SLMA Guidelines for the Management of Snakebite
How to use these Guidelines
These Guidelines have been prepared primarily for the use of doctors serving in hospitals who may be called upon to deal with snakebite admissions. They contain basic information, as well as discussions on rarer scenarios that would be of help in more complex situations. The user who is new to this document is advised to familiarise him-/herself with its contents, so as to be prepared to refer to a particular section for help in case that is needed during management of a case (the articles are all downloadable). If all else fails, refer the Hotline for useful numbers to call for specialist assistance. An explanation of the contents follows (the numbers indicate that in the List of Contents).
General Information Section
A classification of snakes based on their propensity to cause envenoming necessitating medical intervention.
Describes the initial steps to be taken on admission of a patient with suspected or a definite history of snakebite, including confirmation of systemic envenoming. Two algorithms are included in the same file—the General algorithm is the more important, detailing steps in the management of a patient from admission to discharge. The Syndromic algorithm is for use if the identity of the offending snake is unknown, and symptoms and signs of envenoming have developed. It suggests the likely species, helping in further management.
The 20-minute whole blood clotting test, 20WBCT (4.1) is on its own downloadable file.
The correct identification of the biting snake is necessary for appropriate management. Use this section if a dead or living snake is brought with the patient. This file is in three sections—for those who are unfamiliar with snakes there is an Explanation of Terms used in describing snake external anatomy, followed by a Flow chart of venomous snakes, and another of Venomous snakes in a nutshell. These should be adequate to lead to a positive identification of the most important venomous snakes. Included are two plates of Non-venomous Krait mimics (5.1) and Russell’s viper mimics (5.2). The Annotated Gallery of Snake Pictures (5.3) is more for general interest. It contains images of a variety of snakes, both venomous and non-venomous, with some information about them.
An important section that deals in some detail with Premedication, Administration, Reactions & Management of reactions following antivenom. There is a separate section titled Quick reference guide (6.1) summarising the Management of AV reactions in the form of an algorithm.
Special Topics
This section contains authoritative, signed articles that should be read together with the general information on preceding pages. The topics covered are:
Snakebite in children (7), Cobra bites (8), Krait bites (9), Russell’s viper bites (10), Hump-nosed viper bites (11), Green pit-viper bites (12), Saw scaled viper bites (13) and Sea snake bites (14).
Miscellaneous
The Hotline has been re-designed and contains useful telephone numbers as well as links to the Guideline articles on snake identification and other websites.
Malik Fernando
Editor, SLMA Expert Committee on Snakebite
Colombo
30 March 2022
