Snakebite refers to a wound caused by the bite of a snake tooth into the meat, especially a wound caused by the bite of a snake tooth or a snake that secretes venom near the tooth.After being bitten by a non-toxic snake, it's like treating aeye of a needleThe size of the wound is the same.However, being bitten by a poisonous snake may be very serious, which depends on the size of the injured person, the location of the bitesnake venomThe amount of injection, the speed at which snake venom is absorbed into the patient's blood circulation, and the specificAntivenomIt depends on the length of the interval.
Chinese name
Snakebite
Definition
The bite of a snake's tooth into the flesh, especially a wound caused by the bite of a snake that has passed through the tooth or secreted venom near the tooth
Snakebite refers to a wound caused by being bitten into the flesh by a snake's tooth, especially by a snake that secretes venom through or near the tooth.After being bitten by a non-toxic snake, it is like treating a wound the size of a needle eye.But being bitten by a poisonous snake may be very serious,
Snakebite
It depends on the size of the injured person, the bite site, the amount of snake venom injected, the speed of snake venom absorption into the patient's blood circulation, and the specific bite and applicationAntivenomIt depends on the length of the interval.
There are 2500 kinds of snakes in the world, including more than 650 kinds of poisonous snakes, threatening a vast area with a population of one billion.It is estimated that more than 300000 people are bitten by poisonous snakes every year, and the mortality rate is about 10%.Snakebite is a serious problem in Guangdong and Guangxi provinces of China. The incidence of snakebite is about 25 per 10000 every year.There are more than 160 kinds of snakes in China, of which there are about 50 kinds of poisonous snakes. There are 10 kinds of highly poisonous and harmful snakes, such ascobra, Golden Snake, Cobra, Five legged Snake, Silver Snake, Viper, Viper, Viper, Bamboo Leaf Green, Iron Head, Sea Snake, etc., can cause death after being bitten.These poisonous snakes appear in the forests, mountains and grasslands in the south. People are vulnerable to being bitten by poisonous snakes when cutting grass, cutting firewood, picking wild fruits, pulling vegetables, walking and military training.The head of poisonous snake is mostly triangular, the neck is thin, the tail is short and thick, the color spots are bright, the mouth is wide open when biting, and the teeth are long.The snakebite often leaves two rows of deep and thick tooth marks.If it is impossible to determine whether a poisonous snake is injured, it shall be treated as a first aid for a poisonous snake bite.
Snakebite
Disease classification
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General surgery
Disease description
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Snakes are divided into two categories: non poisonous (ordinary) snakes and poisonous snakes.Ordinary snake bites only leave small tooth marks on the skin of the injured part of the human body, causing slight tingling, and some can cause small water scars, without systemic reaction.It can be sterilized with 70% alcohol and wrapped with gauze, generally without adverse consequences.A pair of deep tooth marks can be left on the wound caused by a poisonous snake bite. The inherent snake venom enters the tissue, lymph and blood stream, which can cause serious poisoningfirst aidtreatment.
Symptoms and signs of snake bite
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Ordinary snake bites only leave small tooth marks on the skin of the injured part of the human body, causing slight tingling, and some can cause small water scars, without systemic reaction.A pair of deep tooth marks can be left on the wound caused by a poisonous snake bite.
There are two rows of deep coarse tooth marks in the local area, with bleeding, pain, redness and swelling, and spread to the proximal end of the body.The nearby lymph nodes are swollen, tender, and blistered.Systemic symptoms include fever, chills, dizziness, headache, fatigue, nausea, vomiting, lethargy, abdominal pain, diarrhea, blurred vision, epistaxis, severe convulsions, coma, arrhythmia, dyspnea, paralysis, heart and kidney failure.[1]
Cause of disease
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Snakebite
Pathophysiology
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There are about 50 species of venomous snakes in China, which are distributed regionally.For example, frogs and snakes are mostly found in Fujian, Guangdong and Taiwan provinces;Cobras are also mostly in the south;Five legged snake, bamboo leaf paste, etcYangtze river basinHejian, Fujian;And locusts and snakes are widely distributed.Snake venom contains toxic proteins, polypeptides and enzymes, which can be classified into three categories according to their effects on human body:
Snakebite
① Neurotoxin, which first numbs the wound and spreads to the near heart side, causing dizzinessBlurred visionEyes drooping, unclear language, bodyFlaccid paralysis, dysphagia and dyspnea;Finally, it can lead to respiratory and circulatory failure.
② The circulation of blood toxin can make the wound swollen and painful, and spread to the near heart side, and the adjacent lymph nodes also have swelling and pain;And causeAversion to cold and feverHeart rate and arrhythmia, dysphoria or delirium, skin purpura, hematuria and oliguriaYellow dyeEtc.: It can finally lead to heart, kidney and brain failure.
③ Mixed poisons have the effects of neurotoxicity and blood circulation, but such as the mixed poisons of cobra and agkistrodon halys, they have different effects on nerve and blood circulation.
First aid measures
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1. Prevent the spread and absorption of venom
After being bitten by a poisonous snake, don't panic, run and walk, which will make the venom spread to the whole body quickly.The injured person should immediately sit down or lie down, help himself or call others, and quickly use the shoelaces, trouser belts and other ropes that can be foundBindingThe proximal end of the wound. If the finger is bitten, the root of the finger can be bound;If the palm or forearm is bitten, the elbow joint can be bound;The toe root can be bound if the toe is bitten;If the foot or lower leg is bitten, it can be bound under the knee joint;If the thigh is bitten, the root of the thigh can be bound.The purpose of binding is only to prevent the venom from flowing back into the heart through veins and lymph nodes, without hinderingarteryThe purpose of blood supply is different from that of hemostasis.Therefore, the binding does not need to be too tight, and its tightness should be controlled to slightly weaken the pulse of the lower limb artery being bound.After binding, loosen once every 30 minutes, 1-2 minutes each time, so as not to affect blood circulation and cause tissue necrosis.
2. Quickly expel the venom
Immediately use cold boiled water, spring water, soapy water or 1:5000Potassium permanganateRinse the wound and surrounding skin with solution to remove the venom on the surface of the wound.If there is poison tooth residue in the wound, it should be quickly picked out with a knife or broken glass and other sharp objects. Before use, it is better to burn with fire for disinfection.Make a cross cut with the tooth mark as the center, and then press repeatedly from the proximal end of the limb to the direction of the wound and around the wound, so as to urge the venom to be discharged from the cut wound. While pressing, wash the wound with clean water, and the flushing and squeezing must last for 20-30 minutes.After that, if you carry a cup with you, you canwoundFor cupping, first light a small ball of paper in the cup, then quickly buckle the cup mouth to the wound, make the cup mouth close to the skin around the wound, and use the negative pressure generated in the cup to suck out the venom.If there is no cup, you can also suck the wound to detoxify, butsuckThe person's mouth and lips must be free from damage and caries, otherwise there is a risk of poisoning.Spit out the venom immediately, and rinse your mouth with water after inhalation.
After detoxification, the wound should be wet applied to facilitate the outflow of venom.It must be noted that snake venom isHighly toxic substance, only a small amount can kill people, so you must not refuse for fear of painwoundIncision and detoxification treatment.If you have snake medicine nearby, you can take it orally immediately to detoxify the internal poison.If the patient is thirsty, give him enough water to drink, and do not give him alcoholic drinks to hinder the spread of toxins.The wounded who have undergone incision and detoxification treatment should be sent to the hospital with stretchers and vehicles as soon as possible. After arriving at the medical unit, 0.05% potassium permanganate solution or 3% potassium permanganate solution should be used firstHydrogen oxideFlush the wound;Pull out the remaining venomous snake teeth;If the wound is deep, cut a little of the dermis, or stab the skin layer with a three edged needle at the swelling place, and then use the cupping method or breast suction device to suction, so as to promote the discharge of part of the venom;Pancreatic egg self enzyme has a direct effect of detoxifying snake venom. It can be added to 0.05% of 2000-6000UprocaineOr 10-20ml of water for injection can be used to seal the periphery or proximal side of the wound, which can be repeated after 12-24 hours.To avoid serious situations that cannot be handled in the field.During transportation, the patient's nervousness should be eliminated and the patient should be quiet.
first aid
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1. During self rescue, use ropes, handkerchiefs, plant vines and cloth belts to bind the 5cm near the heart of the wound, and the antitoxin continues to spread in the body.Loosen the band every 15-20 minutes for 1-2 minutes to prevent limb ischemia and necrosis.[1]
2. Rinse the wound repeatedly with well water, spring water, tea, tap water or 1:5000 potassium permanganate solution, and make multiple "cross" shaped small incisions on the wound for detoxification.Then suck out the poison with cupping jar, breast pump and suction device.In an emergency, suck the venom out of the wound with your mouth, and the first aider will spit it out immediately after sucking it to clean your mouth.This method is forbidden when the first aider has oral ulcer.[1]
3. Acupuncture detoxification.If the bite is swollen for more than 24 hours, a blunt needle can be used to prick a needle hole every 2~3cm at the lower end of the swelling to make the affected limb droop. Press from top to bottom to make the venom flow from the eye of the needle 2~3 times a day for 2~3 consecutive days.[1]
4. When the hands and feet are very swollen, the eight evil points between the fingers and the eight wind points between the toes can be respectively acupunctured to speed up detoxification and detumescence.[1]
5. Application of antidote: ① Nantong snake medicine (Jide snake medicine), 5 tablets each time, 3 times/day for mild cases.Take 10 tablets/time, 4-6 hours/time. ②Dissolve the above tablets in warm water and apply them half an inch around the wound. ③Shanghai snake medicine, take 10 tablets each time, and then take 5 tablets every hour. ④30~60g fresh Lobelia lobata (Onunculosa furunculosa), fried in water, or mashed and coated around the wound.[1]
6. Do not use drugs in the first aid, such as morphine, chlorpromazine, barbiturates and other central inhibitory drugs, and rhabdomyosuppressant arrow poison.And sent to hospital for emergency treatment.[1]
Treatment plan
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First aid for snakebite
① At the scene, immediately bind the proximal limb of the bite with a strip. For example, if the foot bites, bind the ankle and calf twice to preventveinal bloodAnd lymphatic return.Immerse the wound in cold water. The retrograde vertebral extrusion will discharge part of the venom.You can also sip the wound (there is no oral disease in the smoker) and gargle while inhaling.During transportation, the wound should still be wet wrapped with cold water, and the binding should be loosened for 2-3 minutes every 20 minutes (to avoid prolonged limb congestion).
Snake bite -- diagnosis and treatment
② After arriving at the medical unit, first flush the wound with 0.05% potassium permanganate solution or 3% hydrogen peroxide;Pull out the remaining venomous snake teeth;If the wound is deep, cut a little of the dermis, or stab the skin layer with a three edged needle at the swelling place, and then use the cupping method or breast suction device to suction, so as to promote the discharge of part of the venom;Pancreatic egg has direct snake venom detoxification effect. 2000-6000U can be added to 0.05% procaine or 10-20ml water for injection to seal the periphery or proximal side of the wound. It can be repeated every 12-24 hours.
treatment
① Snake medicine is a cureSnakebiteEffective Chinese patent medicine, includingNantong(Ji Desheng）Snake medicine,Shanghai Snake Drug、Guangzhou(waiting for Xiaosheng) snake medicine;It can be taken orally or applied locally, and some have injections. See the instructions for usage.In addition, some fresh herbs are also good forSnakebiteIt has curative effects, such as one flower with seven leaves, octagonal lotus, lobelia chinensis, yellow field bolt, hedyotis diffusa, etc.
② There are two kinds of antivenom: univalent and multivalent. Monovalent antivenom has better effect on known snake bites.Allergy test must be carried out before use, and the resultspositiveapplicationDesensitization injection。
③ Antibacterial drugs can be used to prevent and treat concurrent infection.
④ Corresponding treatment measures must be taken for various organ dysfunction or shock.In addition, central nerve inhibitors, muscle relaxants, epinephrine and anticoagulants are prohibited during the treatment.
Health tips
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Prevention is the key:
Prevent snakebite
1. Popularize the knowledge of first aid and self rescue after identifying poisonous snakes and poisonous bites.
2. Kill rats and locusts to cut off snake food, and kill poisonous snakes with drugs.
3. If you don't want to go to places where there may be poisonous snakes, you must wear boots, stockings, hats, and sticks to frighten the snakes, just in case.Go around when you see a poisonous snake.
be careful:
1. Once bitten by a snake, first sit down and try to reduce movement to avoid accelerated blood circulation.
Snakebite
2. Try to identify the type of snake.If it is believed that it is a snake bite, and the bite time is within 5 minutes, and the medical staff can arrive after more than 30 minutes, the wound should be cut and the venom should be sucked out.
3. Gently wash the wound with soap and water.Do not rub the wound, and gently pat it with a cloth to make it dry.If you need to move the patient, you should lift him instead of letting him walk by himself.
preventive measure
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1. Popularize the knowledge of first aid and self rescue after identifying poisonous snakes and poisonous bites 2. Kill rats and locusts to cut off snake food, and kill poisonous snakes with drugs.3. Don't try to catch or tease the snake easily, because it may hurt people if the snake is provoked.4. In the place where poisonous snakes haunt, you should wear thick trousers, leather boots and stockings. The trouser legs should preferably be connected with the boot system. You should wear a hat and hold lighting appliances in your hand;Do not wear bare feet or only slippers.Go around when you see a poisonous snake.5. Do not reach into hollow logs or dense weeds or turn over stones without careful examination;When crossing stones or wood and other objects, pay attention to prevent poisonous snakes from perching on the other side.6. Workers who often come into contact with poisonous snakes must pay attention to safe operation and carry anti venomSnake venom serum。7. When camping, you should choose an open and dry place to camp. Avoid camping near debris piles. At night, you should raise a campfire outside the camp ortorch, especially on summer nights.8. Try not to wade or swim in the area where poisonous snakes often haunt, because most poisonous snakes are swimming masters, and there may be poisonous snakes in the water. 9. Once bitten by snakes, sit down first, and try to reduce movement to avoid accelerated blood circulation.10. Try to identify the type of snake.If it is believed that it is a snake bite, and the bite time is within 5 minutes, and the medical staff can arrive after more than 30 minutes, the wound should be cut and the venom should be sucked out.11. Use gentlysoapAnd wash the wound with water.Do not rub the wound, and gently pat it with a cloth to make it dry.If you need to move the patient, you should lift him instead of letting him walk by himself.
Relevant information
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Snake venom contains many substances such as enzymes or proteins, and its content varies according to different kinds of snakes.These substances can invade the blood, nervous system or other tissues.Some snake venoms have direct toxic effects, but not all of them are fatal to humans.Some have systemic lethal toxicity (such asRattlesnakeAnd some onlywoundThe adjacent tissues ofgangrene。
If the bite is on a limb, the injured limb should be immediately fixed in a horizontal position during first aid, and then the wound should be wrapped with a wide and solid bandage, or the whole limb should be wrapped;A splint can be used as an aid.It is unwise to amputate a limb, suck a wound or use an arterial tourniquet.Avoid exertion and excitement to prevent the increase of pulse rate leading to faster circulation.Similarly, stimulants should also be avoided.yeswoundThe use of potassium permanganate and other drugs is also harmful.
Most kindsSnake venom poisoningIt can be cured with antivenom.The effectiveness of antivenom serum prepared by immunized animals (especially horses) depends on the specificity of antivenom serum, the content of antibody, and the concentration and purity of the product.Although it is better to use specific antivenom to treat a certain kind of snake bite, some antivenom can treat various related snake venoms. For example, the venom of the tiger snake (Notechis scutatus) is also effective for other kinds of snake venoms.
