Snakes can be divided into poisonous and non-poisonous. In fact, being bitten by a poisonous snake is very dangerous. There are about 50 kinds of poisonous snakes in China, including cobra, golden ring snake, silver ring snake, sea snake, Agkistrodon halys, bamboo leaf green, Agkistrodon acutus and so on. The most fundamental difference between poisonous snakes and non-poisonous snakes is that poisonous snakes have fangs and poisonous glands. Fangs are born on the maxilla in front, and there are tubules communicating with poisonous glands. Usually the big teeth are put back. When biting, fangs will stand up and stab people, release venom, and then circulate to other parts of the body with blood or lymph. The composition of snake venom is a complex mixture. Including protein, dermatophytes and enzymes, has obvious cytotoxicity, neurotoxicity, blood toxicity, cardiotoxicity and other toxic effects. The toxic components of various poisonous snakes are different, so the symptoms after being bitten by poisonous snakes are not exactly the same.
What are the symptoms of being bitten by a snake?
The severity of symptoms and the amount of venom, the location and depth of the bite and the human body's resistance to venom. Especially the mental state of the injured. This poisonous snake mainly bites hands and feet. There are two deep and large tooth marks at the wound, which are 1-2cm apart. The surrounding congestion and edema will turn black after a long time. After being bitten by a poisonous snake, there are usually conscious symptoms, such as dizziness, dizziness, chest tightness, palpitation, shortness of breath, fear of cold, fever, body aches and so on. The wound has severe symptoms of shock, pain, swelling and numbness. The surrounding tissues are hyperemia and edema, and rapidly expand to the proximal end, generally reaching the peak at 12 hours after injury, and can spread to the chest and abdomen, often with right lymphangitis and regional lymphadenopathy.
Because each poisonous snake contains different toxins, the symptoms after being bitten are different. Cell, blood and cardiotoxin show local swelling and severe pain caused by bite, which develops rapidly near the heart. Local blisters, blood blisters, tissue necrosis, wound bleeding, systemic bleeding or hemolysis, anemia, jaundice, hemoglobinuria, oliguria and anuria, dull heart sounds, arrhythmia, blood pressure drop, shortness of breath, cyanosis, shock and even death may occur. This kind of poisoning has a short incubation period and serious local symptoms, so it is easy to be paid attention to and treated during the dry period. Neurotoxin shows mild local symptoms, sometimes only local numbness, which is not easy to attract attention. Later, dizziness, lethargy, fatigue, dysphagia, hoarseness, slurred speech, muscle paralysis, quadriplegia, dyspnea, dilated pupils, incontinence, fever, convulsions, coma and even respiratory paralysis died. Among them, glossopharyngeal nerve paralysis is an early indication.
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How to treat a snake bite?
I. General local treatment
Immediately after the bite, the wound is ligated with a soft rope 2-3cm near the heart to prevent venous and lymphatic reflux, but it is relaxed every 1.5-20 minutes to prevent ischemic necrosis of the ligated distal limb. Immediately wash the wound with cold boiled water and strong brine, preferably with 5% disodium calcium edetate or 1:5000 potassium permanganate until the blood flowing out turns bright red. As soon as possible, make a cross incision on the tooth marks with a knife (don't hurt muscle contact, nerves and blood vessels), expand wound and detoxify, and suck out the venom with an aspirator, syringe needle or cupping. In case of emergency, you can inhale through your mouth (no ulcer), vomit while inhaling, and rinse your mouth with clear water to prevent the smoker from being poisoned. If the bite lasts for more than 24 hours, acupuncture drainage can be performed near the swollen heart. Local sealing: inject 0.25%-0.5% procaine and 5 micrograms of dexamethasone subcutaneously around the wound or 3-4 cm above the swelling (the dosage depends on the scope), or dissolve 400 units of trypsin in 5-20 ml of 0.25% procaine, and seal the wound subcutaneously around the tooth marks. Fresh Lobelia chinensis can also be pounded around the wound, or applied externally with realgar, or with snake medicine from all over the country. Never burn the wound with acid or iodine, and ice packs are also prohibited. Injured limbs should be fixed with splints to minimize the patient's activities.
Second, systematic therapy.
There are univalent and multivalent antivenom in serum treatment, univalent antivenom is only suitable for similar snake bites, and multivalent antivenom is effective for many kinds of snake bites. If the species of poisonous snakes can be determined, monovalent antivenom should be used. Do a skin test before injection. Such as intravenous injection of 20-60 ml in time. Its poisoning symptoms were quickly controlled. If the heart, kidney and brain have been damaged, the effect will be poor. If you need another injection every 36 hours, repeat the skin test.
Third, the early use of adrenocortical hormone can alleviate poisoning symptoms and prevent toxic shock. Take prednisone orally for 3-5 days, and in severe cases, inject hydrocortisone or dexamethasone intravenously.
Four, systemic support therapy with vomiting, diarrhea, dehydration, less urine, as appropriate, rehydration. Limited by physiological needs, 10% glucose solution was used as the main solution. Hemolysis, anemia, blood transfusion, shortness of breath, oxygen, etc.
Five, symptomatic treatment of oliguria, urinary incontinence, urine with red blood eggs, diuretics should be applied as soon as possible. Intravenous injection of respiratory stimulants when breathing is shallow and irregular, such as lobeline and Huisuling. When heart failure occurs, digitalis drugs can be used as appropriate, and cedilanid can be given.