Resuscitating the Venomous Snake Patient

Any vet clinic will have the proper tools for intubation, ventilation and monitoring the oxygenation level of an unconscious patient. Drugs that may be used in the resuscitating of snake patients after anesthesia include specific reversal agents, Dopram as a respiratory stimulant and epinephrine as a general stimulant. But in the laboratory or zoo environment, special drugs or equipment like a ventilator may not always be available to help a snake recover or to resuscitate a non breathing animal in an emergency situation.

This is a safe and reasonably effective method for keeping an unconscious or semi conscious, non breathing snake at least partially oxygenated. Grasp the snake firmly with its head in a standard Midwest snake tube and create a partial seal around the tube and the snake's body as shown using a latex or rubber glove, plastic wrap, a sandwich bag, a garbage bag or anything else handy that is flexible and not gas permeable. The plastic should be held firmly against the tube and around the snake's body, but not so tightly that the snake's airway is closed off.

Making sure the snake's head is restrained on the end of the tube nearest your hand, press the other end of the tube over your mouth and blow gently. Only make a full seal on one end of the tube, either with your mouth or with your hand. The other end should allow some air to flow so that you don't create too much air pressure. You can tighten both seals if you don't have enough air pressure to force air into the snake's lungs. If the snake's glottis is open, you should see the snake's body expand slightly in response to your gentle puff. Do not blow too hard or too long. Do not overinflate the snake. To give a full breath to the three meter long, two kilogram king cobra shown in the photo, you should be blowing with barely enough force to move a Ping-Pong ball slowly across a smooth table. Stop immediately if you feel pressure or resistance to your puffing, or loosen the seal. To give a breath to a smaller snake, blow even more softly.

You should be familiar with the normal rise and fall of your snake's breathing so that you can immediately stop blowing when you see the snake's lungs expand to their normal capacity or slightly below that. If you don't see a rise, tighten your seal and try again, waiting 3 to 5 seconds between your attempts. When the snake's glottis is closed there will be no expansion, so you will have to wait until it is open again before you can deliver a breath this way.

If you continue to attempt gentle puffing with a good tight seal at both ends of the tube for more than a minute with no rise, you may need to prop the snake's mouth open with a makeshift gag such as a smoothed-off Popsicle stick and try again. Watch for the glottis to open. As a last resort, you may need to intubate. The trachea is very easily damaged, so it is important to use a very clean, very smooth tube that is well lubricated with KY jelly or a similar water soluble lubricant. In an emergency tap water will do as a lubricant, and you can intubate with a red rubber catheter or a piece of aquarium tubing well smoothed off by being partially melted over a heat source. Once you intubate, you will be blowing directly into the tube which you have placed a short distance down the snake's glottis. Do not blow too hard or too long. Do not overinflate the snake.

After a successful breath, wait at least 10 seconds to see if it is followed by a normal, voluntary respiration before making another attempt. A snake's breathing drive is O2 based rather than CO2 based like mammals, and they actually recover faster on normal room air than if they are maintained on oxygen. Your exhalations contain only slightly less oxygen than room air, which is sufficient to keep a reptile from hypoxia and also sufficient to stimulate their voluntary breathing drive.

Keep checking the patient's heartbeat manually or visually or both. You should easily be able to palpate a heartbeat by pushing all five of your fingers gently into the snake's belly. Start trying about 15% of the way down the snake. Wait a few seconds to see if you feel anything, then move your hand down a few inches towards the tail and try again until you've covered about a third of the snake's length. Elapid hearts can often be clearly visualized from the dorsal aspect (the back or top of the snake as it lies on its belly). Viperid hearts generally cannot be seen to beat while the snake is lying normally on its belly, but they can be visualized if you have an unconscious snake in dorsal recumbency (flat on its back). Once you have successfully spotted the heartbeat, it is a good idea to mark the spot with a nontoxic marker so that you will easily be able to find it again.

If you can't palpate a heartbeat manually, don't assume the snake is deceased. Continue ventilating at a rate of four to six breaths a minute and keep looking for that heartbeat, unless you have other reasons to believe that your patient is non revivable. You can also check pupillary response with a small bright light to help you determine whether or not the snake is still alive.

A physical blockage in the lung such as water or excessive mucous may interfere with respiration. You may want to intubate deeply and apply gentle suction to remove liquids, keeping in mind that some parasites that can be found in snake lungs may also be infective to humans. You may prefer to use a small syringe rather than your mouth for liquid suction. Be extremely careful, slow and gentle. Too much pressure can collapse blood vessels in the well vascularized lung tissue, causing internal bleeding that can kill the snake. If the lungs are full of thick mucous you may want to do a saline wash using sterile water, sterile saline or Lactated Ringer's Solution. Tilting the snake's head down and its tail up, place a small amount (1cc per kilogram of snake is a good starting point) to a shallow depth into the snake's trachea. Try to get as much back out as you put in, using a combination of gravity and gentle suction. The lung may absorb some liquid so you may not get out quite as much back out.

If you have the option of nebulization with saline and Mucomyst (acetylcysteine) in combination with Amikacin this is another good way to help dissolve mucous in the lungs and help a snake that is having difficulty breathing. Nebulization units are sold for home use by human asthma patients, and can be readily adapted to work inside a snake cage. Ask your veterinarian how to administer these drugs to a snake inside a nebulization chamber which you can adapt at home with a nebulization unit and a Tupperware box.

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