WHO lists snakebite envenoming as a neglected tropical disease. It estimates that between about 81,000 and 138,000 people die from snakebites each year, and around three times as many suffer amputations and permanent disabilities. Most victims are farmers, herders and children in rural Africa, Asia and Latin America. In Nigeria, the carpet viper (Echis ocellatus) causes many bites, particularly in the north, during the farming season. Nurses are often the first trained health workers to see a bitten patient.
First aid
- Move away from the snake. Don’t try to catch or kill it; a photo from a safe distance can help identification.
- Reassure the patient and keep them as still as possible. Panic and movement may speed absorption.
- Remove rings, watches and tight clothing near the bite, before swelling starts.
- Immobilise the limb with a splint, like a fracture.
- Get to a health facility quickly, ideally carried or by vehicle, not walking.
- Lie the patient on their side (recovery position) if they vomit or become drowsy.
What NOT to do
- No cutting or incising the bite.
- No sucking out the venom.
- No tight tourniquets: they can cause gangrene and do not help.
- No “black stone”, herbs, chemicals, ice, electric shocks or traditional remedies.
- No delay going to a health facility while trying traditional treatments.
Recognising envenoming
| Type | Typical snakes | Signs |
|---|---|---|
| Haemotoxic (bleeding) | Carpet viper, puff adder (vipers) | Bleeding from gums, bite site, old wounds; blood in urine; blood that doesn’t clot |
| Cytotoxic (local tissue damage) | Puff adder, spitting cobras | Painful, progressive swelling, blistering, tissue death |
| Neurotoxic (paralysis) | Mambas, some cobras | Drooping eyelids (ptosis), double vision, difficulty swallowing and speaking, weakness, breathing failure |
A spitting cobra’s venom in the eyes causes intense pain: irrigate immediately with large volumes of water.
The 20-minute whole blood clotting test (20WBCT)
A simple bedside test used widely in Africa and Asia. Place a few millilitres of fresh venous blood in a new, clean, dry glass tube, leave it undisturbed for 20 minutes, then tip it gently. If the blood is still liquid, the patient has venom-induced coagulopathy and needs antivenom. Repeat the test (commonly 6 hours after antivenom) to see if more is needed. Plastic tubes give false results.
Antivenom
- Antivenom is the only specific treatment. It is given IV when there are signs of systemic or severe local envenoming, as prescribed. It must be appropriate for the snakes of the region.
- Reactions are common. Have adrenaline drawn up and ready before starting, and monitor closely. See our anaphylaxis guide.
- Watch for early reactions (itching, rash, fever, wheeze, low BP) during and after the infusion, and for serum sickness (fever, joint pain, rash) 5–24 days later.
- Access and cost are major barriers in many countries. Nigeria has run snakebite treatment centres, including at Kaltungo General Hospital in Gombe State, a long-standing centre of expertise.
Nursing care
- Observations: vital signs, SpO₂, conscious level, and signs of bleeding.
- Neurotoxic signs: check for ptosis, swallowing and breathing; measure respiratory effort. Be ready for airway support and ventilation.
- Mark and measure swelling regularly to see if it is spreading; watch for compartment syndrome.
- Avoid IM injections and unnecessary needle sticks in patients with coagulopathy.
- Pain relief: paracetamol or opioids as prescribed. Avoid NSAIDs (bleeding risk).
- Tetanus prophylaxis as per policy; wound care; antibiotics only if infection develops.
- Fluid balance: watch for kidney injury (dark urine, low output).
Prevention in the community
- Wear boots and long trousers in fields; use a torch at night.
- Sleep on raised beds under nets; keep surroundings clear of rubbish and tall grass.
- Seek care at a health facility immediately after a bite.
Based on WHO snakebite envenoming fact sheets, the WHO strategy to prevent and control snakebite envenoming, and WHO Regional Office for Africa guidelines on snakebite management. Educational content: follow national protocols.