SNAKE BITES

Dr Tariq Jagnarine
Fam Med, Endocrinology/Diabetes

Snake bites are a serious concern in Guyana, particularly in rural areas where access to healthcare and antivenom can be limited. The World Health Organisation (WHO) says that snakebites cause around 2.7 million cases of poisoning and between 81,000 and 138,000 worldwide deaths each year.
In Guyana, the Labaria species accounts for approximately 90% of venomous snake bites, and timely access to antivenom is crucial for preventing serious complications and death.
* High Incidence:
Guyana experiences a significant number of snakebites, particularly in areas with high agricultural activity and proximity to snake habitats.
A bite from a venomous snake is rarely deadly, but it should always be treated as a medical emergency. Even a bite from a harmless snake can be serious, leading to an allergic reaction or an infection. Venomous snake bites can produce an array of symptoms, including localised pain and swelling, convulsions, nausea, and even paralysis.
First aid steps persons can take after a snake bite occurs include cleaning the wound, remaining calm, and immobilising the affected area. However, it’s essential to get to a medical facility immediately for emergency treatment. If treated in time, the outlook for recovery is good.
IDENTIFYING VENOMOUS SNAKES
In Guyana, some of the venomous snake species include the coral snake, bushmaster, rattlesnake, and the labaria (also known as Fer-de-lance). The Eastern Tiger Snake and King Cobra are also mentioned, though their presence in Guyana may be less common.
* Coral Snake:
This is a neurotoxic species known for its bright bands of red, yellow, and black.
* Bushmaster:
This is one of the largest snakes in the world and possesses a potent venom.
* Rattlesnake:
The Guiana Rattlesnake is found in coastal savannas and beaches, and while bites are rare, it has a potent neurotoxic venom.
* Labaria (Fer-de-Lance):
This snake is known for its hemotoxic venom and is found in various tropical environments.
* Other Venomous Species:
The Eastern Tiger Snake and King Cobra are not specifically mentioned as being native to Guyana, but they are known venomous species.
If you are unfamiliar with the different types of snakes and unable to distinguish between venomous and non-venomous ones, it can be difficult to know how to respond in the event of a bite. Always treat a snake bite as if it’s venomous.
To identify a snake bite, consider the following general symptoms:
* Two puncture wounds
* Swelling and redness around the wounds
* Pain at the bite site
* Difficulty breathing
* Vomiting and nausea
* Blurred vision
* Sweating and salivating
* Numbness in the face and limbs
Some venomous snakes also cause symptoms specific to their type.
* Rattlesnakes
Rattlesnakes are easily identifiable. They have rings at the end of their tails that shake when they feel threatened. This makes a rattling sound and is a warning for you to back away. Rattlesnakes are the largest of the venomous snakes and account for many of the venomous bites in Guyana each year. These snakes can be found in nearly any habitat across the country. They like open areas where they can rest in the sun, such as rocks and logs.
Symptoms
Symptoms specific to rattlesnake bites are immediate and include:
* Severe pain
* Drooping eyelids
* Low blood pressure
* Thirst
* Tiredness or muscle weakness

* Labaria
Labaria snake bites, caused by Bothrops atrox (Common Lancehead), can lead to a range of symptoms, from localised pain and swelling to systemic complications. Key symptoms include severe pain, swelling, bruising, bleeding, blistering, and possible necrosis. Additional signs may include nausea, vomiting, numbness, loss of consciousness, and soft-tissue infections. Systemic effects, such as impaired clotting, can also occur.
* Coral snakes
Coral snakes have black, yellow, and red banding and are often confused with non-venomous king snakes. Persons can distinguish a coral snake by the fact that the red bands touch the yellow bands. They live in the woods, marshes, and sandy areas of the South. Coral snakes typically hide underground and in leaf piles.
Symptoms
Symptoms specific to coral snake bites include:
* Pain that is not immediate
* Symptoms that set-in hours after the bite
* Convulsions
* Drooping eyelids
* Change in skin colour
* Stomach pain
* Difficulty swallowing
* Headache
* Shock
* Paralysis

FIRST AID FOR SNAKE BITES
Should you be bitten by a snake, it’s essential to get emergency treatment as quickly as possible. However, there are some tips that you should also keep in mind:
* Call for help or 911 immediately.
* Note the time of the bite.
* Keep calm and still, as movement can cause the venom to travel more quickly through the body.
* Remove constricting clothing or jewellery because the area surrounding the bite will likely swell.
* Don’t allow the victim to walk. Carry or transport them by vehicle.
* Do not kill or handle the snake. Take a picture if you can, but don’t waste time hunting it down.

FIRST AID MYTHS
There are also several outdated first aid techniques that are now believed to be unhelpful or even harmful:
* Do not use a tourniquet.
* Do not cut into the snakebite.
* Do not use a cold compress on the bite.
* Do not give the person any medications unless directed by a doctor.
* Do not raise the area of the bite above the victim’s heart.
* Do not attempt to suck the venom out by mouth.
* Do not use a pump suction device. These devices were formerly recommended for pumping out snake venom, but it’s now believed that they are more likely to do harm than good.

TREATMENT FOR SNAKE BITES
The most important thing to do for a snake bite is to get emergency medical help as soon as possible. A doctor will evaluate the victim to decide on a specific course of treatment. In some cases, a bite from a venomous snake is not life-threatening. The severity depends on the location of the bite and the age and health of the victim. If the bite is not serious, the doctor may simply clean the wound and give the victim a tetanus vaccine.
If the situation is life-threatening, the doctor may administer antivenom. This is a substance created with snake venom to counter the snake bite symptoms. It’s injected into the victim. The sooner the antivenom is used, the more effective it will be.
For a non-venomous snake bite, the outlook is excellent if the wound is cleaned and treated promptly. For a venomous bite, the outlook is good if the victim receives emergency care very soon after the bite has occurred. Healthy adults with shallow bites have a better outlook than children and those with weakened immune systems who have received deep bites.

PREVENTION OF SNAKE BITES
Snake bites can be prevented in many cases. It’s best to refrain from approaching or handling snakes in the wild. Avoid typical places where snakes like to hide, such as patches of tall grass, piled leaves, and rock and woodpiles. If you encounter a snake, give it space to retreat and let it take cover. It’s in the snake’s nature to avoid interaction.
When working outside where snakes may be present, wear tall boots, long pants, and leather gloves. Avoid working outside during the night and in warmer weather, which is when snakes are most active.