Puff Adder (Bitis arietans) Bite Protocol

[Bushbaby]

As Puff Adders are the most common and widely spread venomous snake in South Africa, it is important to get help as soon as possible in the case that someone get's bitten. These are some guidelines to follow between getting bitten and getting to the hospital and some protocol which the doctors could find helpful.

If you, a family member or a friend (or anyone around you for that matter) get bitten the first and most important thing to do is to stay calm.

Get someone to phone for help (ambulance).

Safely move the snake away (put it away in case it was one you own). Because Puff Adders are such slow moving snakes, you can take a long piece of wood, tongs, or any other object which will put distance between you and the snake, and gently push the snake away. DO NOT try to kill the snake. Most people get bitten while doing that. So avoid it at all times!! DO NOT try to pick the snake up. It is probably hissed off and will try to bite you. They are also one of the fastest striking snakes in the world, so best not to chance it.

If there was no one to phone for an ambulance, and you have not done so, do it now.

Phone the hospital to alert them to be ready for a snake bite victim.

Keep the bite victim calm. Get the person to lie down and move as little as possible. If you can, lower the limb which has been bitten to below the level of the victims heart.

Wrap a large crepe bandage around the limb. Not too tight as to restrict blood flow. Start at the bite site and work your way up the limb. Secure a splint to the bandage to avoid movement of the limb. Avoid bending or moving the limb while applying the splint.

DO NOT remove the bandage and or the splint. Medical staff can remove it once antivenom and adrenaline is at hand and or administered.

Have the SAIMR (South African Institute for Medical Research) polyvalent antivenom ready (if you have in stock) for the Paramedics to take with the victim to the hospital if an ambulance has been called or take it with. Do not attempt to inject the antivenom unless you are trained to do so and can treat any possible anaphylaxis.

Be prepared to give the patient CPR if so required.

Do not cut or incise the bite and do not try suck the venom out.
Do not apply ice or anything hot to the bite.

ref:

http://www-surgery.ucsd.edu/ent/DAVIDSO ... ietans.htm

Snake bite Course meterial by AF Naude

[alexander]

i thought that you mustn't apply a crepe bandage to a puffie's bite because it restricts the swelling and because the venom would do be more localized and do a lot more damage?

[gaboon]

I've heard that before but preventing the venom spreading towards the heart is more important

[alexander]

I thought that was only for venoms that attack vital organs or nerves leading to vital organs such as lungs, or kidneys. isn't the heart only attacked by cardiotoxins (ie black mambas)?
I'd just like to clear some of this stuff up for me.

[Bushviper]

To localise the venom of a puff adder is not a bad thing to do if you are pretty close to a hospital.

What some people do now is pump the hand or move the limb for about 10 seconds and then put on the bandage. This ensures a greater area for the venom to work on but still not enough to cause major damage to an entire limb.

The introduction of antivenom will stop any further swelling and tissue damage.

Puff adder venom works quite slowly and the first hour is not usually a problem and probably will not become life threatening.

Long term use of a pressure bandage for cytotoxic bites is not recommended.

The venom will not spread to the heart unless it is an intravenous bite (in a vein or artery).

[alexander]

Thanks BV, so is it worth putting on a crepe bandage in the case of a puff adder bite and for how long?

[rubida]

Snake bite…the difficult topic

The treatment of snake bite is according to me a science on its on…any way here is my findings after consulting experts and the latest literature on snake bite while revising the protocols at the zoo.

What some people do now is pump the hand or move the limb for about 10 seconds and then put on the bandage. This ensures a greater area for the venom to work on but still not enough to cause major damage to an entire limb.

This method of “diluting” the venom is debatable as there is too many variability’s to be taking into mind… Further, it’s unknown when the venom actually gets so “diluted” that the effect of the venom is less with spreading than through immobility. .

Long term use of a pressure bandage for cytotoxic bites is not recommended.

Bandages or tourniquets must not be applied. This can also be applicable to berg adders as the venom of some specimens may reveal more cytotoxic then neurotoxic effects. Prof. D. Warrell (world expert on snake bite) only promotes the use of bandages or a tourniquet in cases of bites from neurotoxic snakes.

[swazi]

The protocol we follow at the reptile park is to elevate the limb and flex for 5 minutes. As peak envenomation only occurs 12-24 hours later the victim should be in hospital by then. As the venom is predominantly cytotoxic the focus should be damage control to the bite site area.

We followed this procedure with Chad's Rattle bite, he continued to flex his fingers whilst in hospital to improve the blood flow. I personally feel it helped limit the damage, he has no scars and full function of his finger.

Just my opinion. The discussions and opinions are so conflicting that we decided, after many days of research and long discussions with dozens of Dr's & other experts, that we would follow the flexing & no bandage option for cytotoxic envenomation.

Every venomous snake owner should have his/her own protocol based on his/her own research. Plan, prepare, follow your procedure and get to hospital.

[Bushbaby]

I think that we can safely say that for a Puffadder bite, a tourniquet should NEVER be used as it restricts the venom to one area and thus the damage will be larger than without a tourniquet.

Whether or not to use a pressure bandage should be the individual's choice. A pressure bandage will not restrict the venom, but will aid in slowing the spread of venom in the body.

If you choose not to use a pressure bandage, you can record the effects of the venom, i.e. swelling. Marking how the swelling progresses will aid the doctor in knowing how serious the bite is.

[armata]

There appears to be conflicting views here.

I think I would reject the views of multiple doctors and believe the knowledgeable few who specialise and research the subject.

Before I say anything more I am going to get in touch with David Warrell and Gerbus Muller these guys are at the top of their profession.

With regard to emergency protocol as opposed to clinical managemnt - I would say phone the hospital and get there ASAP DON'T wait for an ambulance (especially in SA).

Also a bit worried about this flexing business.

Also regarding protocol - if you are a private keeper, this obviously involves your family/wife/husband/partner. They have to be aware of procedure and not panic (easier said than done).

Be also aware that even milder bites e.g. European adder/ night adder can be fatal if hypertension and collapse occurs - do you and your nearest and dearest need a first aid course; I think so!

[Bushviper]

By the same token I would follow what Professor C. J. Reitz advocated after doing trials with pressure bandages at the University of Pretoria. She found them to be advisable on all local venoms except the boomslang.

The flexing was tested on mice. Some mice were injected with puff adder venom and then forced to swim for a short period of time before being confined. The others were just confined and others were left to continue swimming. The ones who were left to swim died first then those that were just confined and then the ones that swam a bit and then rested.

I seriously doubt that anybody can say that his/her protocol is the best. I believe you must research as much as you can and then choose which protocols have a common thread and possibly apply that.

[armata]

We all need to strive to establish a standard protocol; too much confusion at present.

[Bushviper]

Agreed. Lets ask a puff adder, cause nobody else seems to know for sure.

[Bushbaby]

If there is any "specialist" who would like to research the various protocols available, please could you volunteer to do so for the 3 (main groups/ recognised) types of venom.

[Nasicornis]

Having someone doing research specifically on snake bite treatment protocols would be a great asset to the reptile community in SA.

Keeping calm in any snake bite situation remains the golden rule for me. Some people may say that this is easier said than done but I have found that having (at least) a general knowledge of the type of venom and what the symptoms are which can be expected to develop helps a hell of a lot towards staying calm / or keeping the victim calm. I have found that selectively describing the possible symptoms to the victim before some of them actually start to appear helps in that the person is not surprised about them as if he/she had not expected them, it also seems to help the victim have much more faith and trust in your abilities to assist.

P.s. NEVER describe in too much detail as I once heard someone tell a victim bitten by a puff adder that the major cause of death is the body going into shock. Obviously that did not help the situation at all.