Snake bite (UK adder)

Vipera berus is the only venomous snake native to the UK. Bites mostly occur March–October. Mortality very rare with modern care; morbidity from local swelling and rare anaphylactoid reactions. First aid: • Reassure; keep victim still; immobilise bitten limb at heart level. • REMOVE rings/watches/tight clothing from bitten limb. • Mark advancing oedema and time on skin. • DO NOT apply tourniquet, incise/suck wound, apply ice or alcohol. • Transport to ED. ED: ABCDE; observation in monitored area for ≥2 h (delayed reactions). Bloods: FBC, U&E, creatinine, LFTs, INR/APTT, fibrinogen, troponin (myocardial toxicity rare), ECG. Photograph site; mark oedema border every 30 min. Identify exotic snake — discuss with NPIS / regional zoo veterinary if non-adder species suspected.