Protocol and immunotherapy

Protocol in case of bite “Do It Right”:

R: Reassure the patient
I: Immobilize the limb as a fracture, without tightening
G.H: Get to Hopistal (Go to the nearest hospital, if possible with serum)
T: Tell the doctor – Report to the doctors all information necessary for the care.

Detailed Protocol:

  1. Securing the environment
  2. Take a picture of the snake if the bite was done outdoors, his record as part of the terrarium.
  3. Reassure the victim
  4. Make sure nothing can cause tourniquet: jewelry, watch, etc.
  5. Immobilize the bitten limb, without tightening so as not to provoke tourniquet – Layers of strips of different colors starting from the upper body are recommended.
  6. Call emergencies
  7. If the bite was made indoors, make sure all doors are open to the medical community
  8. If the venom is of the neurotoxic type, give artificial respiration.

Arrival at the hospital

The arrival usually begins with a period of clinical analysis as well as an interrogation phase that allows, among other things, to assess the severity of the envenomation and according to the situation, to identify the aggressor.

The medical profession will perform a generally based analysis of the principle of dry tube coagulation testing. To do so, they will take 2 to 5ml of intravenous blood that they will put in the tube. A clot must form in less than 15 minutes. The absence of clot after this time, or if it is abnormal, there is hemorrhagic symptom. This test, simple to implement must be done throughout the diagnosis and monitoring.

Dry tube envenomation test (M. Stobel, (2007))
Dry tube envenomation test (M. Stobel, (2007))

The use of antivenom should only be made according to the signs of envenomation and adapted to them. The dosage is directly dependent on the amount of venom injected and therefore the symptoms and their evolutions. Examinations, such as the dry tube coagulation test, will be done between the first and second hours, followed by every 4-6 hours and repeated until the end of systemic envenomation.

The following table, based on research by Harry, P., & De Haro, L., in 2002, establishes an assessment of the severity of an envenomation.

ranks Envenomations Clinical picture
0 White bite Traces of hooks at the bite, no edema or local reaction.
1 Minor Local edema, absence of general signs
2 Moderate Regional edema of the limb and / or general symptoms (moderate hypotension, malaise, vomiting, abdominal pain, diarrhea)
3 Severe Extensive edema reaching the trunk and / or severe systemic symptoms (prolonged hypotension, shock, anaphylactic reaction, visceral involvement)

Symptomatic treatments

Edema and necrosis can be treated with a daily bath in lukewarm soapy water or dakin within 48 hours after envenomation. It is possible, taking into account the haematological contraindications, to use nonsteroidal anti-inflammatory drugs such as ibuprofen.

Viperine envenomations can sometimes lead to complications such as cerebromeningeal hemorrhage and renal failure. It is likely that the former will be avoided if the initial bleeding syndrome is properly treated. If not, treatment with corticosteroids and manitol should be performed. The renal insufficiency when to her, perhaps to avoid by an early revival of the diuresis and maintains it around 50ml / hour during all the duration of the envenomation.

Symptomatic treatments are often essential but are sometimes insufficient, since the pain may be resistant to analgesics and opioids.

Anaphylactic shock

Present in less than one in a thousand treatments, anaphylactic shock is a serious allergic reaction that can lead to life-threatening prognosis. The symptoms are recognizable because, in addition to the classic signs of sudden shocks, itching, hives, edema of the face and lips, respiratory difficulties associated with laryngeal edema appear. Then there are symptoms corresponding to circulatory insufficiency: tachycardia, hypotension, skin pallor, coldness and cyanosis of the extremities, confusion or even a coma.

Both the venom and the serum (which are for the most part better tolerated), the only treatment is injectable adrenaline (hepinephrine). If the medical profession has to use a serum, a drop of the latter in the eye of the victim can quickly discover if it is allergic and thus avoid any shock (Christian Derwey, personal communication, 2014, 2017). In case of shock, the injection of serum should be stopped. It is essential to carry out an allergological assessment to identify the allergen. The victim will then have to take an auto-injectable syringe of adrenaline and to avoid as much as possible the pathogen.

Unnecessary actions that can be dangerous in case of envenomation

Auto-immunotherapy, suction, incision, withers, alcohol intake and medication (salicylates), Aspi-venom, Venomex, black stone.


Chippaux, J. P. (2006). Envenimations et intoxications par les animaux venimeux ou vénéneux. II. Envenimations par viperidae. Médecine tropicale, 66(5), 423-428.

Chippaux, J. P. (2006). Les serpents d’Afrique occidentale et centrale (Vol. 35). IRD éditions.

Rollard, C., Chippaux, J. P., & Goyffon, M. (2015). La fonction venimeuse.

Harry, P., & De Haro, L. (2002). Traitement des envenimations par les serpents en France. Réanimation, 11(7), 548-553.

M. Strobel (2007). Envenimation par serpents d’Asie.