealing with, he can immediately initiate the correct therapy. If it is not possible to safely take the dead snake with you, you can alternatively memorize its appearance or take a photo of it (from a safe distance). This makes it easier for doctors to identify.

What not to do if you get a snake bite!

The measures that are taken in many films after a snakebite are often far from advisable. They may do more harm than good. You should therefore take note of the following after a snake bite:

Do not bind: The binding interrupts the blood flow, pinches nerves and increases the local toxicity. As a result, the tissue can swell extremely and even die off (necrosis). Bleeding into the congested extremity is also possible.
Do not burn out, cut in or cut out: Such measures can hardly reduce the amount of poison in the body, but rather promote the spread of the poison (if larger vessels are destroyed). In addition, dangerous bleeding can occur (with impaired blood clotting).
Do not suck out: You cannot create sufficient negative pressure with your mouth to suck enough snake venom out of a bite wound. You could also poison yourself in the process.

Experts also advise against the use of special devices for first aid after a snakebite (poison extractors, electric shock devices).

Snakebite: Risks

Thanks to its more or less characteristic bite mark, many people at least roughly know what a snakebite looks like: The bite usually appears in the form of two adjacent, punctiform puncture points. If a venomous snake has bitten and actually injected venom, further symptoms develop - usually 15 to 30 minutes, but sometimes not until a few hours after the snake bite.

Snake venom

Snake venom is a watery secretion from special salivary glands of venomous snakes. When biting, it usually gets into the victim's body via a hollow front tooth in the upper jaw (in false snakes via poisonous teeth in the back of the throat) - but not with every snake bite. There are also so-called "dry" bites, in which a venomous snake bites but does not inject poison into the skin of its victim.

Snake venom consists of various proteins with poisonous and enzymatic properties. They can cause various symptoms in the human body. For example, the so-called phospholipases can break down the membranes of body cells and thus destroy a great deal of tissue. The enzyme hyaluronidase loosens the surrounding tissue so that the remaining snake venom can spread quickly. Hemorrhagins are very dangerous. These are enzymes that impair blood clotting and damage the tiny vessels (capillaries).

Symptoms after snakebite

It depends largely on the composition and dose of the injected poison mixture which symptoms occur, how severe they are and how dangerous it can be for the patient. Basically, one differentiates between five symptom complexes that can occur after snake bites:

Nerve damage (neurotoxic symptoms)

The venom injected from a snakebite can block the peripheral nervous system. Then the striated muscles become paralyzed. The first signs include drooping of the upper eyelids (ptosis) and paralysis of the facial and jaw muscles. In the further course, the paralysis spreads to the respiratory muscles, which can lead to death by suffocation.

These neurotoxic snakebite symptoms are caused by cobras, mambas, sea snakes, and some rattlesnakes, for example.

Muscle damage (myotoxic symptoms)

In some cases, snake venom has a toxic effect on the striated muscles and damages them. This sometimes results in severe muscle pain.

The destruction of the muscle tissue is also noticeable in the fact that the creatine kinase value rises in the blood and myoglobin can be detected in the urine: Both proteins are normally found inside the muscle cells and are released when the cells are destroyed.

The released myoglobin turns the urine dark brown. It can also damage the tubular cells in the kidneys, which can lead to kidney failure.

Such myotoxic symptoms can be caused by the bites of some vipers, rattlesnakes, poisonous snakes and sea snakes, for example.

Bleeding disorder

Often a snake bite triggers a blood clotting disorder, up to so-called consumption coagulopathy (disseminated intravascular coagulation): The poison first activates the coagulation system. As a result, numerous small blood clots form that can clog fine vessels. In addition, clot formation consumes so many substances that are necessary for clotting (such as blood platelets, coagulation factors) that corresponding deficiencies arise. This can go so far that the blood can no longer clot at all. Unstoppable bleeding (such as bleeding from wounds, gum and nosebleeds) is the result. Vomiting of blood and bloody urine may also occur.

Such a severe blood clotting disorder can develop especially after a viper snake bite, but also after the bite of snake snakes (such as African tree snakes).

Swelling (edema) around the bite site

If the area of tissue around the snakebite swells (edema), this indicates that venom was indeed injected. The edema can be massive and quickly spread to the whole arm or leg. If the bite comes from a viper or rattlesnake, extensive under-bleeding of the skin (with blisters) forms around the bite. In addition, the surrounding tissue dies (tissue necrosis).

Circulatory problems

Occasionally, a snakebite triggers shock and circulatory problems, such as nausea, weakness and dizziness.

If someone develops vomiting, weakness, paleness, and sweating after a snake bite, snake venom doesn't necessarily have to be the cause. Such symptoms can also be psychological, i.e. triggered by the panic of the person concerned. After all, a snakebite terrifies most people.

Serum sickness

Patients who have received an antidote (antiserum) after a snake bite can develop what is known as "serum sickness" after a few days. This is understood to mean allergic late reactions such as hives, slight tissue swelling (edema) and joint pain. They can be treated with medication (with antihistamines and cortisone).

Other risks

Snakebites are usually sterile, so they usually do not introduce germs into the wound. This means that there are usually no primary infections. However, germs can subsequently penetrate and then trigger what is known as a secondary infection. But that rarely happens.

A snakebite that is survived usually has no lasting consequences - apart from possible tissue loss (due to necrosis) and possibly an amputation. The latter may be necessary if the bite wound was treated improperly.

It can take weeks or even months to fully recover from a snakebite.

Risk in this country: adder bite

Adders are among the vipers and are the most common venomous snakes in German-speaking countries. If (sufficient) venom was injected after a viper bite, a painful swelling quickly forms around the bite mark. This can turn bluish and spread to the entire extremity and even further. In addition, the lymph nodes in the affected area of the body often swell and the lymph vessels become inflamed (lymphangitis).

In addition, many patients show severe panic reactions after an adder bite. General symptoms such as abdominal pain, nausea, and vomiting are also sometimes seen.

Severe symptoms of intoxication develop only in rare cases. For example, a bluish blister can form at the bite site and tissue can die off (necrosis). Serious circulatory problems with palpitations, drop in blood pressure and circulatory shock are also the exception.

Occasionally, as an allergic reaction to the adder bite, the tissue around the eyes, upper lip, tongue and larynx swells (angioneurotic edema). Very rarely an adder bite causes drowsiness in children.

Snake bite: when to see a doctor?

Basically, every snakebite is a potential emergency and should be treated as such. That means: Always bring the person affected to the doctor or call the emergency services.

The good news: Around 50 percent of all snakebites (including poisonous snakes) are “dry” or “empty” bites that have not been injected with venom. Although they leave a bite mark, they do not cause any far-reaching symptoms of intoxication such as muscle or nerve damage. This also applies to an adder bite. Even if poison was injected, it was often so little that apart from a local swelling at the bite site, no further symptoms develop. An adder bite rarely causes severe poisoning, and deaths are the absolute exception.

Since it is usually difficult to assess how dangerous a snakebite is in individual cases, it should always be seen by a doctor.

Snakebite: medical examinations

If you have been bitten by a snake, the emergency doctor / doctor will first ask you or any accompanying person for the necessary information. Possible questions are, for example:

When and how did the snakebite come about?
How much time has passed since then?
Do you know which type of snake has bitten?

The doctor will then examine you immediately. He carefully inspects the bite wound, checks your vital functions (such as breathing and blood pressure) and takes blood and urine samples for analysis in the laboratory. He will then initiate appropriate therapy as soon as possible.

Snakebite: Treatment by the doctor

The doctor will treat the bite wound in a sterile manner and closely monitor the further course. To do this, he will monitor your pulse, blood pressure, breathing and neurological values.

In addition, he will treat the various symptoms as needed. For example, if you are in severe pain, you will be given pain relievers (analgesics). If you have circulatory problems, you will likely be given fluids and electrolytes (as an infusion) and possibly medication to increase blood pressure. Artificial respiration may be necessary if you have breathing problems.

If kidney failure occurs as a result of myoglobin excretion in the urine, the doctor will order blood washing (hemodialysis).

Giving an antiserum

An antidote (antiserum) is available against some snake poisons. It is given directly into a vein if the symptoms of intoxication are severe. Only a doctor should do this because the patient may be allergic to it. In the worst case, a severe allergic shock (anaphylactic shock) occurs, which must be treated immediately by a doctor!

An antidote should always be given as soon as possible after a snakebite. The more time passes, the higher the dose of antiserum must be and the lower the chances of success of the treatment (exception: if the blood clotting is disrupted by the snakebite, the administration of an antiserum is always helpful).

Other measures

If you do not have any vaccination against tetanus (tetanus), the doctor will give you a tetanus injection to be on the safe side.

Dead (necrotic) tissue is usually only removed a few days after the snakebite. The resulting wound surface is covered by a skin graft, if necessary.

Prevent snakebite

In order to avoid a snakebite, you should heed the following advice - especially if you are traveling in tropical-subtropical areas:

Correct clothing: When hiking in confusing terrain, you should wear high, sturdy shoes and long trousers, and special gaiters in very endangered areas.
Vibrations: Just like using a walking stick, standing firmly on your feet can drive away snakes (they react to the vibrations).
Keep your eyes open: Pay close attention to where you step, sit down and where you reach (e.g. never blindly reach into bushes).
Do not sleep directly on the floor: If possible, never set up your sleeping place directly on the floor.
Be careful with leftover food: Dispose of leftover food that could attract prey, including snakes.
Withdrawal: If you encounter a snake, you should withdraw, ideally giving it the opportunity to escape and never try to catch, scare or irritate the animal. Otherwise, you will quickly end up with a snakebite.

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