Cobra bite: diagnosis and treatment and resuscitation

2021-07-29 04:35 PM

All patients bitten by a cobra, or suspected of being bitten by a cobra, should be admitted to the hospital, in a ventilator-equipped emergency department, and have a specific antivenom

Naja atra, Chinese cobra seen in the North, when the neck is wide, the back of the neck has a pattern of glasses with 2 frames.

Naja kaouthia, Cobra found in both regions, the glasses have a circular lens.

Naja siamensis, Cobra found in the South, "V" shaped glasses, or cat faces.

When the snake attacks, it has a wide horizontal neck and emits a characteristic sound.

A cobra bite is an emergency. All patients who have been bitten by a cobra or are suspected of being bitten by a cobra should be hospitalized and closely monitored in an emergency department with a ventilator and specific antivenom.

Definite diagnosis

Ask the patient

The patient was bitten by a snake, a snake with the above characteristics. Ask family members to bring snakes (be careful of snake bites), or take a picture of the snake's nape with its neck stretched.

Symptom

Table of  Symptoms of a snake bite

Symptom

Cobra

Monocled cobra

Indochinese spitting cobra

At Place:

-Sharp pain

-Teeth marks, poison hooks

- Diffuse edema

- Caseation

Body:

- Drooping eyelids

-Dilated pupils

-Light Reflection (PXAS)

-Limited mouth opening

- Shortness of breath, paralysis of respiratory muscles

- Paralysis of limbs, decreased liver and bone reflexes

- Digestive disorders

- Acute renal failure (rhabdomyolysis)

 

+

+

+++

 

+++

 

 

-

-

+

±

-

 

 

-

 

 

+

+++

+

+

+++

 

+++

 

 

±

±

+

±

±

 

 

±

 

 

+

+++

+

+

+++

 

+++

 

 

+

+

+

+

+

 

 

+

 

 

+

+++

 

Differential diagnosis

King cobra bite: big king cobra, over 2.5m long, the neck is not wide but extends vertically. Often accompanied by muscle paralysis, swelling but no necrosis.

Viper bite: snakehead is large compared to the body, triangular shape, elliptical pupils erect, causing blood clotting disorder, thrombocytopenia and bleeding, no paralysis.

Snakes often bite: the bite has many teeth arranged in 1 or 2 arcs, the patient itch a lot around the bite.

Rat-bite: deep bite, may have swelling, infection, no necrosis.

Centipede bites: shallow bite, pain, little swelling, no necrosis.

Tests to help diagnose, evaluate, and monitoring

Blood count

Urea, glucose, creatinine, electrolytes, CK, AST, ALT.

Basic coagulation.

Electrocardiogram

Other tests depending on the patient's condition.

Treatment

On-site first aid: sucking, injecting incision, washing the bite wound under clean running water.

Intubation, mechanical ventilation if there is muscle paralysis causing poor coughing or respiratory muscle paralysis.

Massive fluid administration against acute renal failure due to rhabdomyolysis.

Anti-edema, anti-pain.

Antivenom serum is specific for each type (intravenous and local injection). Pay attention to prevent anaphylaxis (if any, inject adrenaline).

Hemodialysis, continuous dialysis, depending on the severity if the patient has acute renal failure due to rhabdomyolysis unresponsive to drug therapy or severe toxic infection.

Wound care, anti-infection:

+ Wash the wound, disinfect (Betadine, hydrogen peroxide), cut out necrotic tissue, make an incision to drain pus, cut muscle membrane if the pressure in the cavity increases causing compression, ischemia.

+ Anti-tetanus, antibiotics (clindamycin, gentamycin).

Prevention

Cobras can actively attack people, but in fact, most snake bites are caused by people actively catching the snake or teasing the snake (accidentally or intentionally making the snake feel threatened). In labor, it is very difficult to completely avoid being bitten by snakes. The following measures can help reduce the risk of snakebite:

Know about the snakes in the area, know the areas where snakes like to live or hide. Know what time of year, day, and weather patterns snakes are most active in. are

Be especially wary of snakes after rains, during floods, harvests, and nighttime.

Try to wear boots, boots, and long pants, especially when walking in the dark, walking in grassy, ​​swampy areas.

Use lights when walking at night.

The more you stay away from snakes, the better: no snake shows, no holding, no threatening snakes. Do not trap, chase or corner snakes in enclosed areas.

Do not sleep directly on the ground.

Do not let children play near snakes.

Do not hold or tease dead or dead snakes.

Avoid being near places where snakes like to live or like to visit such as rubble piles, rubble, garbage piles, termite nests, shelters for family animals.

Regularly inspect the dwelling for snakes, and if possible avoid structures that favor snakes (such as thatched-roof houses, straw-walled, mud walls with lots of burrows, cavities or cracks, etc.) many cracks in the floor).