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Neurotoxic snakebite — DTM&H MCQ

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HardEnvironmental and occupational healthNeurotoxic snakebiteDTM&H

Six hours after a nocturnal snakebite in Sri Lanka, a farmer has bilateral ptosis, pooling secretions, paradoxical breathing and a falling vital capacity. Clotting is normal. Appropriate polyvalent antivenom is available. What is the immediate priority?

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Correct answer: A — Intubate and ventilate while administering region-specific polyvalent antivenom

The best answer is “Intubate and ventilate while administering region-specific polyvalent antivenom”. Bulbar and respiratory paralysis are immediately life-threatening; WHO warns that antivenom alone cannot be relied upon to prevent early death from asphyxia. Antivenom is still indicated, but established paralysis may recover slowly. Observation or an anticholinesterase trial cannot replace ventilation when respiratory mechanics are already failing.

Reference: WHO South-East Asia guidelines for the management of snakebites, second edition: https://www.who.int/westernpacific/publications/i/item/9789290225300