The biting season

2008-12-10 00:00

She thought she had seen a snake but she couldn’t find it. After scanning her bedroom one last time, the 17-year-old reluctantly went to sleep.

During the night she felt a poking sensation on her face and neck and swatted it like one would an irksome fly or mosquito.

The irritation turned into a bite, and then another and the girl managed to scream.

Her family — her mother, brother and grandmother — raced into her bedroom.

The snake, an Mfezi (Mozambique spitting cobra), struck her frail grandmother, by which time the girl’s neck and face had started swelling and blistering like a ripe bulb in summer.

Both victims were now paralysed with pain and struggling to breathe.

“Whack!” Her brother hit the snake with a spade, beheading it.

A few hours later, the grandmother and girl woke up in Ngwelezane Hospital in Empangeni.

“It was touch and go,” said Dr Darryl Wood, who works in the Emergency Medicine Unit at the hospital, “but we managed to save them both.”

It’s summer time and for most of us this means soaking up the sun, visiting exotic forests and camping on the beach. For snakes it means hunting and seeking shelter in cool, dry places such as our homes.

Although 80% of all snake bites are not dangerous (because there are more harmless snakes than dangerous ones), the bite of a really toxic snake like the Mfezi, black mamba, puff adder or boomslang (all of which inhabit the KwaZulu-Natal region) can be fatal.

Wood said the unit’s team of 12 doctors, who offer a high level of care to victims of potentially fatal snake bites, sometimes treats two to three patients a day between December and February.

“We have treated approximately 300 dangerous bites in the past year,” said Wood, who added reassuringly that they haven’t lost a single patient yet — including a one-year-old baby who was bitten by a black mamba.

“The baby was brought in within two hours after having been bitten. The dead mamba was also brought in,” said Wood, cringing.

“It is not recommended that the snake be killed and brought in,” said Wood, explaining that the same antidote is used to treat bites from various snakes.

“We do not place emphasis on the snake when treating the victim. We take a symptomatic approach and treat [the patients] according to their symptoms. Trying to kill a snake after it has struck increases the risk of it striking again and poisoning more people,” said Wood.

The venom of snakes like mambas and cobras is neurotoxic, which means that the venom attacks the nervous system, causing the muscles to stop working. The symptoms of such bites include a feeling of pins and needles, slurred speech, excessive salivation and shortness of breath. If the victim is not treated soon enough, the lungs, heart and other muscles cease to function.

“The lungs after a period just stop working,” said Wood.

The venom from snakes like puff adders and vipers is cytotoxic, which means that the toxin in the venom kills tissue. These bites are extremely painful, causing the affected area to swell and blister and may become further affected if not treated quickly. These bites can result in the victim losing his or her limb and, worse, they can be fatal.

Boomslang and vine snake bites are haemotoxic, which causes thinning of the blood, resulting in excessive haemorrhaging from the wound and other openings on the body.

The anti-venom used to treat a bite is a polyvalent serum cultivated from horse antibodies. The horse is injected with a mixed variety of different venoms and then produces antibodies to combat these toxins. This serum is extracted and stored in vials that are kept cool.

The same anti-venom treats both cytotoxic and neurotoxic bites. A different type of anti-venom is used to treat haemotoxic bites.

Although nobody treated at Ngwelezane Hospital has died from a mamba or Mfezi bite, Wood said “recovery from a bite is influenced by different factors: the size and depth of the bite, the amount of venom injected, the physical health, size and age of the patient and, most importantly, the time they take to come to the hospital for treatment. The faster they get here, the better their chances are.”

With the case of the one-year-old baby who was treated for the mamba bite, Wood said that was one of the only exceptions where bringing in the dead snake helped.

“I treated her more aggressively with more anti-venom and acted a lot faster than I would have for other snake bites,” he said.

However, the biggest thing to worry about when treating a bite is the patient’s reaction to the anti-venom. Some develop anaphylaxis (an allergic shock reaction) after being injected with the serum. This could cause the patient to lose consciousness or he or she may need to be resuscitated.

If the patient does not react badly to the serum, the swelling of a cytotoxic wound will be relieved within a few hours and with a neurotoxin wound, a few minutes.

“Forget the old wives’ tale of bandages, peeing on the wound and fastening the wound with tourniquets,” said Wood. “These practices do not help. If anything, they make the problem worse.”

Some people believe that tying a tourniquet above the wound will prevent the venom from spreading throughout the body. The added pressure increases the swelling and harm caused to the poisoned area. If a patient is saved from such a bite, he or she may lose his or her limb in the process.

Also, do not administer anti-venom to somebody unless it is a last resort (you are stranded and there is no way of getting to a hospital). Anti-venom is highly concentrated and, as mentioned earlier, each person reacts differently to it.

“A person who has been bitten by an Mfezi may need 20 vials of anti-venom. An anti-venom bush kit only contains about three vials,” said Wood. “I cannot stress how important it is to get to a hospital as quickly as possible and to phone in before arriving so that we can prepare the anti-venom.

“Do not suck or pee on a wound. Human saliva can make the wound worse, risking the chances of saving the limb.

“A snake bite is not fatal if it is treated quickly enough. Snakes do not want to attack humans. They only do so when they are feeling threatened. I would therefore encourage people to walk away from a snake and not try to capture or provoke it.”

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