Guidelines for the Management of Snake-bites
(2010; 162 pages)

It is clear that in many parts of the South East Asian region, snake-bite is an important medical emergency and cause of hospital admission... Most of the familiar methods for first-aid treatment of snake-bite, both western and “traditional/herbal”, have been found to result in more harm (risk) than good (benefit). Their use should be discouraged and they should never be allowed to delay the movement of the patient to medical care at the hospital or dispensary. Recommended first-aid methods emphasise reassurance, immobilisation of the whole patient and particularly the bitten limb and movement of the patient to a place where they can receive medical care as soon as possible...

Antivenom is the only effective antidote for snake venom. It is an essential element of treatment of systemic envenoming but may be insufficient on its own to save the patient’s life. Antivenom may be expensive and in short supply.

a. It is recommended that antivenom should be used only in patients in whom the benefits of treatment are considered to exceed the risks of antivenom reactions. Indications for antivenom include signs of systemic and/or severe local envenoming.

b. Skin/conjunctival hypersensitivity testing does not reliably predict early or late antivenom reactions and is not recommended.

c. It is recommended that whenever possible antivenom should be given by slow intravenous injection or infusion.

d. Epinephrine (adrenaline) should always be drawn up in readiness in case of an early anaphylactic antivenom reaction.

e. No method of preventing antivenom reactions has been proved effective, including prophylactic epinephrine/adrenaline...

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