ASSESSMENT AND INITIAL TREATMENT OF SNAKEBITE FOR HEALTHCARE WORKERS

by | Mar 17, 2026 | PUBLIC HEALTH ADVISORY

Introduction

Snakebite envenoming (SBE) is a life-threatening medical emergency. The saw-scaled or carpet viper is a major cause of snakebites in Nigeria and along with the African spitting cobra, Egyptian cobra and forest cobra and puff-adder, covers more than 90% of serious snakebites in Nigeria. While carpet viper is an important cause of bleeding, the puff-adder is recognised for causing severe local swelling, necrosis and tissue damage; paralysis remains the hallmark of Egyptian or forest cobra and mamba bites. Antivenom is the mainstay of SBE therapy although it carries the risk of early adverse reactions (EAR) which may, in rare cases, lead to death.  These  EAR may  require specific treatment  and/or premedication given prior to antivenom administration to reduce the risk of its occurrence.

This technical guide provides a concise step-by-step approach to the initial assessment and treatment of victims of snakebite.

Healthcare workers

On arrival in the healthcare facilities, healthcare workers should:

  1. 1. Reassure the victim and relations to allay fears as much as possible.
  2. 2. Admit all patients for at least 24hrs even if they are asymptomatic given that there could be rapid progression of an asymptomatic state to a severe and potentially life-threatening situation.
  3. 3. Conduct a quick assessment to determine whether there is envenomation or if it is an asymptomatic case. A simple bedside 20-minute whole-blood clotting time (20MWBCT) could be helpful.
  4. 4. Counsel patients and relatives in simple language about severity, potential complications, treatment plan, and the potential need for critical-care or referral.
  5. 5. Determine the most likely type of snake by the physical examination of the snake if killed and brought, local knowledge  of  the  victims  and relations  (could  be misleading),  clinical  presentation,  or

20MWBCT. This will guide the selection and use of a monospecific or polyspecific antivenom for treatment.

  1. 6. Commence treatment with an appropriate antivenom if there are features of systemic envenomation or severe local envenomation (eg progressive swelling of the bitten limb) and look out for and treat potential adverse reactions to antivenom.
  2. 7. Avoid use of non-steroidal anti-inflammatory agents like Aspirin, Diclofenac, among others, as they increase the risk of severe or prolonged bleeding.
  3. 8. Continue reassessment for improvement in clinical condition or worsening (progressive limb swelling, persistent 20MWBCT, muscle paralysis, respiratory symptoms, shock, among others.
  4. 9. Inform the intensive care unit (ICU) or preferably transfer to the ICU if the patient has severe enven- omation, early features of respiratory failure, or neurological manifestations.
  5. 10. Consider intubation with mechanical ventilation in the ICU and parenteral use of an anticholinester- ase inhibitor following respiratory muscle paralysis even after administering antivenoms.
  6. 11. Reach out to and discuss with experts and professional colleagues for further guidance.

About NIDS

The NIDS was established to advance the prevention and control of infectious diseases in Nigeria and our members actively support the NCDC and other relevant ministries, departments and agencies engaged in emergency preparedness and response to infectious diseases in the country.

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For more resources on snakebite, kindly check out the NSIRC site