Snakebite
India records more snakebite deaths than any country on earth, and most are preventable. Antivenom in a hospital is the only treatment. Everything done at the roadside is about not making it worse.
When to call an ambulance immediately
- Drooping eyelids, double vision, slurred speech or difficulty swallowing, which suggests neurotoxic envenoming
- Bleeding from the gums, nose, or the bite site that will not stop
- Rapidly spreading swelling, severe pain, or blackening of the skin
- Passing dark brown or red urine
- Difficulty breathing, drowsiness, or collapse
- Any bite from a snake seen to be a cobra, krait, Russell's viper or saw-scaled viper
What to do
Work through these in order. If you are alone, put your phone on speaker so the 108 call handler can guide you while your hands stay free.
- 1
Move away from the snake and keep calm
Step back out of striking range. Panic and exertion speed venom through the body. Reassure the person continuously, because most bites, even from venomous snakes, are survivable when treated properly.
- 2
Keep the person still, especially the bitten limb
Lay them down and stop them walking. Immobilise the bitten limb with a splint exactly as you would for a fracture, and keep it at or slightly below the level of the heart. Movement pumps venom into the circulation.
- 3
Remove rings, bangles, watches and anklets immediately
Swelling can become severe and fast. Anything constricting must come off in the first minutes, before it becomes impossible.
- 4
Get to hospital with antivenom, fast
Call 108. Ask specifically for a hospital that stocks polyvalent anti-snake venom, because not every facility does. Carry the person rather than letting them walk.
- 5
Note the time and watch the symptoms
Record when the bite happened and note any new symptom and when it appeared. Mark the leading edge of the swelling on the skin with a pen and time it, so the hospital can see how quickly it is progressing.
- 6
Remember the snake, do not chase it
A description or a photograph taken from a safe distance is helpful. Never try to catch or kill the snake. A large share of second bites happen to people attempting exactly that, and a severed head can still envenomate by reflex for up to an hour.
- 7
Be ready to support breathing
Krait and cobra bites can paralyse the breathing muscles while the person remains conscious. If breathing becomes weak or stops, begin rescue breaths or CPR and keep going. This is a bridge to hospital, and people have survived hours of it.
Never do these
Most of these are well-intentioned and widely believed. All of them make the situation worse.
- Never apply a tourniquet or tie a tight cloth. It does not stop venom, it concentrates it, and it causes limb loss. This single practice is responsible for an enormous amount of preventable amputation in India.
- Never cut the wound, and never try to suck out the venom, by mouth or with any device. It does not work and it introduces infection.
- Never apply ice, chilli, herbal pastes, kerosene, cow dung or a snake stone.
- Never give alcohol, aspirin or sedatives.
- Never take the person to a traditional healer, a temple, or a village practitioner first. Delay is the commonest cause of snakebite death in this country, and antivenom is the only thing that reverses envenoming.
- Never assume a painless bite means a harmless one. Krait bites are famously almost painless, often happen during sleep, and can be fatal.
Once the immediate danger has passed
- Even if the person looks well, they need at least twenty-four hours of hospital observation. Symptoms from a krait or Russell's viper bite can be delayed by many hours.
- Dry bites, where no venom is injected, are common, but that can only be established by observation in hospital, not at the scene.
- Ask about tetanus cover once antivenom decisions have been made.
Frequently asked
The bite barely hurt. Can we wait and watch at home?
No. Krait bites are typically painless with minimal local swelling, frequently occur at night while sleeping on the floor, and then cause progressive paralysis hours later. A painless bite is not a reassuring bite.
Should we use a pressure immobilisation bandage?
Indian national guidance favours simple splinting and rapid transport over pressure bandaging, because badly applied pressure bandages behave like tourniquets. Immobilise, do not constrict.
How do we prevent bites at home?
Sleep on a cot rather than the floor, use a mosquito net tucked in under the mattress, carry a torch when walking after dark, wear closed shoes in fields, and keep the area around the house clear of rubble and rodent food.
Reviewed and written by
Dr. Poonam Sekhon Chahal, MBBS, MEM
Senior Emergency Physician, Manipal Hospital, Patiala · Certified in ACLS, ATLS, PALS and PoCUS