Snakebite (cont.)

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Medical Author:

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Snakebite Symptoms

Bites by venomous snakes result in a wide range of effects. They range from simple puncture wounds to life-threatening illness and death. The findings following a venomous snakebite can be misleading. A victim can have no initial significant symptoms, and then suddenly develop breathing difficulty and go into shock.

Signs and symptoms of snakebites can be broken into a few major categories:

Local effects: These are the effects on the local skin and tissue surrounding the bite area. Bites by vipers and some cobras (Naja and other genera) are painful and tender. They can be severely swollen and can bleed and blister. Some cobra venoms can also kill the tissue around the site of the bite.
Bleeding: Bites by vipers and some Australian elapids can cause changes in the victim's hematologic system causing bleeding. this bleeding can be localized or diffuse. Internal organs can be involved. A victim may bleed from the bite site or bleed spontaneously from the mouth or old wounds. Unchecked bleeding can cause shock or even death.
Nervous system effects: The effect on the nervous system can be experienced locally close to the bite area or affect the nervous system directly. Venom from elapids and sea snakes can affect the nervous system directly. Cobra (Naja and other genera) and mamba (Dendroaspis) venom can act particularly quickly by stopping the breathing muscles, resulting in death without treatment. Initially, victims may have vision problems, speaking and breathing trouble, and numbness close to or distant to the bite site.
Muscle death: Venom from Russell's vipers (Daboia russellii), sea snakes, and some Australian elapids can directly cause muscle death in multiple areas of the body. There can be local effect of muscle death (necrosis), or distant muscle involvement (rhabdomyolysis). The debris from dead muscle cells can clog the kidneys, which try to filter out the proteins. This can lead to kidney failure.
Eyes: Spitting cobras and ringhals (cobralike snakes from Africa) can actually eject their venom quite accurately into the eyes of their victims, resulting in direct eye pain and damage.

Spitting cobra bite. Many elapid bites result in little local swelling, but the spitting cobras are known for the amount of swelling and tissue damage they can cause. Photograph by Clyde Peeling.

Western diamondback rattlesnake (Crotalus atrox) bite. Rattlesnake bites can cause severe swelling, pain, and permanent tissue damage. Photograph by Clyde Peeling.

Copperhead (Agkistrodon contortrix) bite. These bites usually result in local pain and swelling but usually have less tissue loss than rattlesnake bites. Photograph by Tom Diaz.

Timber rattlesnake (Crotalus horridus) bite. Pit viper bites can cause a leakage of blood cells out of the blood vessels, even on parts of the body away from the bite site. Note the significant bruising of the upper forearm and arm. Photograph by Clyde Peeling.