Providing medical care for a venomous snake bite

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.