Treating snakebite without antivenom

What type of location? What type of snake?

(I believe that with a lot of venomous snakes, in the absence of antivenom there is unlikely to be a good outcome. Thousands of people die of snakebite across the world every year.)

There are three groups of venomous snakes in southern Africa – cytotoxic, neurotoxic and haemotoxic. The best to hope for would be a dry bite with very little toxin released into the bloodstream.

What the doctor might try:

• Remove constricting clothing, rings, bracelets, bands, shoes, etc. from the bitten limb/area.
• Immobilise the patient.
• In suspected neurotoxic bites, especially if the patient is far from medical help, apply a tight crepe bandage over and proximal to the bite site. This procedure may reduce rapid distribution of the venom. Avoid crepe or other bandaging in all cytotoxic bites.
• The classic ‘pressure-immobilisation technique’ demands special equipment and training and is considered not practicable for general use in South Africa.
• A tight arterial tourniquet should NEVER be used! The dangers of tourniquets include the development of ischaemia and gangrene if they are applied for more than about 1½ hours.
• In suspected neurotoxic snake bites, the patient should be assessed regularly (every 10 - 15 minutes) for the development of complications of neurotoxicity.
• Cardiopulmonary resuscitation (CPR) may be needed. This includes clearance of the airway, oxygen administration by face mask or nasal catheters, and establishment of intravenous access. If the patient is unresponsive and no respiratory movement is detectable, start CPR. In case of respiratory distress/failure: clear the airway, lift the chin, give oxygen by face mask or nasal catheters with or without assisted ventilation and consider the need for endotracheal intubation. Shocked, hypotensive patients should be given intravenous fluids. Pressor agents, such as dopamine or phenylephrine may need to be administered.
• Give analgesia by mouth if required: paracetamol (acetaminophen) or paracetamol/codeine combinations are preferred. Aspirin and other non-steroidal anti-inflammatory agents should be avoided in patients with haemostatic disorders. When using parenteral opioids in neurotoxic snake bite, respiratory function should be monitored closely.
• In the cases of berg adder bite, hyponatraemia should not be treated by means of fluid restriction, but rather by a titrated infusion of hypertonic saline. In this respect the administration of normal saline may prove useful as a means of partially meeting both fluid and salt requirements.

I know the above sounds horribly complicated and I went to local websites hoping for something simpler. But snake bites have certain pathogens and neurotoxins, anti-coagulant properties etc that make treatment extremely complex. What might work is for the girl to get venom in her eye from a spitting cobra or the interplanetary equivalent: she might lose some vision but her eyes could be washed out and bandaged. A bite on the hand would mean the loss of an arm, paralysis, heart failure or death.

It might be helpful if we know if the girl should live or not. Not that that info will help me help you, but it might help others

Have her simply live after the bite. Basic treatment might include sucking the wound, either with a snake bit kit or orally. It's worked in a lot of cases where antivenin wasn't available. She can be in a delirium for a few days, wake up in rough shape but survive.

Jeff

Comfrey is used as a poultice to draw out infections. I am sure there are other plants that are used as well. Since this is a fantasy world, you could have your doctor know herb lore, take a plant and use it to draw the poison out of the wound after the initial removal with some type of device to "suck it out". The plants would have a dual benefit of possibly stopping the destruction of surrounding tissues caused by the poison so she is not disfigured.

If you don't want the girl to lose her life or body parts, I wonder if the creature has to be a snake?

I believe spiders and scorpions are venomous to varying degrees. Your bad guy might possibly mis-identify a spider/scorpion, thinking it more venomous than it actually is. The girl could still have a nasty reaction, but perhaps not a catastrophic one. Also your fantasyland might also have its own venomous denizens and you could think of making up whatever suits your plot.

PS I think your scenario sounds interesting.

To get a little convoluted, but to get tricky medical treatment out of the story - is the hopeful killer a snake expert?
Maybe he mistook the really venomous snake for it's less venomous, but filthy-mouthed fellow snake? He grabs up the less venomous snake by mistake, it bites her, there's the initial panic of "Oh, she's been bitten by a deadly snake! What can we do?", followed by the relief of a local expert saying "No, it's not the deadly killer asp, it's the almost-identical non-poisonous jack asp!"

Followed, unfortunately, by "Get a doctor, quick, it's mouth is full of bacteria, she's already infected! We must do something immediately!"

I have seen people sitting in Outpatient IV departments with red streaks running up their swollen hands because domestic house-cats bit or scratched them. Mouths can be filthy. They say the human mouth is bad, so I wouldn't be surprised that an alien snake's is worse. However, antibiotics are easier to hand-wave than antivenin.

Marian Perera said:

Oh, that could work. The whole point of the scene is for someone to try to kill her with the snake, and the doctor saves her. The exact mechanism of the venom's delivery is up for grabs.

It's also necessary for her to be confined to bed for a few days afterwards, with the doctor continuing to treat her/monitor her condition, but I'm sure that could happen even if she got the venom in her eyes.

One thing, though: a few days later, she needs to be able to read something. Is it plausible that the snake could blind her in just the one eye?

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Of course. All it has to do is just hit one side of her face and miss the other.

I think that you might be over thinking this though. If the whole point is to get the girl laid up for a few days, then she gets bit and survives. Maybe the snake didn't inject a full load of venom. Maybe the girl just gets lucky. Whatever - she spends a few days desperately sick and under the doctor's care while she rides out the recovery from the venom.

Following up. If someone is serious about murdering this girl, then planting a spitting cobra in her sleeping roll or tent or backpack is not implausible. What might happen is that the girl hears the cobra move (snakes can give tiny cries as they rear up) or a rustling noise and jumps back. A spitting cobra is able to direct venom accurately as far as two metres. The speed of the strike is very fast. If left untreated, this would result in blindness.

The girl would feel as if she had gritty sand mixed with a burning liquid in her eye. Ideally, the doctor reaches her almost immediately and has a water bottle (the snake has slithered away). He flushes away the venom from her eyes and face ( no harm done to skin). Then calls for more water and keeps flushing out the eye. If there is no access to water, then milk, beer, cold drink or even urine can be used, but water works best. There is no evidence that milk is more effective than water. She will need to lie in bed for a few days (she is also suffering from shock) and the eye would heal without corneal damage.

Marian Perera said:

Thank you! I decided to go with a snake, mostly because it's bigger. The snake is hidden in a crate filled with clay jugs that is carried to a location where it's unpacked. So my concern is that something small, such as a spider, might either get crushed by these jugs shifting around, or might find it easier to hide in a corner of the crate rather than being angry enough to attack the first person who reaches into the crate.

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This past Winter, I bought a bag of grapes from my local grocer. I was two-thirds through the bag after three days when a flippin' spider crawled out of it as I lifted it from the fridge!

Of course, that spider didn't bite. Still, even though I'm a fan of spiders (they kill the REAL bugs!), I jumped something fierce. I had jittery nerves all the way down to my pinkie toes.

*SQUICK WARNING*

Something to consider while working on this: the effects of venom on human blood.

I first saw this about five or six years ago and thought, Interesting but I'll never have a need to find this again!

Surprise.

Good news/bad news time:

- Bad news: I have a book of poisons (it's from the "howdunit" series and it's my favorite) and I recall most venomous snakes you're pretty much reduced to trying to manage the symptoms, if you don't have an actual antivenin. I also recall from other sources that antivenins are not the most reliable or pleasant of things.

- Good news: Snakes have control when they're biting/spitting. They know how much of their venom it will take to accomplish their goal and they can control it so they don't use more than necessary. If the snake doesn't want her dead, she'll be fine.

(Hi I love snakes though I haven't done any reading on them in far too long. In fairness, I've hardly done any reading in far too long.)

As the old saying goes, "the dose makes the poison." So, arrange it that she doesn't get a full bite. The snake might just graze her hand because she was recoiling. It might have hit her with one fang not both, or even had bitten something else recently (perhaps striking into whatever the villain used to catch it), and hadn't replenished its venom yet.

It's not like snakes can pop down to the venom store after using their current stock. Their bodies must manufacture a new supply, and that takes time. If, say, they spent some biting into a glove as they were caught, they would have less to inject the character.

Twick said:

As the old saying goes, "the dose makes the poison." So, arrange it that she doesn't get a full bite. The snake might just graze her hand because she was recoiling. It might have hit her with one fang not both, or even had bitten something else recently (perhaps striking into whatever the villain used to catch it), and hadn't replenished its venom yet.

It's not like snakes can pop down to the venom store after using their current stock. Their bodies must manufacture a new supply, and that takes time. If, say, they spent some biting into a glove as they were caught, they would have less to inject the character.

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Very nice

Figuring out the effect of a snake bite gets complicated. Full disclosure: I am a former zoologist.

As an aside, my professor for Herpetology (reptiles and amphibians) had a hilarious story about a guy who needed to answer the call of nature in the woods. He dropped his pants and hung his butt over a log to do so, but the rattlesnake resting there took objection to being dumped on and that butt offered an easy target.

Anyway, the guy lived even though his hunting buddy declined to suck the venom out from the wound.

Some factors involved in what happens after a venomous snake bite:
1. Did the snake actually inject venom? As another poster has suggested, venom is metabolically expensive to produce, and snakes instinctively conserve it. Many warning or defensive bites from poisonous snakes, in other words, not aimed at prey, do not include the injection of venom at all. That's how the guy in my professor's story lived.
2. How deep was the snake's bite? Did both fangs get in or did one or more simply scrape the surface? Also, contrary to widespread belief, not all venomous snakes have hollow fangs. Some get the venom in via flow along a side groove in the fang. As a result, the "quality" of the bite can make a big difference in how much venom makes it into the target.
3. What's the size of the snake, and what's the size of the victim? The first controls the maximum amount of venom that might go in, and the second affects how much of an effect, and how quickly, that venom will have. This makes a child much more vulnerable than an adult.
4. What's the nature of the venom? There are the three basic types mentioned by another poster, but most snakes have a mix of components, for example, the venom might be mostly neurotoxic but also have some haemotoxic components. Also, the mix and nature of the components can vary based on the usual prey of that snake species. For example, the venom from those snakes specialized in eating amphibians won't have the same effect on mammals, such as humans, as the venom of snakes that specialize in eating rodents.
5. The extent of the victim's physical activity after the bite, which influences how far and quickly the venom is distributed, and how soon after the bite there is knowledgeable medical attention.

So, if it's a small snake from a species specialized for "cold-blooded" (reptiles and amphibians) prey with a grooved rather than a hollow fang that did not get a firm hit on the girl's hand, and she gets medical attention right away that includes keeping her calm and inactive, it would be quite possible for her to survive even without anti-venom. There would certainly be tissue damage, probably considerable, and it would take a long time to heal. I would be willing to bet, however, that the majority of venomous snake bites of a human child that include the injection of at least some venom would result in death, so you need to have the facts necessary to credibly get your situation out of the likelier result.

One option you have is to use a poisonous lizard rather than a snake. They have only grooved, not hollow, fangs, and need to get a really good bite and hang on for a while before enough venom gets in so the bite will be fatal.

My neighbor's son is a soldier in Eastern Ukraine. Last year he told a story about another soldier who was bitten on the hand by a viper. Apparently they were not in a position in which they could get to a hospital or doctor, and the soldier directed his friends to immediately amputate the finger on which he was bitten. And he lived with no ill effects from snake venom (he lost his index finger, though, and wasn't able to get out for treatment for a few days).

edit: I just reread this and realized how crazy it sounds, so I'd like to add that I actually do live in Ukraine.