You’ve been bitten by a snake … now what?

It’s crossed everyone’s mind that has ever ventured into the more rural areas of Australia. You are there enjoying the view, but suddenly you feel a sharp, excruciating pain, look down and see a snake slithering away. Thought’s suddenly flash through your head. How worried should you be? Are you going to die? What should you do? What will happen if you ever make it to hospital? What is antivenom? These are all answers you want to know because it may well be the difference from life and death.

So, dear reader how worried should you be of dying of a snake bite? Well in Australia there has been on average 2 deaths each year between  2000 and 2016 [1]. That means that there is a 0.00013 % chance that your inevitable demise will come from the contents of a snake’s fangs.

Ok let’s just say you have been bitten by a snake, what symptoms should you expect? Well in order to make assessment of symptoms by doctors easier there is a four grade system used to describe different levels of envenomation[2]. A grade 1 bite is where no envenomation occurs, colloquially known as a ‘dry bite’. A dry bite can never be 100% confirmed but is usually suspected when a patient receives a bite from a known venomous snake but presents no symptoms. Now you would probably think in these cases antivenom would be given as a precaution, but this in not actually the case. Anti- venom is used sparingly for two main reasons, the first being that the supply is scarce for reasons that will be discussed later and the more drastic reason is that anti-venoms can actually make a patient really sick through an anaphylactic, or really severe allergic, reaction. This is often known as serum sickness[3] and this can lead to symptoms such as a bad rash and muscle weakness but like all anaphylaxis can potentially be fatal. This can turn 12 – 24 hours of hospital observations for a dry bite to a 2 week stay[4]. A grade 2 is known as a mild envenomation and is where there is swelling and pain in the area around the bite. A grade 3 or moderate envenomation encompasses a spread of swelling beyond the limb or body segment of the bite site and severe local and systematic pain. The highest grade, a grade 4, is known as a severe envenomation. Symptoms that should be expected are severe bleeding from the bite site or any other recent breaks on the skin, intense swelling all over the body and really dark urine caused by kidney failure [5].

Now you know what to expect, but what should you do immediately after receiving a bite? The first thing to remember is not to panic, it may be easier said than done but this will only make the situation much worse. Traditionally a tourniquet was thought to be the best option as it stopped blood from flowing further into the body, whilst this is true, it can also cause many more problems than it solves. First worry of course is that cells in the affected limb my die if they do not receive blood for an extended period. A second worry is the risk of infection of the wound site that can lead to septic shock [6]. Current guidelines for the first aid of a snake bite is the use of a pressure immobilisation bandage[7]. This technique involves wrapping a compression bandage around the affected limb (the assumption is that a bite has occurred on a limb which almost all do. If you are bitten on the trunk you are in huge trouble.) starting at the digits, leaving them exposed to monitor blood flow, and wrapping all the way to either the armpit or bottom of the pelvis. This should not be too tight that the fingers or dose start to become discoloured but should be tight enough to compress that skin around the bite site. It is also important not to wash the bite site or suck the venom out as the venom from the site will be used at the hospital in order to identify the snake [8]. It is also a very good idea to minimise the movement of the affected limb by using a splint and minimising the amount of movement the victim has to do as not to spread the venom through the lymphatic system.

Below is a video with some St John’s Ambulance officers explaining to the Sunrise crew what first aid techniques to perform in a situation where either yourself or someone else has been bitten by a snake.

 

The final step know is the anti-venom. You are probably expected this anti venom to be made in a sterile lab by people in lab coats, but what might surprise you is that this anti venom is actually made by the immune system of a horse. Horses are used thanks to their immune system being very similar to ours. Also, due to their larger body mass than us can be introduced to a dose snake venom that would likely kill a human and show very little symptoms. The horse immune system produces antibodies to fight the compounds in snake venom, these are then isolated and injected into the unlucky person who was bitten by a venomous snake [9]. The main issues of antivenom’s are serum sickness as previously mentioned and the scarcity of available anti venoms. The production of anti-venom is  a very inefficient process, as first a venomous snake needs to be caught, kept in captivity to be ‘milked’ and then this venom needs to be injected into a horse in order to finally isolate the specific antibodies. Overall this makes antivenoms quite expensive [10].

The point of this blog post is not to scare you about what can happen with possible encounters with snakes but rather reassure you that you will probably be fine and help you make good choices in order to give yourself the best chance of survival.

 

  1. Welton, R.E., D. Liew, and G. Braitberg, Incidence of fatal snake bite in Australia: A coronial based retrospective study (2000–2016). Toxicon, 2017. 131: p. 11-15.
  2. Naik, B.S., “Dry bite” in venomous snakes: A review. Toxicon, 2017. 133: p. 63-67.
  3. Ryan, N.M., M.A. Downes, and G.K. Isbister, Clinical features of serum sickness after Australian snake antivenom. Toxicon, 2015. 108: p. 181-183.
  4. de Silva, H.A., et al., Low-Dose Adrenaline, Promethazine, and Hydrocortisone in the Prevention of Acute Adverse Reactions to Antivenom following Snakebite: A Randomised, Double-Blind, Placebo-Controlled Trial. PLOS Medicine, 2011. 8(5): p. e1000435.
  5. Wüster, W., Venomous snake systematics: implications for snakebite treatment and toxinology. Toxicon, 1996. 34(2): p. 143.
  6. Yanamandra, U. and S. Yanamandra, Traditional first aid in a case of snake bite: more harm than good. BMJ Case Reports, 2014. 2014: p. bcr2013202891.
  7. Stewart, C.J., Snake bite in Australia: first aid and envenomation management. Accident and Emergency Nursing, 2003. 11(2): p. 106-111.
  8. Sutherland, S.K., Venomous creatures of Australia. A consideration of the animals, their potential lethality to man and mode of action of their toxins. Toxicon, 1983. 21: p. 433.
  9. Fernandes, I., H.A. Takehara, and I. Mota, Isolation of IgGT from hyperimmune horse anti-snake venom serum: Its protective ability. Toxicon, 1991. 29(11): p. 1373-1379.
  10. Pandey, D.P., et al., A season of snakebite envenomation: presentation patterns, timing of care, anti-venom use, and case fatality rates from a hospital of southcentral Nepal. Journal of Venom Research, 2016. 7: p. 1-9.

 

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  • Like some other comments have mentioned, I feel like it would be a good idea to define certain terms that may not be universally understood. Otherwise it is a good read and it has a logical flow to it.

  • strengths:
    1. Good Title
    2. Great flow of content
    3. written for a general audience
    4. engages with the reader

    Weaknesses:
    1. No layout
    2. use of colour is missing
    3. no pictures or diagrams to connect with the content
    4. grammatical errors
    5. explanation of scientific words is missing

  • Content was interesting and was engaging. The flow of information was excellent. This sentence: ‘Also, due to their larger body mass than us can be introduced to a dose snake venom that would likely kill a human and show very little symptoms’ didn’t make sense to me when I first read it- maybe just reword it or correct it so that it makes sense. Great job overall!

  • The content you have provided have some flow but however you need to really reword the language you have used such as the contractions especially in the first sentence- It’s to ‘It is’ and instead of writing thought’s it should be ‘thoughts’. Also, try adding more images to your article to balance the white background and black text.

  • Great flow of content, however but I would recommend breaking up some of that content up into smaller paragraphs. Use diagrams to help with your explanation and remember to do a second check for spelling/grammatical errors. Best of luck!

  • Some grammatical errors that could be fixed. Consider adding some images to better explain your points. Well done!

  • Great flow to your writing here. I’ve seen it mentioned before, but an explanation of those scientific words here and there would definitely make this piece more consistent. An easy way to accomplish this may be to add pictures that include descriptions of these concepts. Looking forward to the final layout.

  • Very creative writing style! very easy to understand. The layout could do with a makeover but the content is wonderful

  • It was a good blog, easy to read and understand but the layout design is plain, it would be better with some colour and photos.

  • Great read, engaging title, and the content keeps the reader interested. There is a good flow of ideas and is not overly complicated. I’d suggest for the final to read over it and fix up grammar errors and perhaps add some useful images. Also, i’d suggest to add a bit of colour in maybe a banner at the top of the page or some columns on the side.

  • Really good draft, engaging and keeps the reader intrigued. Once you fix up the grammar / spelling and add some diagrams / images to break up the wall of text it’ll flow really well.

  • Writing is really good, informative but still easy to understand. Make sure you add a few pictures to break up the huge block of text in your final blog and you’re all set!

  • Great writing style that engages with the audience well. Good explanation of concepts. Once images and figures are added, will be a great blog.

  • Liked the title very much! Some spelling errors though but the information is very interesting!

  • In the first section where you describe grades of envenomation, maybe put this into some kind of dot point or table format so its less to read and more spaced out visually.
    Is the dark urine actually caused by kidney failure or is something else responsible – I suggest you look this up and go over it again.
    A key point to include is WHY the pressure immobilization technique is used instead of a tourniquet – i.e. where does the venom travel before it reaches the circulation.
    Good referencing, adding some images and diagrams would be good.

    Cheers,
    Carly

  • -Engaging Introduction
    -There are some grammatical errors and spelling mistakes, wrong use of words in some areas. e.g. ‘Know you Know’ in the 4th paragraph or ‘expected’ instead of expecting in the 5th paragraph
    -Info is good, all it needs is some good grammar and spelling and some images plus layout for the final. 🙂

  • Great use of Language, make sure to add pictures and diagrams for your final submission. Remember to reduce the scientific jargon used in your explanations. Remember to explain why a pressure bandage is used in contrast to a tourniquet. Maybe also explain how venom travels via the lymphatic system and the rate of venom throughout the body and what affects the venom has on the human body, What systems it attacks etc.

  • It is a good blog is the sense that is written for the general audience and it keeps the reader engaged but most blogs also have pictures or links. Part of the marks does go towards making it look like a blog on a website, so it would be good to invest some time in that.

  • Great title, well researched and written, presentation is easy to read, but visuals would improve it.

  • The title is very catchy and content is really engaging. It would be more engaging and fun to read if there would be some images. It would also be good to explain some of scientific jargons. Great job!

  • easy to read and understand, engaging and I think you did a good research. but maybe a brief explanation for some scientific jargons that you’ve got is useful for the laypeople to understand. and more importantly, don’t forget to include images that could explain the first aids visually which will make it easier to understand. but overall I think you’ve done a good job explaining and answering the questions of your topic.

  • – written well as the questioning makes the reader continue to read,
    – there are some scientific jargon which are not explained eg anaphylactic reaction,systematic pain,septic shock, trunk
    – try rewarding this sentence as its confusing I had to read it more than 2 or 3 times to understand what you are trying to say “The highest grade, a grade 4, is known as a severe envenomation and symptoms that should be expected are severe bleeding from the bite site or any other recent breaks on the skin, intense swelling all over the body and really dark urine caused by kidney failure [5].”,
    -i assume you are trying to say “NOW” You Know rather than “Know you know what to expect”
    -an image of immobilization technique would be great so the reader can also visualize what has to be done, also try rewarding the last bit of this sentence and simplify it as a reader wouldn’t know how u got from dark urine to kidney failure “pressure immobilization bandage, , This technique involves wrapping a compression bandage around the affected limb (the assumption is that a bite has occurred on a limb which almost all do”

    – try to use another word rather than using minimise twice “to minimise the movement of the affected limb by using a splint and minimising”

    -grammar> “The final step know is the anti-venom”

    overall great work explained in an engaging way!!

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