(1) Prevention of venom absorption: After being bitten, the venom quickly enters the body within 3-5 minutes, and effective measures should be taken as soon as possible to prevent venom absorption.
1. binding method: it is a simple and effective method, and it is also an easy-to-do self-help and mutual rescue method on site. That is, after being bitten by a poisonous snake, you should immediately wrap it with cloth, towel or bandage at a distance of 5- 10 cm from the injured limb or at the root of the injured finger (toe) to reduce the reflux of veins and lymph, thus temporarily preventing the absorption of snake venom. During the evacuation, you should relax every 20 minutes for 1-2 minutes to prevent limb congestion and tissue necrosis. The wound is thoroughly debrided, and the bandage can be loosened after taking the snake pill for 3-4 hours.
2. Ice compress method: When conditions permit, ice is applied to the injured limb while dressing, so that blood vessels and lymphatic vessels contract and the absorption of snake venom is slowed down. You can also immerse the injured limbs or fingers in cold water at 4-70℃, and then apply cold compress with ice packs for 24-36 hours after 3-4 hours, but pay attention to keeping the whole body warm while cooling locally.
3. Limb fixation: Walk slowly after injury, don't run, and reduce the absorption of toxins. It is best to temporarily brake the injured limb, put it in a low position and send it to the medical station. Appropriate sedation can be given when necessary to keep the patient quiet.
(2) Promoting the discharge and destruction of snake venom: corresponding measures should be taken to promote the discharge or destruction of snake venom left in the wound. The easiest way is to inhale through your mouth and rinse your mouth with water after each inhalation. Of course, the mucous membrane and lips of the sucker should be ulcerated. You can also suck the snake venom out of the wound by breast pump and cupping, and the effect is satisfactory.
If the wound is deep and contaminated, it should be thoroughly debrided. After disinfection, the wound should be cut into the shape of "+"or "++",so that the residual snake venom can easily flow out, but the incision should not be too deep to avoid hurting blood vessels. When biting hands or feet, you can also use a triangular needle or a knife tip to pierce the proximal subcutaneous one centimeter, and then gently massage from near to far to accelerate the discharge of snake venom. After the wound is enlarged, various drugs can also be used for local wet compress or washing to achieve the purpose of destroying or neutralizing snake venom. Commonly used drugs for external use are 30% normal saline or alum water, and 1: 5000 potassium permanganate solution and 5%- 10% normal saline for wound irrigation.
Local injection of trypsin has a certain effect, which can decompose and destroy snake venom, thus alleviating or inhibiting the poisoning symptoms of patients. The usage is to dissolve trypsin with 2-4 ml physiological saline, and then inject it around the wound basal layer, and repeat the injection after 12-24 hours. Injection of furosemide, diuretic sodium or mannitol can accelerate the excretion of snake venom from the urinary system.
(3) Inhibition of snake venom: Effective Chinese herbal medicines and snake slices are mainly used for internal and external use to achieve the functions of detoxification, anti-inflammation, hemostasis, heart strengthening and diuresis. Anti-venom serum has been widely used in clinic and has good curative effect on similar snake bites.
1. Various snake pills: At present, there are more than ten kinds of snake pills used in clinic. When using, we should first find out which kind of poisonous snake the pill is effective for, and then take it as soon as possible, with a large dose and a long course of treatment. Finally, we must adopt other auxiliary treatments of traditional Chinese and western medicine. Nantong Snake Pill (also known as Ji Desheng Snake Pill) is the most widely used in clinical practice, and 20 tablets should be taken immediately after injury, and then 10 tablets should be taken every 6 hours until the poisoning symptoms are obviously alleviated. At the same time, the tablets are mixed into paste with warm water and applied around the wound and 3-4 cm above the swollen limbs. Guangzhou snake tablet (He snake tablet) also has a good curative effect. Take 5 tablets immediately after injury, and then take 5 tablets every 3 hours. Double the dose for severe cases. In addition, Shanghai snake slices are mainly used for the bite of Agkistrodon halys, and Snake Sanquan snake slices are mainly used for the bite of golden ring snakes and silver ring snakes.
2. Chinese herbal medicine prescription: 30-60 grams of fresh Lobelia chinensis (whole grass) can be used, and its juice can be taken orally after mashing, which has the functions of detoxification, diuresis and detoxification. You can also use 30 grams of fresh bird buds, mash the juice for oral administration, and apply the residue externally to prevent snake venom from attacking the heart.
3. Serum treatment: Antivenom has a certain effect on snake bites. The curative effect of monovalent serum can be as high as 90%, while the curative effect of multivalent serum is only 50%. At present, the serum that has been successfully tested includes anti-Agkistrodon halys venom serum, anti-cobra venom serum, anti-Agkistrodon acutus venom serum, anti-bungarus venom serum, etc. Some of them are refined into powder, which is convenient for storage. Skin allergy test should be done before using antivenom, and those who are negative can be injected.
(4) Whole-body support therapy: within a few days after being bitten by a poisonous snake, the condition is serious, the symptoms of poisoning are obvious, and it is often accompanied by different degrees of water and electrolyte disorders and shock. In severe cases, respiratory failure, heart failure, acute renal failure and hemolytic anemia may occur. Therefore, it is important to actively treat the whole body and correct the functions of major organs. When blood pressure is low, blood transfusion and rehydration should be given in time and anti-shock treatment should be given. When breathing is weak, breathing stimulants and oxygen should be given, and auxiliary breathing should be carried out when necessary. The application of adrenocortical hormone and antihistamine has a certain effect on neutralizing toxins and relieving poisoning symptoms. Systemic anti-infective drugs are of great significance to the prevention and treatment of local tissue necrosis, and routine injection of TAT can prevent tetanus.