National Guideline for Snake bite Management in Nepal 2019

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Recommended first aid treatment 

REASSURANCE

• The victim may be very frightened and anxious. Reassure victim that most of the suspected snakebite are caused by nonvenomous snakes. Reassure victim on that snakebite is a treatable condition.

IMMOBILIZATION

• Immobilize the bitten limb with a splint or sling. Any cloth or bandage may be used for this, as done for fracture limb. Any form of movement causing muscle contraction like walking, undressing will increase absorption and spread of venom by squeezing veins and lymphatics.
• Pressure immobilization (PIB) is believed to delay in spread of venom to systemic circulation and PIB method is commonly recommended by many experts in pre-hospital management. However, the pressure-immobilization technique demands special equipment and training and is not considered practicable for general use in Nepal. Searching for the material to apply pressure immobilization may cause delay in seeking much needed health care for treatment of envenoming.
• Moreover, envenoming by cobra and vipers snakes causes local tissue damage and localization of toxin by PIB may worsen tissue damage. n Pressure pad immobilization has been found to be useful in Myanmar. It’s applicability in Nepal is not known. n Remove rings, jewelries, tight fittings and clothing and avoid any interference with the bite wound to prevent infection, increase absorption of venom and increase local bleeding.

RAPID TRANSPORT

• The victim should be transported to the hospital where he can receive the medical care.
• The most common cause of death due to snakebite envenoming in Nepal is due to respiratory paralysis (and rarely shock due to bleeding from Russell’s viper envenoming). In one of the community- based study, 80% of the patient with envenoming died even before reaching snakebite treatment center or hospital. Rapid transport using motorcycle has been found to decrease mortality in Nepal. The victim is seated and held between driver and pillion rider.