Animals

How to act before the snake bites

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It is when a snake bites the skin. It is a medical emergency if the snake is poisonous.

Poisonous animals represent a large number of deaths and injuries worldwide. It is estimated that there are 2.5 million poisonous bites every year of snakes, causing about 125,000 deaths. The actual number can be much higher. Southeast Asia, India, Brazil and areas of Africa have the most deaths due to snake bites.

Considerations

Snake bites can be deadly if they are not treated quickly. Due to the small size of their bodies, children have the highest risk of death or serious complications due to such bites.

The right antidote can save a person's life. It is very important to go to the emergency room as soon as possible. If treated properly, many snake bites will have no serious effects.

Most species of snakes are harmless and their bites are not life threatening.

Bites of venomous snakes include bites by any of the following species:

  • Cobra
  • Copper Snake Snake
  • Coral snake
  • Snake water moccasin
  • Rattlesnake
  • Various snakes found in zoos

Most snakes will avoid people as much as possible, but all snakes will bite as a last resort when they feel threatened or surprised. If a snake bites you, treat the bite seriously.

Symptoms depend on the type of snake, but may include:

Rattlesnake bites hurt immediately. Symptoms usually begin right away and may include:

The bites of the water moccasin and the copper viper are painful immediately. Symptoms, which usually begin immediately, may include:

  • Bleeding
  • Respiratory distress
  • Low blood pressure
  • Nausea and vomiting
  • Numbness and tingling
  • Bite site pain
  • Shock
  • Changes in skin color
  • Swelling
  • Thirst
  • Fatigue
  • Tissue damage
  • Weakness
  • Weak pulse

Coral snake bites may be painless at first and major symptoms may not occur for hours. You should NOT make the mistake of thinking that it will be fine if the area of ​​the sting looks good and does not hurt much. The bites of these snakes that are not treated can be fatal. Symptoms may include:

  • Blurred vision
  • Respiratory distress
  • Seizures
  • Drowsiness
  • Eyelid drooping
  • Headache
  • Low blood pressure
  • Water in the mouth (excessive salivation)
  • Nausea and vomiting
  • Numbness
  • Pain and swelling at the site of the bite
  • Paralysis
  • Shock
  • Bad pronunciation
  • Difficulty swallowing
  • Swelling in the tongue and throat
  • Weakness
  • Changes in skin color
  • Damage to skin tissue
  • Stomach and abdominal pain
  • Weak pulse

First aid

Follow these steps to provide first aid:

1. Keep the person calm. Bring him the assurance that bites can be treated effectively in an emergency room. Restrict movement and keep the affected area below the level of the heart to reduce the flow of poison.

2. Remove any ring or constrictive object as the affected area may swell. Place a loose splint to help restrict movement in that area.

3. If the bite area begins to swell and change color, it is likely that the snake is poisonous.

4. If possible, monitor the vital signs of the person, such as temperature, pulse, respiratory rate and blood pressure. If there are signs of shock (such as paleness), put the person to bed, lift the feet more or less one foot (30 centimeters) high and cover it with a blanket.

5. Get medical help immediately.

6. If possible, take note of the color, shape and size of the snake. This can help with bite treatment. Don't waste time trying to hunt the snake, nor catch it or pick it up. If the snake is dead, be very careful with the head: a snake can actually bite (by reflex) for several hours after death.

It is not due

Take these precautions:

  • DO NOT pick up the snake or try to catch it.
  • DO NOT wait until symptoms appear if bitten. Seek immediate medical attention.
  • DO NOT allow the person to strain too much. If necessary, sail to a safe place.
  • DO NOT apply a tourniquet.
  • DO NOT apply cold packs to the place of the bite.
  • DO NOT apply ice or soak the wound.
  • DO NOT cut the bite area with a knife or a razor blade.
  • DO NOT try to suck the poison with your mouth.
  • DO NOT provide stimulants or pain relievers to the person, unless the doctor so says.
  • DO NOT give the person anything by mouth.
  • DO NOT lift the place of the bite above the level of the person's heart.

When to contact a medical professional

Call 911 (United States) or your local emergency number if someone has been bitten by a snake. If possible, call the emergency room in advance so that they have the antidote ready when the person arrives.

The local toxicology center can also be called by calling the national direct line Poison HelpВ (1-800-222-1222) from anywhere in the United States. This national line will allow you to speak with poisoning experts. They will give you additional instructions.

It's about a free and confidential service. All local toxicology centers in the United States use this number. You should call if you have any concerns about poisonings or how to prevent them. It does NOT necessarily have to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Prevention

To prevent snake bites:

  • Avoid areas where snakes can hide, such as under rocks and logs.
  • Although most snakes are not poisonous, refrain from grabbing them or playing with them, unless you have the proper training.
  • Do not provoke snakes. This is the way many serious bites of these animals occur.
  • Score with a cane where you will pass before entering an area where you cannot see your feet well. Snakes will try to avoid it if they are warned enough.
  • When hiking to areas where it is known that there are snakes, wear long pants and boots, if possible.

WHAT TO DO BEFORE A SNAKE BITE

In case of suffering a snake bite, the Ambuibérica Foundation recommends following these steps:

- Try to reassure the victim

- Prevent the person who has suffered the bite from moving or making movements of the affected area, which should be kept below the level of the heart to reduce the flow of the poison

- Call emergency services (112)

- Remove any object that can press the affected area (watch, ring, bracelet)

- If possible, take note of the shape, size and color of the snake

WHAT YOU DON'T HAVE TO DO

The Ambuibérica Foundation advises not to carry out any of these actions:

- Do not pick up the snake or try to catch it, even if it had killed it, as it may bite, by reflex, even if it has been dead for several hours.

- Do not allow the victim to make efforts.

- Do not apply turnstiles as they can cause gangrene.

- Do not cut the bite area, as infections and persistent bleeding may occur.

- Do not suck the affected area, it is also subject to poisoning.

- Do not apply ice to reduce swelling or pain, as it can necrotize tissues.

- Do not give the victim anything orally, nor aspirin or anti-inflammatory.

- Do not raise the bite area above the level of the victim's heart.

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In the Iberian Peninsula, 13 species of ophidians are located, which every year cause 140 bites that require health care, compared to 8,000 registered throughout Europe.

Although snake bites are rare, they are still one of the emergencies that are treated in our country. In fact, every year 140 people require health care for the bite of an office, compared to the 8,000 cases registered in the European continent.

Given these data, the Ambuibérica Foundation, which recalls that in the Iberian Peninsula there are 13 different species of ophidians, specifically of the families of the vipéridos and of the colúbridos, wants to draw the attention of the population on the degrees of poisoning, its manifestations systemic and what to do in case of snake bite.

Degrees of poisoning

There are four degrees. The slightest is grade 0, in which there is no poisoning, but there are marks of the reptile's fangs and slight pain. In grade 1 there is light poisoning and, in addition to the animal's marks, severe pain and local edema. When a grade 2 is diagnosed, there is moderate poisoning, with progressive edema, severe pain and systemic manifestations (hypotension, nausea, vomiting, dizziness and diarrhea). Finally, grade 3 accounts for severe poisoning, edema in the limb, very severe pain and severe systemic symptoms (acute renal failure, respiratory failure, shock, neurological disorders and intravascular coagulation).

What to do?

In the event that a person is bitten by a snake, the Ambuibérica Foundation recommends following the steps below: try to reassure the victim, prevent the victim from moving or making movements of the affected area, which should be kept below the level from the heart to reduce the flow of the poison, call the emergency services (112), remove any object that can oppress the affected area (watch, ring, bracelet ...) and, if possible, take note of the shape, size and the color of the snake.

What not to do?

Among the actions that the Ambuibérica Foundation advises not to do in any case are the following: not picking up the snake or trying to catch it, even if it had killed it, because it may bite, by reflex, even if it has been dead for several hours, not allow the victim make efforts, do not apply tourniquets because they can cause gangrene, do not cut the bite area (infections and persistent bleeding can occur), do not suck the affected area (we can also poison ourselves), do not apply ice to reduce swelling or pain As it can necrotize the tissues, do not give the victim anything by mouth, or aspirin or anti-inflammatory drugs, and do not raise the bite area above the level of the victim's heart.

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  • Summary
  • Keywords
  • Abstract
  • Keywords
  • Introduction
  • Summary
  • Keywords
  • Abstract
  • Keywords
  • Introduction
  • Clinic
  • Supplementary tests
  • Severity of the poisoning
  • Grade 0
  • Grade 1
  • Grade 2
  • 3rd grade
  • Prehospital management
  • Treatment
  • Therapeutic scheme
  • We should also know
  • What is viperfav and how is it administered?
  • What to do in pregnant women?
  • What to do in children?
  • What to do before a compartment syndrome?
  • What happens after hospital discharge?
  • Bites by exotic snakes
  • Discussion
  • conclusion
  • Conflict of interests
  • Bibliography

The viper bite is, by far, the most frequent official accident in our country. It causes between 100 and 150 annual income in Spain, being difficult to know the real number of emergencies treated for this reason. A correct classification of the degree of poisoning and the use of antivenoms are the key to an adequate management of the situation. Currently, controversies about the use or not of antivenoms are being overcome due to their high purification, the decrease in allergic reactions they produce and their therapeutic efficacy.

This article intends to be an update on the emergency care of this condition, clearly exposing the possibilities of treatment.

Viper snake bite is, by far, the most common ophidian accident in Spain. It is responsible for between 100 and 150 hospitalizations per year in this country, although it is difficult to determine the frequency of emergency admissions due to this cause. The cornerstone to their approach rests on the correct evaluation of the possible effects derived from envenomation and the use of anti-venoms. In spite of all the controversies surrounding the use of anti-venoms, they have become a powerful therapeutic weapon ever since the serum has been highly purified and the great decrease of related anaphylactic reactions.

The aim of this article is to update the emergency room procedures when viper bites are suspected, and to clarify the main therapeutic recommendations.

The official accident in Spain can be caused by a snake bite, snake or an exotic species imported from another country.

Of the dozen snakes that inhabit the Peninsula, only the bastard (Malpolon monspessulanus) and that of cogulla (Macroprotodon brevis) are poisonous 1. However, due to the posterior placement of their inoculatory teeth (opistogliphal dentition) it is uncommon for them to inject poison.

Thus, if we exclude non-native snakes, the official accident in Spain is practically synonymous with a snake bite. The viper inoculation system is the most advanced, having long and retractable front fangs with which they introduce the poison in depth voluntarily (solenoglyphic dentition).

In Spain there are 3 species belonging to the genus Vipera: the viper ásp> (Vipera aspis) is present in the Pyrenees, practically throughout the pre-Pyrenean area, from Barcelona to the north of Burgos, the Ebro valley in its upper and middle sections, and the northern Iberian system. The snout viper (Vipera latastei) is found in southern Galicia and south of the Cantabrian and Pyrenean mountain ranges, is absent in the northern extremes of the provinces of León, Palencia and Burgos, and in the commune> (Vipera seoanei) inhabits in almost all of Galicia, coastal areas of the Cantabrian, mountain areas of the Atlantic climate of the north of León, Palencia, Burgos, Álava and Navarra, and also at the western end of Zamora.

Geographical distribution of vipers in Spain.

As in the rest of Europe, the most frequent location of the bite is the upper limb (> 60%) 2, especially in the hand and around the first corner. It is believed that this is so because they are not aggressive, but attack when they feel threatened.

The ophidians hibernate, so the bites occur from March to October. The months from May to August are the ones with the highest incidence, especially around the summer solstice.

The clinic is usually locoregional in nature, systemic symptoms rarely occur, and if they do, they are usually not serious. Signs and symptoms that indicate severity appear practically from the beginning, and the severity of poisoning increases in the first 12-24 hours.

Usually, in the place of the bite 2 inlets are visible separated from each other by more than 6 mm, they are the marks of the fangs. Only one can be seen, either because he has not managed to bite with the 2, or because he lacks it. A med> cm. Non-venomous snakes are characterized by leaving several rows of wounds, since their fangless marks are uniform.

Typical signs are manifested in the first 10 min, and it is uncommon that they have not appeared> min.

The first symptom is severe pain, which is constant when poisoning occurs. If it is mild or absent it will make us suspect that it has not been produced> h can be considered as lack of poison inoculation.

After the onset of pain begins an edema in the area. The evolution of inflammation and edema can be correlated with the severity of the poisoning. And it will be this, along with systemic symptoms, that will be used to classify it. Vasomotor alterations caused by venom frequently cause changes in skin coloration, with violet or cyanotic macules alternating with other pale areas. Interstitial damage can be so severe that vesicles or interstitial hemorrhages appear and be accompanied by ecchymosis, lymphangitis and adenopathies. Edema and ecchymosis, following a lymphatic pattern, can cover the entire limb and, in severe cases, even pierce the limb and reach the trunk. Although exceptionally, a compartment syndrome may develop in the affected limb.

The general symptoms often go unnoticed if we do not give them due importance. Vomiting, malaise, arterial hypotension, diarrhea or abdominal pain may occur. The presence of general symptoms, although these are banal, indicate severity in poisoning. Systemic complications, such as renal failure, rhabdomyolysis, haemorrhage or DIC, due to a poor evolution of a severe poisoning picture, do not usually occur in the area of ​​urgency.

Neurological symptoms have been seen by bite of Vipera ammodytes in Europe and lately in Vipera aspis in France 5, but not in Spain. The most common symptom is palpebral ptosis, although any cranial nerve can be affected.

In a very unusual way, the venom can cause an anaphylactic reaction and cause shock, which will manifest itself with the usual clinic of marked hypotension, paleness, dizziness, coldness, etc., which has nothing to do with the severity of the poisoning but requires a immediate action

Analytics is the complementary test that most helps estimate the severity of poisoning. It must be complete and incorporate at least hemogram, coagulation and biochemistry with renal function. You can have leukocytosis, thrombocytopenia, coagulation abnormalities and anemia (this is late) directly caused by the poison. Severity criteria are leukocytosis greater than 15,000, a thrombocytopenia less than 150,000, an activity> mg / dl 6.

It is convenient to repeat the analysis in the first 6 hours, since at this time there will have already been hematological alterations that tell us if poisoning is important.

Severity of the poisoning

A correct classification of the degree of poisoning is the basis that will allow us to decide which driving pattern to follow, especially in 2 issues: the indication of antivenom and the need for admission.

Studies have been carried out using ELISA techniques to measure the concentration of venom in plasma, being able to correlate the clinical course with the results. At the moment these techniques are experimental and cannot be applied in emergency situations 7.

The bite has not inoculated poison, so we will only see the fang marks. It is commonly called "dry bite," and it is estimated that half are of this type, since the snake needs a lot of energy to create poison and reserves it for when it thinks it really needs it. The clinic is of moderate pain limited to the area of ​​the bite.

In this case> h has been produced. The concentration of venom in blood is around 1 ng / ml.

When the inflammation crosses the local area, but without overflowing the limb> h after the bite, but usually they begin at 6 h, and can even do so early half an hour after the bite. Serum determinations reveal that the average level of poison is around 5 ng / ml. In the analytical alterations such as leukocytosis, thrombocytopenia and a decrease in fibrinogen, which are detected in the first 24 h. Although neurotoxic> Vipera aspis has not been described in France 9, so we should know the possibility of its appearance. The classic symptom is ptosis, but ophthalmoplegia, dysphagia or dysarthria, and even lethargy or vertigo may also manifest.

In some cases the inflammation crosses the limb> ng / ml.

It is essential to reassure the patient and his family environment. The wound will be washed with serum and soapy antiseptic and a soft bandage with moderate limb elevation will be placed. Pain treatment is imperative, since it is the most pronounced symptom in the initial phase. No other type of measures is necessary, since they have not demonstrated effectiveness.

Knowing if the bite was due to a snake or snake will mark the need for a hospital referral, which is achieved through exploration and interrogation about the characteristics of the animal, however, it is not necessary to know the species, since the treatment It is similar in all of them.

In the 90s the use of antivenoms was questioned and in parallel a management was consolidated aimed at treating the symptoms and performing prophylaxis of the problems derived from inflammation.

Currently the consensus in Europe in favor of the faboterápicos is increasing, based on a good tolerance and its great effectiveness. After the commercialization of highly purified immunoglobulin fragments, there is a return to their use, although reserved for moderate and severe poisonings.

The effectiveness of complementary treatments has been studied, concluding that many of them do not provide benefits. In fact, the biggest problem comes when symptomatic treatment is used as the main treatment, since by not acting on the cause, poisoning develops in all its intensity, and serious complications can occur.

Several studies show that antibiotic prophylaxis is not effective 10, so the use of antibiotics is reserved for the appearance of infection in the area.

On many occasions corticosteroid> 11 have been administered. Its use is justified only in case of symptoms related to allergic complications, such as anaphylactic reactions, or later, for serum sickness.

The administration of low molecular weight heparin has been associated with a longer hospital stay and a greater persistence of discomfort at 15 days. Therefore, it would only be justified in prolonged immobilizations with significant inflammation in the lower extremities and for the treatment of a disseminated intravascular coagulation syndrome.

We must reassure the patient, since it is a picture that causes a lot of fear in them and their relatives. In addition to informing that it is not a deadly process, we can add some anxiolytic.

Tetanus prophylaxis is necessary, depending on the state of immunization. Although no case of tetanus has been published in Europe for this cause, there is a theoretical risk of being a bite.

It is important to thoroughly clean the area with some soapy antiseptic. The application of a soft bandage throughout the limb helps immobilization, providing a feeling of protection to the patient.

The bites are very painful, so they should always be given pain relievers, sometimes every 4 hours due to the intensity.

We will obtain a complete analysis with blood count, coagulation and biochemistry, including fibrinogen and renal function.

Depending on the degree of poisoning, the handling will be as follows:

In these cases, the absence of pain is striking. A profuse washing of the her> h is sufficient.

When significant pain and local inflammation appears, it should be monitored for a minimum of 24 hours, to verify that there is no progression of the condition. This control can be carried out in a> h, just prior to discharge.

In mild poisonings it is not necessary to administer antivenom. We should only be attentive to signs that indicate that we are facing more severe cases, such as analytical alterations, the presence of mild systemic symptoms and the progression of edema towards the rest of the limb.

The management of these patients requires admission, with stays that are around 2 or 3 days, during which we will repeat the analysis daily, trying to have a recent one, prior to discharge.

Treatment in these cases, apart from antivenom, will be aimed at managing complications. Depending on the patient's condition, it may be necessary to enter an intensive care unit, for the support measures required.

Table 1 summarizes the management of patients bitten by vipers.

Viper bites

To allReassure the patient (midazolam) and the family
Wash and cure with antiseptic, soft bandage, moderately elevated limb
Tetanus according to previous immunization
Analgesia (every 4 hours if necessary)
Severity of poisoning (blood poison)Local symptomsGeneral symptomsAnalyticsMain treatmentDo you need income?
Grade 0: dry bite (1 ± 0.3 ng / ml)Mild or moderate localized pain. Fang markDo notWithout modificationsCleaning and cure with antisepticObservation 4-6 h
Grade 1: mild (5 ± 1.8 ng / ml)Moderate local edema, which does not exceed the area of ​​the biteDo notWithout modificationsCure bandage24 h observation
Grade 2: moderate (32 ± 7 ng / ml)Important inflammation that covers the entire member without overflowing it. LymphangitisMild Nausea, vomiting, mild hypotension, diarrhea, abdominal pain, neurological symptomsLeukocytosis> 15,000. 150,000 thrombocytopenia. Fibrinogen 200,000 mg / mlUnofficial serumEntry
Grade 3: severe (126 ± 50 ng / ml)Very important inflammation that exceeds the limb and reaches the trunkSerious IRA, CID, hemorrhages in different organs, shockSevere electrolyte imbalance, major coagulation disordersSerum antiofídico. Treatment of complicationsIncome / ICU

Its administration must be carried out under medical supervision, as it contains heterologous proteins and there is a risk of an anaphylactic reaction. It has been shown that the intravenous route causes a rapid> ml of physiological serum and the infusion rate will be 50 ml / h.

What to do in pregnant women?

What to do in children?

In children the risk of serious poisoning is greater because having a lower body weight, the concentration of blood poison is always higher. They are, therefore, a group of special indication in the administration of antivenom serum. The dose is exactly the same as for adults, that is, a vial.

What to do before a compartment syndrome?

Rarely, an increase in pressure inside the muscle compartments may occur. The difficulty res> 16. There are no prospective studies comparing the efficacy of fasciotomy against the use of anti-ophidic serum, although numerous publications and experiments with animals would endorse an initially medical approach 17.

What happens after hospital discharge?

Patients have to be evaluated in about 7-10 days to verify their status and maintain an analgesic treatment if necessary. This is because functional discomforts that last for weeks and, in some cases, months may persist. At the same degree of poisoning, residual discomfort is minor if antivenom has been used.

Although not very frequent, the appearance of a rare hypersensitivity reaction> iii, called serum sickness, is possible. Its symptoms include fever, rash, hives, arthralgias, adenopathies, as well as headache, nausea and vomiting. It usually starts between 7 and 21 days after the administration of the trigger agent, so we must be careful to identify and treat it.

Bites by exotic snakes

The management of bites by exotic snakes greatly exceeds the objective of this article. Of these we will only say that the identification of the species and the treatment with specific antisera are necessary in sufficient quantity to be effective. In these cases, the most complicated thing is to obtain this antiserum, since Spanish hospitals lack them. At the present time there is no protocol that allows a supply if necessary. A possible emergency solution may be to contact zoos with their own supply of antidotes, such as the Madrid Zoo, the Barcelona Zoo, Terra Natura or Adibo. This supply channel raises problems of all kinds, but in the absence of another means of urgent distribution, a particular agreement between the hospital and the zoo may be the only viable option.

Table 2 shows the indications for special situations and the method of administration of Viperfav ®.

Viperfav ®Type F (ab ’) 2 Fabotherapeutic of equine origin
4 ml vial
Refrigerated storage
Intravenous administration with medical supervision
One vial diluted> ml of physiological serum
Slow infusion (50 ml / h)
Special casesAntivenom serumDiscussionDose
Pregnant womenYesHigher risk of fetal damage from poison than from antivenomA vial
ChildrenYesSame amount of poison in smaller continent, so there is a greater degree of poisoningA vial
Compartment syndromeYesIntracompartmental pressure measurement, antivenom, mannitol 1 to 2 gr / kg, reevaluate hourly, if at 4 h it has not normalized: fasciotomyOne vial can be repeated at 5 h
Exotic snakesYes. Specific to each species and at a sufficient doseIt is necessary to know the species to get the specific antivenom. Contact the zooDepending on the degree of poisoning and the type of antivenom. Normally, many vials

In the 1990s antivenoms ceased to be used largely in Europe due to doubts about their efficacy and the risk of anaphylactic reactions. Since the manufacture of highly purified immunoglobulin fragments, their use in moderate and severe poisonings once again has strong support. The consensus in favor of immunotherapy is based on excellent tolerance and the benefits of early application, intravenously and at sufficient doses. El antiveneno reduce la morbilidad, las complicaciones, las secuelas posteriores y el tiempo de hospitalización.

No parece útil ni el uso profiláctico de antibióticos ni la administración de corticoides para disminuir el edema. La utilización de heparina de bajo peso molecular solo estaría justificada en los casos de necesidad de tratamiento de complicaciones vasculares o inmovilizaciones prolongadas. Las medidas físicas, como torniquetes o vendajes apretados, pueden ser un mal en sí mismos, de igual forma que lo son cauterizaciones, succiones o incisiones en el lugar de la mordedura, por lo que deben evitarse en todos los casos.

El tratamiento de un síndrome compartimental producido por veneno se ha tratado con fasciotomías hasta que diversos estudios en animales y el uso de faboterápicos modernos han cuestionado su utilidad. Debido a que la causa es controlable médicamente, es la excepción que confirma la regla, aconsejándose inicialmente un manejo médico mediante faboterápicos.

Después de las dudas generadas sobre los antivenenos en los años 90, que propiciaron terapias de soporte que se han revelado ineficaces, es necesario establecer un manejo claro de los pacientes apoyándonos en su grado de envenenamiento. En realidad, el problema no reside en si se administran o no corticoides o profilaxis antibiótica, el riesgo real para el paciente es si los usamos «en vez de».

Partiendo de la evolución de los síntomas locales, la presencia o ausencia de síntomas generales y la aparición de alteraciones analíticas, debemos hacernos las 2 preguntas más importantes para su manejo en Urgencias: ¿precisa ingreso?, ¿necesita suero antiofídico? Si somos capaces de responderlas de forma adecuada, la probabilidad de que el paciente presente complicaciones se reducirá notablemente.

Conflicto de intereses

Los autores declaran no tener ningún conflicto de intereses.

Reducir el riesgo

Para los expertos, una de las cosas mбs importantes es tomar las medidas adecuadas para disminuir el riesgo de picaduras de serpientes. Antes de ir a un бrea de montaсa, los autores de este trabajo recomiendan "sacar toda la informaciуn sobre la presencia de serpientes en la zona y los tipos". Ademбs aconsejan, si es posible, "llevar fotografнas a color de las serpientes, lo que facilitarб las labores de rescate posteriores en caso de que alguien sea mordido".

Las medidas de prevenciуn tambiйn deben incluir ropa holgada y gruesa, botas altas y calcetines gordos, que pueden dificultar la mordedura a las serpientes. Otros consejos de los especialistas consisten en observar cuidadosamente el terreno antes de sentarse o montar la tienda de campaсa, tentar la tierra con un bastуn antes de pisar y evitar poner las manos en zonas donde pueden esconderse estos reptiles –rocas, hierba larga o troncos-. Tambiйn seсalan la importancia de revisar las bolsas y mochilas con cuidado antes de meter la mano, ya que puede haber un habitante inesperado.

Dario Svajda, de la Comisiуn Mйdica de Equipos de Rescate en la Montaсa y uno de los autores de la revisiуn, indica a elmundo.es que "hay que moverse lentamente si estamos ante una serpiente, sin hacer movimientos bruscos". Ademбs, los expertos destacan que "si alguien ve una serpiente no intente cogerla o matarla, ya que es durante estas acciones cuando ocurren muchas de las mordeduras". En algunos casos, el veneno permanece activo hasta bastante tiempo despuйs de la muerte del reptil, por lo que tampoco conviene tocarlo en esas circunstancias.

Antнdoto: їsн o no?

La decisiуn de llevar o no un antнdoto contra el veneno de serpientes depende de varios factores: el peligro real de picaduras de serpientes, las caracterнsticas del terreno, que puede complicar o retrasar las labores de rescate, la presencia de alguien que sepa cуmo administrar el veneno y lidiar con las posibles complicaciones que surjan y los recursos econуmicos de los excursionistas.

Ademбs, se debe contar con la infraestructura necesaria en el caso de decidir llevar un antнdoto, ya que requiere unas condiciones de transporte que garanticen que el producto no se va a estropear.

En cuanto a las reacciones adversas al administrar el antнdoto, йstas se registran entre el 5% y el 80% de los pacientes.

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