What to do in case of a snake bite?

“It was very violent, very, very violent. He screamed in pain.” says the father of a 10-year-old boy bitten by a viper in August while they were both hiking in Ariège. Snake bites, especially vipers, can occur from April to October when there are more outdoor walks. In metropolitan France, there are around 2,000 snake bites per year responsible for 500 poisonings and one death per year, mainly due to the viper aspic or European viper. You must react quickly and well to prevent the poisoning from leading to death. People allergic to snake venom can go into anaphylactic shock if bitten.

Why does the snake bite?

A snake bite is usually inflicted on humans only when the snake feels threatened, as a defense mechanism, and cannot escape. The snake bite is inflicted by hooks that pierce the skin. Many snakes are non-venomous. Some snake bites do not contain venom, and snakes control the volume of venom they deliver to their prey. “In France, only vipers and the Montpellier snake have venom fangs. But in the latter, the fangs are so far back in the mouth that you would have to stick your finger in its mouth to risk envenomation.”explains Frédérique Thiennot, emergency doctor in Ariège.

“In vipers, the fangs are very forward. These teeth transformed into hollow points allow an effective injection of venom into the prey.”

“In vipers, the fangs are very forward. These teeth transformed into hollow points allow an effective injection of venom into the prey.“.

What symptoms?

The bite of a viper is brief (a few hundredths of a second), often described as a hammer blow sensation. The wound has the shape of two punctures, like two hooks planted in the skin with two small red lesions 6 to 10 mm apart. About half the time, the snake does not inject its venom when biting. In this case, we speak of dry bite : the person only has traces of the hooks and feels pain at the bite site. No other symptoms appear.

In case of envenomation (injection of venom), Edema appears 15 to 20 minutes later and gradually spreads. The affected limb is red and may become purplish or ecchymotic (with bruising). A pain appears at the injection site. Other general symptoms due to the toxin may also appear when the amount of venom injected by the animal is significant: digestive, cardiovascular, respiratory symptoms, confusion. Some people are allergic to snake venom and may experience a anaphylactic shock. In the absence of appropriate emergency treatment and hospitalization, this anaphylactic shock carries a life-threatening risk.

What to do if you are bitten?

• Call emergency services by dialing 15 or 112
• While waiting for help, stay calm and reassure the victim and those around them.
• Place the victim at rest, agitation promotes the spread of snake venom, it can lie down or even turn to the side (in lateral safety position) ;
• Remove rings, watches, shoes and anything that can squeeze the bitten area because it will start to swell;
• Place ice in a cloth
• If possible, disinfect the wound with an antiseptic And immobilize the bitten limb to slow the spread of venom in the body;
• In case of pain, use only paracetamol. Be careful not to give anti-inflammatory drugs or aspirin which increase the risk of bleeding;
• Aspivenin. The use of Aspivenin is not recommended as its effectiveness has never really been demonstrated.

What are the treatments?

In France, any poisoning must be hospitalized for a minimum of 24 hours due to the risk of worsening. It is always necessary to Go to a hospital emergency room or call 15 or the poison control center in the event of a snake bite. A doctor will examine the lesion and consider, in the event of extension of the local edema, indicating a significant quantity of venom in the blood, an injection of antivenom serum. “These are immunoglobulins manufactured (since 1999) from horse serum that bind to the venom to neutralize it, they are effective and well tolerated. This antivenom concerns French vipers. Antivenoms concerning new pets are not very available in France“, says Frédérique Thiennot. This serum can only be injected in a hospital setting because it requires medical monitoring.

What Not to Do if Bitten by a Snake

• Do not apply a tourniquet. Toxins will naturally accumulate below the level of the tourniquet. Cardiac arrest is always possible upon removal, not to mention the risk of gangrene of the extremities.
• Contrary to old indications, do not inject anti-venom serum, corticosteroids or subcutaneous heparin on site (up to 10% of complications much more serious than the bite)
• Do not suck the venom into your mouth. If there is a mouth wound, the venom will enter the body very quickly.
• Do not incise or cauterize the wound.
• Do not use a suction pump, such as Aspivenin, which is of little use.

• If you decide to go for a walk: do not go alone and take a mobile phone with you to call for help if necessary;
• Never walk barefoot, but wear closed, high shoes (or boots) and trousers;
• Walk briskly: the jolts are enough to scare away the snakes.
• Watch where you put your feet and hands: tall grass, stones and rocks, piles of leaves, piles of wood, bushes…, especially if they are exposed to the sun (snakes like heat);
• Do not enter the bushes. When harvesting mushrooms, berries and fruits, hit and shake the bushes with a stick to scare away any snakes;
• Do not put your hands on walls, under stones, in crevices, under piles of wood before having checked for snakes;
• Check for snakes before settling in for a break and do not sleep on the ground in snake-rich areas;
• At night, do not collect wood or lift stones, visibility is poor;

Thanks to Dr. Frédérique Thiennot, emergency doctor in Ariège.