Providing medical care for a venomous snake bite

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详细

Mortality from viper bites among the adult population ranges from 2–12%, in children it is even higher – about 25%. According to the I.I. Janelidze Research Institute of Emergency Medicine, an average of 7 to 12 people annually seek help, while snake venom poisoning with a fatal outcome is noted. Mortality after the bite of the common viper is about 1% of the total number of victims.

According to the mechanism of action, the poisons of all snakes are divided into three groups, and this is due to their composition. Snake venoms have a complex composition, in addition to exotoxins, proteins with specific properties (neurotoxic, hemolytic, cardiotoxic), they contain enzymes that determine the species specificity of snake venom. The venom contains proteases, hyaluronidase, trypsin and thrombin activator enzymes with kallikrein-like action.

To date, the mechanisms of action of many snake venom toxins have been established (crotoxin; caudoxin; viperotoxin; crotamine; serine proteases; thermolabile proteins; beta-bungarotoxin; mojavetoxin; textilotoxin; typoxin; notexin); they have been shown to alter the activity of enzymes, receptors or ion channels, thus disrupting the normal functioning of the central or peripheral nervous system, cardiovascular system, muscular system, coagulation system and hemostasis.

Many species of snakes contain toxins of various types of exposure in one venom. The main toxic effect of the venom of the common viper is due to the presence of hyaluronidase, phospholipase-A2 and proteolytic enzymes in it. When such a poison enters the tissues, extensive hemorrhagic edema develops, due to both vascular and tissue permeability, and a violation in the coagulation potential of the blood. The body’s reaction to the bite is accompanied by the release of histamine, bradykinin, prostaglandins and serotonin. The release of biologically active substances leads to a violation of vascular permeability and a drop in BCC, with a decrease in systemic blood pressure. One of the severe coagulopathies against the background of snake bites of these families is the development of disseminated intravascular coagulation with typical multiple organ lesions. Possible development of cortical or tubular necrosis of the kidneys. And if medical care is not provided in time, a person may die.

From practical activity in medicine, it is customary to determine the danger of a snake not from the degree of toxicity of the poison, but in accordance with the categories of danger. And the combined experience of professional herpetologists and physicians allowed us to develop very simple first aid rules.

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作者简介

Valeriy Kutsenko

FSBEI HE «St. Petersburg State Pediatric Medical University»

Email: val9126@mail.ru
ORCID iD: 0000-0001-9755-1906

Ph.D. Sci., Associate Professor, Department of Modern Methods of Diagnostics and Radiobeam Therapy named after V.I. Professor Reinberg

俄罗斯联邦,

Daria Kovaleva

FSBEI HE «St. Petersburg State Pediatric Medical University»

Email: dasha753k@gmail.com
ORCID iD: 0000-0002-6236-4526

student

俄罗斯联邦,

Ekaterina Peresada

JSC North-West Center for Evidence-Based Medicine

Email: ekaterina.bezvulyak@mail.ru
ORCID iD: 0000-0003-1809-4597

head of the testing laboratory

俄罗斯联邦,

Pavel Seliverstov

North-Western State Medical University. I.I. Mechnikov

编辑信件的主要联系方式.
Email: seliverstov-pv@yandex.ru
ORCID iD: 0000-0001-5623-4226

Candidate of Medical Sciences, Associate Professor of the Department of Internal Medicine, Clinical Pharmacology and Nephrology

俄罗斯联邦,

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1. JATS XML
2. Figure 1

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3. Pic. 1. The first five are poisonous snakes (punctures with fungs are visible), and the sixth is a non-poisonous snake

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4. Pic.2. Typical color variations in the coloration of common vipers

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5. Pic.3. Targets of reptile neurotoxins at the neuromuscular junction

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6. Pic.4. Model of the interaction of cytotoxins with cell membranes

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7. Pic.5. Technical means used to remove poison from a wound various stings and bites

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