Rasmussen AR, Murphy JC, Ompi M, Gibbons JW, Uetz P (2011)

First Aid for Belcher's Sea Snake Bite

Article
Brain & Nerve
First Aid
+7
Contributed byKrish Tangella MD, MBAApr 22, 2019

IMPORTANT INFORMATION: Read This First

All Sea Snake Bites should be evaluated by a trained medical professional, as early as possible. Failure to obtain prompt evaluation and appropriate treatment may result in severe complications and/or death.

DO NOT WAIT!

Call 911 (within the US) or your local emergency number immediately, if you experienced a Sea Snake Bite.

What is Belcher’s Sea Snake Bite?

  • The Belcher’s sea snake is a highly venomous snake that is usually found along seashores and coral reefs in the South China Sea, Celebes Sea, and western Pacific Ocean regions
  • The snake may average around 3 feet in length and has a small head and neck, light yellow to gray colored body with wide dark bands and a flattened tail
  • Like many other sea snakes, the Belcher’s sea snake is a gentle reptile that tends to bite only when severely provoked or threatened

Belcher’s Sea Snake Bites usually take place unintentionally or inadvertently, when individuals come in contact with the highly venomous Belcher’s sea snake.

What are the Causes of Belcher’s Sea Snake Bite?

The cause of Belcher’s Sea Snake Bite may include:

  • Residing near coastal regions in the endemic regions
  • Occupational hazard: Fishermen and fisherwomen, while sorting fish, setting out fishing nets, pulling in the ‘catch’
  • Swimmers, surfers, divers, and beachgoers are prone to a higher risk in the endemic areas
  • Wading in ocean waters without suitable protective clothing
  • Walking barefoot on the beach or in shallow sea waters
  • Amateur and scientific marine life explorers who come into contact with sea snakes
  • Keeping them as pets in aquaria

What are the Signs and Symptoms of Belcher’s Sea Snake Bite?

The signs and symptoms of a Belcher’s Sea Snake Bite may depend on the quantity of venom injected. It can vary from one individual to another and may be mild or severe.

These include an initial set of symptoms such as:

  • Minimal to no pain at the bite site, including the absence of any swelling
  • Bite or fang marks on the affected limb may be visible (the puncture marks on skin may be one, two, or more)
  • Bruising or redness is not generally observed
  • Muscle stiffness and tenderness
  • Fatigue and weak muscles
  • Body aches and muscle aches; joint pain
  • Anxiety and drowsiness
  • Blurred vision
  • Nausea, vomiting, and diarrhea
  • Thickening of tongue

It is important to note that the following three are the most commonly observed symptoms of envenomation by sea snakes (generally observed within 30-120 minutes of sea snake bite):

  • Droopy eyelids or ptosis
  • Swallowing difficulties or dysphagia
  • Flaccid paralysis (that involves poor muscle tone)

After 4 to 8 hours, the following symptoms may be observed:

  • Poor reflexes
  • Confusion
  • Uncontrollable salivation; drooling
  • Breathing difficulties
  • Speaking difficulties; difficulty in opening one’s mouth
  • Enlarged lymph nodes
  • Abdominal pain
  • Dark-colored urine
  • Blue-colored skin due to poisoning
  • Weakness and malaise
  • Dizziness
  • Unconsciousness

With severe venom injection, a host of systemic (neurological) symptoms and complications that include generalized muscle damage, paralysis of voluntary muscles, and organ damage (renal failure) may be noted.

How is First Aid administered for Belcher’s Sea Snake Bite?

If a sea snake bite is suspected, it is always important to call your local emergency helpline number (or dial 911 in the US) without any delay, and provide as much information as possible, even if the individual does not have any symptoms.

Until medical help arrives:

  • Remove the individual from the water; move him/her away from water (incident spot)
  • Expose the bite site by removing or cutting the dress material, if necessary
  • Do not immerse the wound in water, but wash it gently with soap and water, if possible. A sterile bandage may be used to cover the wound
  • Avoid unnecessary movement (running or walking) and try to keep the victim as comfortable and warm as possible; stay with the victim until help arrives to provide reassurance
  • Make a note of the exact time of the incident and notify the emergency medical personnel accordingly
  • Try to identify or locate the marine reptile (only if safely possible) and keep the medical personnel informed; if possible, try to take a picture of the snake using one’s mobile phone
  • If the snake is dead, then try to carefully take the snake in a safe container to the healthcare center for identification
  • Use pressure bandage to immobilize the affected site or limb, such that blood circulation is not cut-off; the pressure immobilization technique should be attempted by trained personnel only
  • Remove any jewelry, such as bangles, bracelets, wrist watches, and rings, from the limb that is involved before applying pressure immobilization
  • Further a splint (or stick) should be used to prevent the limb joints from bending
  • Avoid anything that can cause an obstruction in the airways
  • DO NOT give anything orally to the individual
  • Unless directed by the physician, DO NOT give any medication
  • Safely transport the affected individual to the nearest and appropriate healthcare facility (having expertise in snakebite treatment, if available)
  • Administer antivenom if available, and ONLY if a qualified healthcare provider is present

The following methods to help the victim SHOULD NOT be allowed or considered:

  • Shaking the affected arm or leg of the bitten individual
  • Forcing the individual to walk long distances (the victim should be carried, as far as possible)
  • Tying constricting bandages above the fang mark
  • Applying ice or pouring other liquids (alcohol) on the bite site
  • Applying heat packs or trying to burn the bite site (applying hot embers)
  • Immersion in hot water or oils
  • Cutting the wound in an attempt to wash away the venom
  • Sucking the bite wound, in an attempt to suck and spit out the venom
  • Applying topical creams/ointments or any chemicals such as potassium permanganate
  • Giving tea, coffee, or any alcoholic beverages to the victim (water may be given to keep the individual hydrated, if required)
  • Administering ANY form of traditional treatments, use of herbal/native medicines, or other unapproved treatment measures

It is important to note that pressure immobilization bandaging is not the same as providing a tourniquet, which is essentially a constriction of the body part to control blood flow for a certain period of time.

Information on administering antivenom:

  • Administration of antivenom serum (AVS) should be allowed only when there are identifiable signs and symptoms of local and systemic envenomation along with supporting laboratory test evidence
  • At many health centers, the antidote to snake bite envenomation is scarcely available and usually very expensive; thus, it is important to not waste such a life-saving resource
  • Also, in many individuals, there is a high risk for severe allergic reaction, such as anaphylaxis, to the antivenom that may even be fatal

Any indiscriminate use of antivenom serum either due to improper training and knowledge or under compulsion from the victim’s family or friends is therefore highly discouraged. Nevertheless, a qualified healthcare provider is best-placed to determine whether the administration of AVS is necessary or not in each and every specific case.

Who should administer First Aid for Belcher’s Sea Snake Bite?

  • The individual himself/herself or someone nearby may begin administering basic First Aid
  • Call your local emergency helpline number or 911 (within the US) immediately

Sea snake bites are generally painless (initially), may barely show any local swelling, and may go unnoticed by the victims. Nevertheless, for all cases involving actual or suspected sea snake bites, it is very important to immediately seek the advice, evaluation, and treatment of a qualified healthcare provider.

What is the Prognosis of Belcher’s Sea Snake Bite?

The prognosis of Belcher’s Sea Snake Bite is usually dependent on the following set of factors:

  • Site of bite and the amount of toxin injected
  • Age and overall health status of the individual
  • Timely manner in which antivenom is administered
  • Severity of allergic reactions, if any develop
  • Effectiveness of the treatment following admission

In many cases, with urgent first aid, prompt treatment and hospitalization of the victim, the prognosis is typically good. Without treatment or access to proper healthcare, deaths from severe systemic symptoms and complications from Belcher’s Sea Snake Bites have been reported.

How can Belcher’s Sea Snake Bite be Prevented?

A few helpful tips to prevent sea snake bites include:

  • Avoid touching or handling marine animals unnecessarily, especially sea snakes; in many cases, it is also difficult to distinguish between the head and tail of a sea snake (since they may look the same)
  • Educating fishing community about sea snakes, including on techniques to handle sea snakes entangled in nets, particularly in the endemic regions
  • Generally be aware and watchful of the waters you are in (seas, rivers, freshwater lakes, etc.)
  • Wear protective clothing if you plan to swim or dive in infested areas
  • If possible, try to move or swim away from areas where sea snakes are spotted
  • Do not ignore warnings of lifeguards or health officials at the beach
  • Do not probe into dark recesses and crevices of sea floors with your bare hands
  • Wear protective footwear while walking on beach sand
  • Ensure safety precautions while cleaning marine animal aquariums
  • Marine life study researchers and explorers are requested to carry marine first aid kits

What are certain Crucial Steps to be followed?

All sea snake bites should be considered as medical emergencies and accorded prompt attention with evaluation by trained medical professionals, as soon as possible, particularly in the first 4-8 hours.

Do’s:

  • Remove the victim immediately from the water
  • Call your local emergency helpline number (or 911) for help
  • When in doubt, wash the affected area with seawater and not freshwater
  • Immobilize the affected site (arm or leg)
  • Transport the victim without delay to an appropriate health center of care

Don’ts:

  • Do not hesitate to call your emergency help services
  • Do not waste precious time attempting to catch or kill the snake for identification purposes
  • Do not medicate the individual, unless advised by a healthcare professional
  • Do not move the affected region of the body too much
  • Do not run or exercise which might increase the circulation of toxin in the body
  • Do not elevate the affected area above the heart level, since this can also increase circulation of the toxin
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Krish Tangella MD, MBA

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