Trendelenberg if hypotension

Management
- Wound dressing
- Firm bandage (crepe bandage), fairly tightly, cover
proximal of the bitten area (limb) as high as possible
- Immobilize the bite site (Splinting if a limb)
- Immobilize the patient (use stretcher)
- DO NOT incise/suck into the snake bite area unless
the snake identified venomous.
- Stabilize and evacuate to the hospital immediately.
(Also refer to anaphylactic shock treatment)

1. ADRENALIN / EPINEPHRINE
Mild Reaction : 0,3 - 0,5 ml 1:1000 IM or 0,01 ml/kgBW
additional 0,2 - 0,3 ml near port d’entry.
Severe Reaction : 5 ml 1:10.000 IV/via endotracheal, if no IV access
can give into venous plexus at the bas of the tongue,
repeat every 15 min
2. ANTIHISTAMINE
Diphenhydramine (delladryl 50 mg IM/IV) or
Pheniramine hydrogen maleate (avil 25 - 50 mg IM or 25 mg IV/Min)
3. GLUCOCORTICOID
Hydrocortison (solu-cortef) 100 - 250 mg IV or
Methylprednisolon (solu-medrol) 50 -100 mg IV may repeat 1-4 hourly
4. B-AGONIST
Ventolin nebulizer 2,5 mL in 2 - 3 ml NaCl or Ventolin inhaler 1- 2 puff or
Bricasma Inj. 0,25 - 0,5 mg SC/IM/IV
5. TETANUS TOXOID : 0,5 ml IM
5. ANTIBIOTIC : Amoxycillin ( + wound dressing)
6. ANTI VENOM
Anti Venom Polivalen (SABU) … vial by slow intravenous drip, be prepared
adrenalin and delladryl at the same time.

PS: If the snake has captured, take the snake to the hospital for identification