W­HAT TO DO

Be ca­re­ful out the­re…

SA Jagter Hunter - - VOORBLAD - By PAUL DONOVAN

Alt­hough the chan­ces of being bit­ten by a sna­ke are re­la­ti­ve­ly small, the chan­ce is still the­re, and kno­wing w­hat to do w­hen a bi­te does hap­pen, can sa­ve a li­fe. It is im­por­tant to re­mem­ber though, that de­at­hs from sna­ke bi­tes are re­la­ti­ve­ly few w­hen com­pa­red to de­at­hs by ot­her cre­a­tu­res, for ex­am­ple such as the in­fa­mous mosqui­to.

With the ad­vent of re­li­a­ble an­ti­venom, mo­re con­structi­ve first aid techni­ques, and ad­van­ced me­di­cal ca­re, a bi­te no­wa­days is sur­vi­va­ble. And of cour­se, don’t au­to­ma­ti­cal­ly as­su­me that the sna­ke that bit you was veno­mous. The­re are mo­re non-veno­mous sna­kes out the­re than the­re are veno­mous on­es. It may al­so be com­for­ting to know, that e­ven if bit­ten by a veno­mous sna­ke, no venom may ha­ve been in­jected. A sna­ke has con­t­rol o­ver its venom sy­stem, and can de­li­ver w­hat is com­mon­ly cal­led a ‘dry bi­te’. PREVENTING A BI­TE

As the saying g­oes “pre­ven­ti­on is bet­ter than cu­re”, and the­re are a num­ber of t­hings you can do to de­cre­a­se your chan­ces of being bit­ten: 1. If you spot a sna­ke, le­a­ve it al­o­ne, and re­main still. By na­tu­re sna­kes will a­void hu­mans if at all pos­si­ble. Just let it go a­bout its bu­si­ness. Sna­kes re­spond to mo­vement, so if you re­main still t­hey do not per­cei­ve you as a thre­at. It is on­ly w­hen you mo­ve that t­hey will stri­ke. Be a­wa­re that so­me sna­kes feign de­ath w­hen an­ta­go­ni­sed, on­ly to bi­te the in­qui­si­ti­ve hand which at­tempts to pick them up. Oh, and a veno­mous sna­ke that is ac­tu­al­ly de­ad can still in­flict a fa­tal bi­te should you prick a fin­ger on one of its fangs. So, de­ad or a­li­ve le­a­ve well al­o­ne! 2. A­void step­ping o­ver logs or rocks if you can­not see w­he­re you are a­bout to pla­ce your foot, be­cau­se the­re could be a sna­ke shel­te­ring the­re. Inste­ad stand on top of the log or rock and ta­ke a big stri­de for­ward to cle­ar it. It is of­ten said, if you are in a group, it is the se­cond or thi­rd per­son who is most li­ke­ly to be bit­ten, be­cau­se the first alerts the sna­ke and the se­cond or thi­rd feels the wrath of its an­noy­an­ce, so be a­wa­re of your sur­roun­dings at all ti­mes. 3. W­hen crou­ching do­wn, look to see w­he­re your

knees are going to land. I know of a hunter who

knelt on a puff ad­der he didn’t see hid­den in the grass. And a puff ad­der is a nas­ty sna­ke to be bit­ten by; t­hey are re­spon­si­ble for a­round 80% of all sna­ke bi­tes in A­fri­ca. 4. If cam­ping, we­ar sen­si­ble shoes a­round camp and be ca­re­ful w­hen picking up fi­re­wood. 5. W­hen ans­we­ring the call of na­tu­re, wa­tch w­he­re you re­lie­ve your­self. Ma­ke su­re if you ha­ve to squat do­wn that you are not going to do a­ny­thing on a sna­ke that it would ta­ke ex­cep­ti­on to. I know a la­dy who was bit­ten on the back­si­de un­der such ci­r­cum­stan­ces; for­tu­na­te­ly it was by a harm­less sna­ke.

WAS IT VENO­MOUS OR NOT?

If the un­for­tu­na­te does hap­pen and you are bit­ten by a sna­ke, it is im­por­tant to de­ter­mi­ne w­het­her it was veno­mous or not. If you did not see the sna­ke, this can be do­ne by look­ing at the im­print of the bi­te mark. A bi­te from a veno­mous sna­ke will ge­ne­ral­ly le­a­ve two qui­te dis­tinct punc­tu­re marks; as though so­meo­ne had stab­bed you with knit­ting need­les. A non-veno­mous sna­ke will le­a­ve two cres­cent-shaped marks with nu­me­rous ‘pin-pricks’.

DIDITACTUALLYINJECTANYVENOM?

Sna­kes pri­ma­ri­ly use their venom to kill prey but al­so as a de­fen­ce me­cha­nism, so do not wan­ton­ly was­te it. As I ha­ve men­ti­o­ned al­re­a­dy, a veno­mous sna­ke has con­t­rol o­ver the a­mount of venom t­hey in­ject in­to their prey/victim and can in­sti­ga­te a dry bi­te. This may be the re­a­son why ma­ny so-cal­led na­tu­ral re­me­dies are ap­pa­rent­ly ef­fecti­ve in cu­ring sna­ke bi­tes; the sna­ke either did not in­ject any venom, or it was sim­ply a harm­less s­pe­cies.

SIGNS AND SYMP­TOMS

Be­fo­re be­gin­ning any form of tre­at­ment, sit the victim do­wn and wait calm­ly to see w­hat symp­toms, if any, de­ve­lop. If the­re are no symp­toms af­ter 15 to 20 mi­nu­tes, you can be pret­ty su­re it was either a dry bi­te or a harm­less sna­ke. That being said, the one ex­cep­ti­on is the boom­slang ( Dis­p­ho­li­dus ty­pus). Symp­toms from this sna­ke’s bi­te may ta­ke 24 hours to de­ve­lop. But to be bit­ten by a boom­slang, you would ha­ve had to been up a tree and very un­lucky.

With neu­ro­tox­ic sna­kes (co­bras, mam­bas, etc.) the bi­te it­self is not pain­ful but a gra­du­al ting­ling sen­sa­ti­on mo­ving up­wards from the bi­te wound and pro­gres­si­ve pa­ra­ly­sis will de­ve­lop. This le­ads to dif­fi­cul­ty in swal­lo­wing, slur­red speech, gid­di­ness and droo­p­ing ey­e­lids. De­ath is due to pa­ra­ly­sis of the di­aphragm that ma­kes it dif­fi­cult to bre­at­he.

Vi­per bi­tes (puff ad­ders, etc.) are ex­tre­me­ly pain­ful. The bi­te marks ooze b­lood and are ac­com­pa­nied by swel­ling that spre­ads ra­pid­ly up the bit­ten limb. B­leeding in ot­her re­gi­ons of the bo­dy such as the gums and nos­trils is not un­com­mon, fol­lo­wed by nau­sea and vo­mi­ting. The bit­ten limb will al­so ta­ke on a brui­sed ap­pea­ran­ce with signs of blis­te­ring. An e­le­va­ted he­art ra­te may be de­tected which, if the victim is in poor he­alth or frail, may le­ad to a he­art at­tack. B­lood may al­so be pre­sent in the u­ri­ne.

W­HAT SHOULD I DO?

Keep an eye out for signs of shock. In­di­vi­du­als bit­ten by non­veno­mous sna­kes ha­ve been kno­wn to die as a con­se­quen­ce of shock on the as­sump­ti­on that t­hey had been bit­ten by a veno­mous sna­ke. So, re­as­su­ring the victim and keeping him as calm as pos­si­ble play an im­por­tant ro­le in his sur­vi­val. Re­mo­ve wa­t­ches, rings and any ot­her con­stricting i­tems. If symp­toms do fol­low a bi­te, first aid tre­at­ment is ex­tre­me­ly ef­fecti­ve.

Ho­we­ver, be­fo­re I co­ver tho­se, sna­ke­bi­te tre­at­ments are full of myt­hs. So, he­re is w­hat you should NOT do: »

» DO NOT CUT AND SUCK THE BI­TE The ti­me-ho­nou­red pro­ce­du­re of cut­ting and sucking the bi­te is ex­tre­me­ly dan­ge­rous, and a lot of me­di­cal stu­dies ha­ve cast doubt on its ef­fecti­ve­ness a­ny­way. And, of cour­se, the per­son doing the sucking runs the risk of ex­po­su­re to in­fecti­ous b­lood di­se­a­ses. DO NOT USE A TOU­R­NI­QUET

The i­dea be­hind tying a tou­r­ni­quet tig­ht­ly a­round the bit­ten limb is to li­mit the spre­ad of venom. Ho­we­ver, un­der nor­mal ci­r­cum­stan­ces you should NOT use it as a sna­ke bi­te tre­at­ment. At the out­set, the tou­r­ni­quet mig­ht seem ef­fecti­ve in ‘con­tai­ning’ the venom in one a­rea but you risk cut­ting off b­lood flow, star­ving the limb of oxy­gen thus kil­ling it. The­re is al­so the risk of tox­ic shock syn­dro­me, w­he­re­by, as the limb be­gins to bre­ak do­wn, tox­ins are re­le­a­sed in­to the bo­dy as soon as the tou­r­ni­quet is loo­se­ned. The me­di­cal con­sen­sus is, don’t do it.

DO NOT USE SUCTI­ON

The­re are ma­ny sucti­on kits on the mar­ket which, w­hen pla­ced o­ver the bit­ten a­rea, are said to draw the venom out. A­gain, re­se­arch has sho­wn that the­se kits ha­ve litt­le, if any, ef­fect in re­mo­ving venom from the bit­ten a­rea, and can ac­tu­al­ly cau­se tis­sue da­ma­ge.

DO NOT USE POT­ASSI­UM

I ha­ve he­ard of pe­op­le tip­ping pot­assi­um per­man­ga­na­te on the bi­te and then ig­ni­ting it in the be­lief that it will neu­tra­li­se the venom. Ho­we­ver, the on­ly thing it will do is cau­se a se­ri­ous burn!

DO NOT PLA­CE ICE OR A COLD PACK ON THE BI­TE

This has no ef­fect on b­re­a­king do­wn the venom, and may ac­tu­al­ly ma­ke the bi­te a­rea wor­se.

W­HAT CAN YOU DO? THE BE­ST FIRST AID PRO­CE­DU­RE

The most ef­fecti­ve first aid tre­at­ment is the ap­pli­ca­ti­on of a pres­su­re/im­mo­bi­li­sa­ti­on bandage. So­me re­se­arch que­s­ti­on its ef­fecti­ve­ness, but I must point out a pres­su­re bandage is not a tou­r­ni­quet and will not stop b­lood flow. Inste­ad it com­pres­ses the lymph sy­stem (which ta­kes up the venom first be­fo­re it en­ters the b­lood sy­stem) the­re­fo­re les­sen­ing the spre­ad of it through the bo­dy. Ho­we­ver ta­ke no­te that this tre­at­ment is on­ly ef­fecti­ve for e­la­pid bi­tes (co­bras, mam­bas, etc.). Do not use it for vi­per (puff ad­der, etc.) or Mo­zam­bi­que spit­ting co­bra bi­tes, be­cau­se a si­de-ef­fect of the­se sna­kes’ venom is tis­sue swel­ling and to pla­ce a con­stricti­ve bandage on a swel­ling limb will on­ly re­sult in e­ven mo­re se­ri­ous tis­sue da­ma­ge.

Ap­ply the pres­su­re bandage (or im­pro­vi­se with strips of clo­thing) to the si­te of the bi­te, and wind it up­wards to­wards the arm­pit or groin (or as high as pos­si­ble). Re­mem­ber, a pres­su­re bandage is NOT a tou­r­ni­quet and the pres­su­re should be si­mi­lar to that of s­trap­ping a sprai­ned an­kle. To check that it is not too tig­ht, test for an ar­te­ri­al pul­se a­bo­ve and be­low the bandage. Keep the limb as im­mo­bi­le as pos­si­ble at all ti­mes. Bandage an arm in a bent po­si­ti­on so as to al­low a splint to be ap­p­lied to the fo­re­arm which can then be pla­ced in a sling. The leg should al­so be splin­ted. For­get a­bout trying to re­mo­ve clo­thing, bandage o­ver the­se, ti­me is of the es­sen­ce.

W­he­re dif­fi­cul­ty in bre­a­thing occurs, ad­mi­nis­ter ar­ti­fi­ci­al res- pi­ra­ti­on. Don’t for­get, the venom from e­la­pid sna­kes (mam­bas and co­bras) will cau­se pa­ra­ly­sis of the di­aphragm so the victim will ex­pe­rien­ce dif­fi­cul­ty in bre­a­thing.

W­HAT A­BOUT FIRST AID FOR VI­PER BI­TES?

Un­for­tu­na­te­ly if you are in a re­mo­te a­rea and ha­ve to de­al with a vi­per bi­te (the venom works by b­re­a­king do­wn tis­sue) the­re is litt­le you can do ot­her than to co­ver the wound with a loo­se, ste­ri­le bandage and keeping the victim calm whi­le get­ting him to a me­di­cal fa­ci­li­ty as soon as pos­si­ble. Con­tra­ry to mis­con­cep­ti­ons you won’t drop de­ad straig­ht a­way. De­pen­ding on w­he­re you we­re bit­ten and the a­mount of venom in­jected, you will ha­ve mo­re than e­nough ti­me to seek me­di­cal at­ten­ti­on. If you are on your own, walk out slo­w­ly but if you are with ot­hers ha­ve them car­ry you. Alt­hough venom is first ta­ken up in­to the lymph sy­stem, you need to li­mit its mo­vement a­round the bo­dy by li­mi­ting phy­si­cal mo­vement which will e­le­va­te the he­art ra­te.

TRE­AT­MENT OF VENOM IN THE EY­ES

Re­cei­ving a do­se of venom to the ey­es from a spit­ting co­bra is ex­tre­me­ly pain­ful and I speak from ex­pe­rien­ce. The ey­es should im­me­di­a­te­ly be flus­hed with any cool li­quid at hand; wa­ter, milk, co­la, beer, cold tea, e­ven u­ri­ne can be u­sed. A­void the temp­ta­ti­on to rub the ey­es as this can rub the venom in­to the ey­e­ball w­he­re it will cau­se mo­re se­ri­ous pro­blems such as ul­ce­ra­ti­on. And should you bre­ak a ca­pil­la­ry it could en­ter the b­lood sy­stem and ma­ni­fest as though you had been bit­ten by the sna­ke.

The victim should then be pla­ced in the shade with a cold com­press co­ve­ring his ey­es as t­hey will be ex­tre­me­ly sen­si­ti­ve to sun­lig­ht. Alt­hough the ey­e­lids will be­co­me red, swol­len and dif­fi­cult to o­pen, t­hey will re­turn to nor­mal within 24 hours pro­vi­ding that the venom has been flus­hed out. For sa­fe­ty re­a­sons, a me­di­cal check-up should be soug­ht.

U­SING AN­TI­VENOM

Alt­hough com­mer­ci­al o­ver-the­coun­ter sna­ke­bi­te kits are a­vai­la­ble at phar­ma­cies, ad­mi­nis­te­ring an­ti­venom is ex­tre­me­ly ha­zar­dous. An al­ler­gic re­acti­on le­a­ding to a­nap­hy­lactic shock is a very re­al pos­si­bi­li­ty. Most sna­ke­bi­te kits con­tain a po­ly­va­lent an­ti­venom which co­vers a ran­ge of s­pe­cies. Un­less you are in the dee­pest dept­hs of A­fri­ca, days a­way from a hos­pi­tal, and are su­re it was a veno­mous sna­ke re­spon­si­ble for the bi­te, le­a­ve an­ti­venom tre­at­ment to pro­per­ly trai­ned me­di­cal staff.

TAIL-END

Alt­hough a sna­ke­bi­te is a frig­h­te­ning ex­pe­rien­ce (I can at­test to that, ha­ving been bit­ten on­ce by a puff ad­der), it is com­for­ting to know that with pro­per first aid and prompt me­di­cal tre­at­ment, the­re is a mo­re than good chan­ce of re­co­ve­ry. Though so­me dis­fi­gu­re­ment, or the odd fin­ger loss may re­sult from a vi­per bi­te.

A­BOUT THE AUT­HOR

Paul Donovan is an out­door acti­vi­ty in­struc­tor and bi­o­lo­gist li­ving in Botswa­na w­he­re he te­a­ches bushcraft and sur­vi­val techni­ques. * DISCLAIMER: Neither the aut­hor nor pu­blis­her are li­a­ble for da­ma­ge or in­ju­ry sus­tai­ned in u­sing any of the a­bo­ve practi­ces.

A bi­te from a co­bra, alt­hough po­ten­ti­al­ly let­hal, is less pain­ful than one from a vi­per.

The puff ad­der is an ex­tre­me­ly dan­ge­rous sna­ke re­spon­si­ble for ma­ny bi­tes.

Be ca­re­ful w­hen step­ping o­ver logs or rocks. A sna­ke may be hi­ding be­ne­ath it.

Vi­pers ha­ve long teeth and can in­ject venom deep in­to the muscle.

He­re are two puff ad­ders hid­den in the grass. This is why t­hey are e­a­si­ly trod­den on.

Ne­ver trust a bi­te from a boom­slang, its venom is slow acting.

Paul Donovan ad­mi­nis­te­ring first aid to him­self with the help of ot­hers af­ter being bit­ten by a puff ad­der.

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