First Aid & Medical Emergencies in the bush




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  1. #1
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    Default First Aid & Medical Emergencies in the bush

    This is guide prepared for the forum Zambia trip, but of use to anyone travelling into Africa. It was prepared by Gary110, a paramedic with long experience of working in Zambia, and it is worth printing and taking with in your medical kit. I attach a Word version to make printing easy.

    Common Sense for Africa

    This is a basic guide for people travelling through or into deepest darkest Africa, and who are nervous about getting injured or falling ill whilst out of their comfort zone.

    The first rule for any emergency scenario is not to panic. Yes, much more easily said than done when the buffalo has just shown how cross he can get and stomped on a fellow traveller. I always try to remind myself that if Iím not the one bleeding, then its ok, then I can be the one to be calm. Acting calm has another role as well, it helps to calm your patient, and often that is a major contributing factor to the continued well-being of your patient.

    The second rule is safety. Safety for yourself as the rescuer, safety for the scene (is the cross buffalo still around) and safety for the patient. It will not be at all helpful if in the event of a motor accident another car comes crashing into you because you failed to make sure that approaching vehicles were timeously warned. (Hint Ė in Africa the general rule is to pick a few branches and place them in the road before an accident scene or a broken down vehicle) Always wear gloves before touching any of the bodily fluids, unless it is a direct family member. HIV is more prevalent than you would suspect, and itís actually one of the least of your worries, Hepatitis and some other nasties are much more easily transmitted.

    The third rule is preparedness. If you are reading this for the first time while someone is lying there bleeding after a buffalo stepped on them, I think you may find its going to be a tad late. Just maybe. A good first aid course is a great starting point, it teaches the basics, but never prepares one for the sheer terror that is experienced when you suddenly find yourself having to try and save the life of someone who got in the way of the buffalo. Also have a well-stocked and accessible first aid kit handy. Itís a good idea to put a pair of gloves right in the top, in a little zip-lock bag, just to remind you to wear them when you open the kit.

    A list of emergency numbers for the areas or regions, or even countries that you are visiting is next. Make sure that you know WHO to call, and make sure that you have MEANS to call them. A cell phone works well in most areas, but often a satellite phone is the ONLY way to get help when the chips are down. Know how to use a satellite phone, and keep it fully charged. As the trip that is being planned will mainly be in Zambia, here are the important numbers that you may need:

    Firstly, the country dialling code for Zambia: + (00)260 (put this in front of the local number and take away the first ď0Ē. e.g. If your local sim card number is 097 123 4567, people from outside Zambia dial +26097 123 4567 to get hold of you. The country dialling code for South Africa is +27. So your Vodacom number back home would be +2782 123 4567. Always use the country code you are dialling to when using a satellite phone, a satellite phone is set up like itís in its own special country.

    If you have a medical aid provider, it is normally a part of their policy that you have to inform them when travelling beyond the borders of South Africa. Contact your Medical Aid Provider and make sure that you are covered during your trip to Zambia, also donít forget to tell them that you will be travelling through Botswana to get to Zambia. Tell them EVERYTHING. Get a reply in writing (email). Make sure that you have the emergency contact numbers for your medical aid International Service Provider close at hand. Some use the services of companies like International SOS; you may have to call them directly in the event of an emergency. Make sure that you, and your travelling companion know exactly who to call, and on what numbers. This will save a LOT of time and effort in the event of an emergency occurring in the bush.

    Write your personal Medical Aid Contact Details here:

    Medical aid Name: __________________________________________________ ____
    M/A Number: __________________________________________________ ________
    M/A Emergency Contact Number: __________________________________________

    Zambian Emergency Numbers:
    SES (Specialised Emergency Services) is a PRIVATE Ambulance service in Zambia. It is staffed by SOUTH AFRICAN PARAMEDICS and you will get the best medical attention in Zambia from these guys. However, make sure that you either have a very good medical aid, or a bag of cash Ė US Dollars, as they are not cheap. They are based in Lusaka, and also have offices in Livingstone and in Kitwe. They also have access to an air-ambulance to reach those far-away places a little more quickly, but they donít fly at night. Most Zambian towns have some sort of a grass landing strip.
    Lusaka Office +260 211 273 302
    Lusaka Senior Paramedic (Francois Prinsloo) +260 962 740 303 or +260 977 770 304

    The SES paramedics will also advise you via the telephone as to what you should do for the patient, take their advice, they have all been working up in Africa for a long time and know the local conditions intimately. If they advise you to get the patient to the local clinic in the next town/village, do so. If they advise against it, stay away. They have their reasons.

    Next I will describe the basic treatment for a number of possible eventualities. This does not replace what you may have learned in a first aid course, nor does it replace common sense. What I describe is what I have found works best for me, and I have been doing this for quite a long time now. But then Iím not a doctor, just a paramedic working in the bush. And if you donít appreciate my sense of humour, well tough, spank me later.

    Breathing Problems
    The biggest breathing problem is not breathing. This patient will die, right now, if you donít fix the problem. If there is something physically blocking the airway (choking), try to remove it with the Heimlich Manoeuvre, or if the patient is already on the ground, with abdominal thrusts or chest compressions. Do mouth-to-mouth ventilations and check to see if the patientís chest rises. If you are not moving air into his lungs, reposition the airway (head back), open the mouth and see if you can visualise (see) anything blocking or obstructing the airway, remove it if you can, and try again. If the patient loses his pulse, start chest compressions immediately. You will also need to have called for help here.

    Another breathing problem is difficulty breathing, or breathing too fast or too slow. Difficulty breathing could be caused by disease such as asthma, TB, emphysema, or any other pulmonary disease. These patients usually have some sort of medication, like an asthma pump/inhaler. All that may be needed is for you to get it for them. Calm and reassure these patients, the more stressed they are, the faster they will get worse.

    Hyperventilation is often caused by stress or fear or shock. Give the patient a paper bag to breath into and out of until they breathe normally. Tell them to breathe like you are, and breathe together.

    Sometimes when people are really sick or badly injured, they may need some assistance with breathing, especially if their level of consciousness is low. If the patientís lips are blue, itís usually a sign that they arenít breathing enough, and they may require assisted ventilations. This is the same as mouth-to-mouth, you just breathe into the patient each time he tries to take a breath himself. Maybe a breath in between each of their breaths, if they are really breathing too slowly. A person bitten by a Black Mamba will become paralysed and stop breathing. This is what kills him 99% of the time. If you breathe for this person using mouth-to-mouth you can almost certainly save his life.

    When a patient has serious breathing problems, always get help. Donít waste time, and if necessary, do mouth-to-mouth.



    Bleeding you can See
    Severe bleeding can be immediately life threatening. A severed artery can cause a person to bleed out within minutes. This bleeding needs to be stopped immediately. You will know it by the stream of blood that will often squirt out of the wound like in the movies. Apply a pad directly to the wound and apply very firm pressure. Keep pressure until bleeding stops. If blood seeps around the pad, add another pad (donít remove the first one) and apply pressure. Only use a tourniquet if nothing else is working. A tourniquet does need to be slowly released every few hours, or the limb will die. I would rather not use a tourniquet unless I had absolutely no other choice. This patient does need to get to a hospital, call for assistance.
    Moderate bleeding can also be life threatening. The same principle applies, use a pad directly on the wound and apply pressure. If blood seeps around or through the pad, add another pad, and maintain the pressure. Get this patient to a hospital too; wounds that bleed this badly normally need sutures to keep them closed, and antibiotics to sort out the infections. Blood that is in the sand is lost, people need their blood, donít waste time looking for your fancy first aid kit, use anything as a pad. Like a shirt, a sock, a hat, whatever. Cotton also works better than synthetics, but beggars canít be choosers. (T shirts and underpants are normally cotton)
    Additional methods to stop or slow bleeding include indirect pressure (pressure points) and elevation of the affected limb. Immobilisation of the affected limb will also go a long way to stopping bleeding, preventing further bleeding and keeping pain levels as low as possible.

    Bleeding you canít See
    This is also known as internal bleeding. It includes bruising too. Most internal bleeding is relatively minor, but following a serious trauma like a car crash or getting stood on by the buffalo can result in fatal internal bleeding. There is nothing that most people can do for this, it needs an operating theatre. Immobilise the patient and treat for shock. A human can lose up to 2 litres of blood in the upper leg (thigh), and virtually bleed to death in the abdomen or chest without any blood being seen outside of the body. A high index of suspicion and an early call for evacuation is what can save a life here. Rather err on the side of caution.

    Shock
    Shock can be caused by many things, including being injured, sick, emotionally traumatised and stomped on by a buffalo. Signs of shock include a fast heart rate, fast breathing, pale and clammy skin, nausea, vomiting, dilated pupils and even headache. Persons who are in shock because of physical injury need to be calmed down, rested, kept cool, or warm if itís cold, and often sitting or lying down will help a lot. Sugar water only if the injury is not very severe, and never give alcohol. Call for medical assistance if signs of shock are noted following a medical emergency.

    Fractures and Dislocations
    Some fractures are quite easy to diagnose. Fall from the roof-rack of your Landy and you can easily break an arm or a leg. Get stomped on by that buffalo and limbs will break. If itís bent in a place, or a direction that it shouldnít normally bend, then itís probably broken. If itís all swollen and very painful in a joint, then itís possibly dislocated. Never try and reduce (medical term for putting it back) a dislocation or straighten a fracture if you donít have medical training in this. You can cause even worse damage and pain. Immobilise the dislocation or fracture (put a splint on it) as best as you can, and get the patient to medical assistance. Bandages, clothing torn into strips, even ropes can be used, and a splint can be just about anything that you can imagine. A few examples include: Sticks, rolled up newspaper, sun visor, pillow, rolled up blanket, cardboard box cut into shape, tent pole, tent peg, whatever. You can even tie the broken leg to the uninjured leg, and lie the patient down. Broken fingers are immobilised well when tied together. Always remember to check the splints regularly, swelling can cause them to get very tight and cut off blood flow. Loosen them off a bit if this is suspected. Try to check for a pulse or capillary refill in the injured limb beyond the fracture or dislocation. Squeeze the tip and count how many seconds it takes for the ďpinkĒ to return. More than 3 or 4 seconds is a bit slow and could be a problem.

    Injuries to the Eye
    Eye injuries can be caused by something entering the eye, or by an impact to the eye. Never remove anything that is stuck into the eye-ball. Close the injured eye and place a dressing over it. Itís also a good idea to close the uninjured eye as well. Eyes move together, and if one eye is open, they will both move as the uninjured eye looks around, worsening the pain. Get medical assistance.
    Dust, pollens, chemicals or other foreign bodies can be flushed with clean water. Always flush away from the good eye, or it may end up in both eyes. Rinse for as long as necessary to clear the foreign matter. Never use anything to try and scratch something out of an eye. If you HAVE to try and remove an embedded piece of dust or similar, fold a piece of normal paper, and use the edge, it will soften slightly as it touches the wet eye and not harm the eye further.
    Arc-eyes are very painful, but can be relieved by placing soaked tea-bags on the eyes and keeping them there for a few hours. Rooibos tea works the best.

    Bugs in Ears
    Donít laugh if you have never had a bug in your ear. Itís not a nice thing to endure. Try shining a torch into the ear; it may entice the bug out, IF it is small enough to turn around inside the ear canal. Put a few drops of cold cooking oil into the ear. This will suffocate the bug and stop it from scratching at the ear drum. Sometimes it even floats out. Never try and dig it out with a toothpick or similar, you will end up deaf and in a lot more pain. A tiny pair of needle nose pincers may be able to get it out, but only if you can actually see it, and be very careful, it is very easy to cause a bad injury. Rather try and get it removed by a medical professional. Luckily buffalos donít fit into ears.

    Illnesses:

    Tummy Problems
    Tummy problems are normally the most common illnesses on a trip like this. Normal precautions like making sure drinking water is clean, food is washed, and of course fresh and disease free will normally prevent most issues. Washing hands, especially after shaking hands with locals, is also a very good tip, take it!
    A runny tummy is normally because of something that needs to get out. I prefer to let it run (excuse the pun) its course for at least 24 hours before medicating. If it hasnít resolved itself by then, use Loperamide (Imodium) to stop it. Normal dosage for an adult is two tablets immediately, followed by one tablet after each loose stool. If it doesnít resolve within another 24 hours, seek medical attention. It is also imperative to ensure that you stay properly hydrated during this time. Take lots of fluids, not just water, but energy drinks like Energade or Rehidrat sachets. You need to replace the lost electrolytes and salts as well as the water.

    Nausea and Vomiting
    Car-sickness can cause nausea and vomiting, especially for passengers when travelling off-road. Motion sickness tablets should be obtained prior to departing if any members of your party may be prone to this. Opening windows, stopping for a while, or putting that person in the front seat often helps. They should not close their eyes, or read, while moving. This makes it a lot worse.
    Tummy problems can also cause nausea and vomiting. Same as diarrhoea, it is usually caused by something that needs to get out. Let it get out, for at least 12 hours, then try medicating to stop the vomiting. If the patient vomits the pills out, give them more pills. Only let them sip very small amounts of water or Energade. If too much enters the tummy it will be expelled. One mouthful every 5 or 10 minutes is normally little enough for the tummy to accept it. Eat plain and bland foods, they normally stay down better than rich or fatty foods. The lecithin in apples is a great natural cure for vomiting and diarrhoea. If the vomiting persists and the patient shows signs of dehydration, get medical assistance. A local Zambian hospital can put up a drip to rehydrate a patient, if they have drips.

    Dehydration
    This is when the body does not have enough electrolytes and salts and water for the cells to continue with their metabolism. It can be caused by vomiting or diarrhoea, or by failing to take in enough fluids (not just water) on a hot day or while exercising. Signs and symptoms include headache, dizziness, pale skin, not sweating when should be sweating, not urinating, urine that is dark or deep yellow, a rapid heart-rate, fast breathing, feeling hot, and also confusion or change in mood.
    Cool these patients down, give them fluids to drink, keep them in the shade, and monitor their condition until they feel better. Rehidrat sachets work well, so does Energade. Other cool drinks to a lesser degree. Do not give alcohol or coffee or any other caffeine-containing drink. Caffeine and alcohol are diuretics (they make you pee) and will just make the patient worse.
    Running away from the buffalo can also dehydrate you.

    Allergies
    Some people are allergic to pollens and dust and stuff. They need to take lots of their usual anti-histamine with them. There will be lots of pollens and dust in Zambia. Others may be allergic to bees or insect bites. If you are allergic to bee-stings, make sure you have your epi-pen with you at all times, and make sure that the others in your vehicle know EXACTLY how to use it.
    For the rest, just take a few general anti-histamine pills along, they will help for those unknown itches and rashes that often plague in the bush.

    Malaria
    Zambia is a malaria area, and there are a lot of mozzies about. Prevention is better than cure, so take the precautions against being bitten and also take malaria prophylaxis. A lot has already been written about this subject, but I will just lift out the facts.
    There are only 3 types of effective prophylaxis; Doxycycline, Mefloquine, and Malanil. Doxy is the cheapest, start taking it a week before entering the malaria area, and take for 30 days after leaving. Common side effects include nausea and vomiting, diarrhoea, and very susceptible to sunburn. Mefloquine is taken once a week, start taking two weeks before entering malaria area, and take for 4 weeks after exiting. Common side effects are nausea and vomiting, especially the day of taking the pill. Malanil is the most expensive; take 1 pill a day, start 3 days before entering malaria area, and take for 7 days after exiting. Common side effects are vivid dreams about 4 - 7 days after starting course.
    Common symptoms of malaria include flu-like symptoms, headache, joint pains, nausea, diarrhoea, vomiting, sore eyes, fevers, chills. If any of these symptoms develop within 7 days of entering a malaria area, or up to 3 months after exiting, have a high suspicion for malaria, get tested, and if positive the best treatment is a dose of Coartem. If caught early the malaria is easily treated and cured within 24 hours. If left late, it can be fatal. Malaria kills more people than angry buffaloes do.


    Pain and Fever
    For common pains and fevers, headaches, arthritis, gout, muscle strains and sprains, stiff backs, toothache, etc. a very effective over-the-counter pain medication is Paracetamol (Panado) and Ibuprofen (Brufen). Taken together they have a synergistic effect (they work well together and complement each other) and are very effective if taken in the correct dosages. For the average 80kg adult, a starting dose of 1500mg Paracetamol (3 tabs) and 800mg Ibuprofen (2 tabs) normally gets severe pain well under control. After that if pain persists, continue with 2 Paracetamol and 2 ibuprofen every 4 Ė 6 hours. Always take ibuprofen with food, it is very acidic and will mess up your tummy badly. Almost as bad as the buffalo stomping on it. Never take any medications if you have a sensitivity or an allergy to them.

    Common Sense in the Bush
    Itís incredible how some people leave their common sense at home when they go camping. And often we (paramedics) find that this lack of common sense coupled with the bravado of a few toots of alcohol will provide for some really interesting medical emergencies. You would never play with a snake at home, so donít play with one when you are in the remote bushveld. The same goes for all the other creepy-crawlies you will come across. Look at them, take their pictures even, and then move away so they can get on with their day. If you upset them, they can and will upset you even more.
    The same with food. If you wouldnít buy meat from a street-side vendor in Joburg, donít buy it in Mumbwa. Itís going to make you rather ill. Water in Zambia is better and cleaner than in South Africa, but you would still not drink from the Crocodile River at Harties, so donít drink from the Kafue. Oh, and the Kafue does have crocodiles, so donít swim in it either. Crocs say humans taste just like chicken, not as tough as buffalo.
    When you are camping at Mukambi and you hear the lions outside your tent at night, keep quiet, listen and enjoy the experience. If you go outside the tent for that ďspecial photoĒ your pic will appear in the obituary column.
    Tsetse flies can be in issue in the Kafue National Park and surrounding areas. Keep your windows closed if you see them appearing, and turn the aircon up if you have one. Then stop the car and then beat those inside the car to death. Donít try and do it while you are driving, you will find something to crash into. Probably that buffalo, and he will get really angry. Oh, and a tsetse fly isnít dead if he just falls down, you have to see the guts squish out, or he will crawl up and bite you again. Buggers!

    Enjoy the trip, Zambia is a lot safer than South Africa from a security perspective and its scenery and wildlife is nothing short of spectacular. A smile and a friendly greeting with a wave will get you the same in return, and you will find a wonderful vibrant society always willing to help and have a chat. The local clinics in each town are good at treating most general illnesses, and they know what they are doing when it comes to treating malaria.
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  2. #2
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    Great read, thanks!
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    I suggest acquainting yourself with some non-first aid medical knowledge for when you're in remote locations.
    Most 1st Aid training gives advice based on you not being far from a hospital and based on saving first world legal liability anguish.
    But if you're in the gammadoelahs and have a dislocation or amputation or whatever you sometimes need to provide treatment that in a first world environment would get you in deep trouble.

    Take for example a dislocation. You're told to NOT reduce it because of possible serious nerve damage. Speak to a trauma doctor and they (privately) want you to reduce as soon as possible. Hours on a rough road back to the nearest hospital could be better with a reduced dislocation

    Take an amputation or hectic wound involving an artery. You're miles away from help and your tourniquet won't suffice. You may need to tie off the artery to save the life.

    You might need to drain a chest wound.

    etc.

    Try do an out-of-the-box medical course or get advice from a military medic type person or similar
    The medical equivalent of a "bush mechanic"

    edited to add: Take for example my maritime medical course. Roughly equivalent to a Level 2.5 (not quite a Level 3). Covers most basic things BUT you're not even allowed to apply ointment. So having certificates can be a handbrake. (that particular certificate is compulsory for everybody on a ship regardless of any other certs you might have)
    If I need to help somebody I always have to remind myself of my environment. On a ship only ABC's, wrap, and take to the medic. In a city run for your liability lawyer. In an austere environment go hardcore and do what needs to be done to save the life. On a rescue do what the trauma doctors train us
    Last edited by Spike; 2012/09/21 at 12:33 PM.
    * "Wat Spike probeer sÍ in sy min woorde" -Die Skim "
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    Thanks for this. I have been at a number of incidences where that feeling of helplessness is terrible. Any extra knowledge makes it easier to cope with a medical incident.

  5. #5
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    Cool

    Hi Mike,

    Thanks a lot for your advice.

    I would like to highlight again four points:

    - Most important thing in your first aid kit is definitely a basic training.
    - Second most important is emergency numbers (not only the doctors in the capital city, but I think it is a good idea if you stay somewhere to have the number accessible, or if you enter a NP to take their call numbeer - if they have one - I always do it).
    - Third most important thing is a Satphone, even if you are not very skilled (which is the case after having only a first aid training), you can seek help from professionnals who guide you on the phone.
    - 4th most important is the contents of your bag. Mine is based on an extended car first aid kit plus appropriate drugs, including the first aid booklet..

    Cheers...

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    Mike:Thanks for taking the trouble.I will be extra careful next time I see those Buffalo.

    Bruce

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    Default Re: First Aid & Medical Emergencies in the bush

    We purchased snake and scorpion venom in Dec 2016 from SA Vaccine Produces as a precautionary measurement for our trip to the Kalagadi.

    We travel with small children and felt is was needed. Very thankful that we did not have to make use of either the snake and scorpion venom we would like to sell the unopened parcel with all its instructions and telephone numbers. We also have the original invoice and emails as proof of purchase.

    Quantity Description
    6 SAIMR Polyvalent antivenom 10ml amp
    2 SAIMR Scorpion antivenom 10ml amp
    1 SAIMR Snakebite outfit

    The venom has a shelve life of 2 and 3 years. We will be happy to accept R6000.00 for the package. We paid R11900.00.

    If anyone is interested please let me know

  8. #8
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    Default Re: First Aid & Medical Emergencies in the bush

    Some information on Antivenom. The South African Vaccine Producers, part of the National Health Laboratories in South Africa, produce a Polyvalent Antivenom that covers most of the medically important snake venoms in Southern Africa.

    Antivenom is manufactured by SAVP by hyper immunising horses - the horses are injected with a cocktail of snake venom over a period of nine months with ever-increasing dosage...s as the horses build up a resistance to the snake venom. Once immune the horses are bled at two month intervals and the serum removed. This then goes through a variety of purification processes and is packaged in 10 ml glass vials. Each vial of antivenom must be refrigerated and will expire after 3 years.

    The venom of the following snakes is used in the production of Polyvalent Antivenom: Black Mamba (Dendroaspis polylepis), Green Mamba (Dendroaspis angusticeps), Jameson's Mamba (Dendroaspis jamesoni), Cape Cobra (Naja nivea), Forest Cobra (Naja melanoleuca), Snouted Cobra (Naja annulifera), Mozambique Spitting Cobra (Naja mossambica), Rinkhals (Hemachatus haemachatus), Puff Adder (Bitis arietans arietans) and Gaboon Adder (Bitis gabonica).

    Antivenom saves many lives and the sooner it is administered, when required, the better the outcome. This is also the case in cytotoxic bites where the early administration of antivenom may reduce the extent of tissue damage.

    Not all victims bitten by one of the above snakes require antivenom therapy, in many cases the symptoms are not severe enough. Less than 15% of all snakebite victims need and receive antivenom. When administered the initial dosage is in the region of 8 - 10 vials of antivenom (80 - 100 ml) intravenously. Two or three vials of antivenom are largely a waste of time, as are intramuscular injections. If the patient does not show a marked improvement within about 20 minutes, another one or two vials will be administered and most snakebite victims receive around 10 - 12 vials. In an exceptional case in Zululand a Black Mamba victim received 40 vials of antivenom and recovered fully. Polyvalent Antivenom costs R1,165.00 per vial.

    Although Polyvalent Antivenom can be purchased without a script it should only be administered by a medical doctor in a hospital environment. The biggest danger when administering antivenom is anaphylaxis. Up to 40% of snakebite victims have some level of an allergic reaction to antivenom and around 20% of them may experience anaphylaxis - a life-threatening medical condition that is treated with. Epinephrine, also known as adrenaline.
    For domestic pets the treatment is exactly the same with around 2 - 6 vials of Polyvalent Antivenom used on dogs for bites from the above snakes.

    A monovalent antivenom is produced for the venom of the Boomslang whereas no antivenom is made for the Twig Snake, Berg Adder and Stiletto Snake.

    Snakebites are expensive to treat and easily cost in excess of R100,000 with a recent case costing close on R1M See more

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