Ghi nhận tại các cơ sở y tế, cứ vào mỗi mùa mưa, số bệnh nhân bị rắn độc cắn lại gia tăng. Đáng chú ý, do sơ cứu không đúng cách, nhiều bệnh nhân bị hoại tử tay chân, nhiễm trùng máu, thậm chí bị tử vong. Vì vậy, nhận biết rắn độc cắn và sơ cứu ban đầu đúng cách là vô cùng cần thiết.
1. Các loại rắn độc thường gặp ở nước ta: Ở nước ta thường gặp 2 họ rắn độc sau:
Họ rắn hổ:
• Rắn hổ mang:
– Rắn hổ mang thường: (rắn hổ đất, hổ mang bành, hổ phì, hổ mèo) có cổ bạnh và phát ra âm thanh đặc trưng khi đe doạ hoặc tấn công. Có ở vùng rừng núi, trung du, đồng bằng, thậm chí gần khu dân cư.
– Rắn hổ mang chúa: cổ cũng bạnh nhưng không bạnh rộng, có hai vảy lớn ở đỉnh đầu, có ở vùng rừng núi, trung du, đồng bằng, hiện nay còn được nuôi ở nhiều nơi. Kích thước lớn nặng hàng chục kilôgam, thường dài hơn 2,5m.
• Rắn cạp nong, cạp nia: khoang đen – trắng rõ (rắn cạp nia), khoang đen – vàng (rắn cạp nong), thường ở vùng trung du, đồng bằng, khu vực gần nước.
• Rắn biển.
• Biểu hiện nhiễm độc:
+ Tại vùng vết cắn: đau, sưng nề, có thể có hoại tử đen da vùng bị cắn (da bị chết do nọc độc), nhiễm trùng (sưng đỏ, sốt, có mủ). Vết rắn cắn do rắn cạp nia, cạp nong cắn thường không có gì đặc biệt.
+ Toàn thân: đau nhiều, nói khó, mờ mắt, yếu chân tay, khó thở, liệt toàn thân, loạn nhịp tim, đái ít,… dễ tử vong hoặc tàn phế. Nguyên nhân tử vong chủ yếu do liệt các cơ hô hấp gây khó thở.
Họ rắn lục:
• Đặc điểm chung là: đầu thường hình tam giác, mắt có con ngươi hình elíp dựng đứng.
– Rắn lục xanh: có màu xanh lá cây các mức độ khác nhau, thường ở vùng rừng núi cả ba miền.
– Rắn khô mộc, rắn lục mũi hếch: thân màu nâu hoặc giống như màu cành cây khô, thường ở vùng rừng núi phía Bắc.
– Rắn choàm quạp: thân màu nâu, thường ở vùng rừng phía Nam.
• Biểu hiện nhiễm độc: Sưng nề, phỏng nước, chảy máu vùng vết cắn, chảy máu toàn thân khó cầm. Tử vong do chảy máu, mất máu.
2. Nhận biết rắn độc và rắn không độc
• Phân biệt rắn độc và rắn không độc nhiều khi rất khó. Tuy nhiên có thể nhận ra được một số loại rắn độc thường gặp dựa vào các đặc điểm đặc trưng bên ngoài của rắn: rắn hổ mang (khi chuẩn bị tấn công thì cổ bạnh, phát âm thanh đặc trưng), rắn cạp nong (thân mình ‘khúc vàng khúc đen’), rắn cạp nia (thân mình ‘khúc trắng khúc đen’), họ rắn lục (đầu to hình thoi hoặc tam giác).
• Rắn độc có thường có hai răng độc lớn (còn gọi là móc độc) và thường ở vị trí răng cửa hàm trên, do đó khi cắn thường để lại vết cắn đặc trưng có thể giúp phân biệt rắn độc. Răng độc đóng vai trò như một kim tiêm dưới da hoặc tiêm vào bắp thịt. Một số loại rắn hổ mang mặc dù ở cách nạn nhân một khoảng cách vẫn có thể phun nọc độc về phía nạn nhân và gây tổn thương mắt, có thể từ đó gây nhiễm độc toàn thân.
3. Cách sơ cứu ban đầu khi bị rắn cắn
Sau khi bị rắn độc
cắn cần sơ cứu ngay, tiến hành trước khi vận chuyển bệnh nhân đến bệnh viện. Có
thể người khác giúp đỡ hoặc do bản thân bệnh nhân tự làm.
3.1. Mục tiêu của sơ cứu
• Loại bỏ bớt nọc độc và làm chậm sự dịch chuyển của nó từ vết cắn xâm nhập vào trong cơ thể.
• Bảo vệ tính mạng của bệnh nhân, ngăn chặn và xử trí sớm các biến chứng trước khi bệnh nhân đến được cơ sở y tế.
• Vận chuyển bệnh nhân một cách nhanh nhất, an toàn nhất đến cơ sở y tế.
• Không gì hại thêm cho bệnh nhân.
3.2. Các bước sơ cứu nên làm
• Trấn an người bệnh.
• Không để bệnh nhân tự đi lại. Bất động chân, tay bị cắn bằng nẹp (vì vận động làm cho nọc độc xâm nhập vào trong cơ thể nhanh hơn).
• Cởi bỏ đồ trang sức ở tay, chân (nếu có) bị cắn (vì có thể gây chèn ép khi vùng đó bị sưng nề).
• Áp dụng biện pháp băng ép bất động với một số loại rắn hổ (rắn cạp nong, cạp nia, hổ mang chúa, rắn biển và một số giống rắn hổ mang thường), băng ép bất động để làm chậm sự xuất hiện triệu chứng liệt.
– Dùng các băng chun giãn, băng vải hoặc tự tạo từ khăn, quần áo. Băng tương đối chặt nhưng không quá mức (còn sờ thấy động mạch đập). Bắt đầu băng từ ngón chân, tay đến hết toàn bộ chân, tay bị cắn. Dùng nẹp cứng (nẹp, miếng gỗ, que, miếng bìa cứng,…) cố định chân, tay bị cắn.
– Không băng ép khi rắn lục cắn vì có thể làm vết thương nặng thêm.
• Có thể chích nặn rửa vết cắn dưới vòi nước sạch với xà phòng rồi sát trùng.
• Nếu bệnh nhân khó thở thì hô hấp nhân tạo (hà hơi thổi ngạt hoặc bằng phương tiện y tế có tại chỗ như bóp bóng, máy thở xách tay,…). Nếu có dấu hiệu ngừng tuần hoàn thì tiến hành hồi sinh tổng hợp ngay tại chỗ và chờ nhân viên y tế đến.
• Vận chuyển bệnh nhân bằng phương tiện đến cơ sở y tế đồng thời duy trì băng ép, bất động, để vùng bị cắn thấp hơn vị trí của tim, nếu ở chân, tay thì có thể để thõng tay hoặc chân…
• Chú ý: Bất cứ
trường hợp nào bị rắn cắn, ngay cả khi xác định là rắn lành, đều cần xử trí và
theo dõi tại bệnh viện như trường hợp rắn độc cắn, ít nhất trong 12 giờ đầu. Nếu
trễ sau 24 – 48 giờ, kết quả điều trị rất kém hoặc không hiệu quả.
3.3. Không sử dụng các biện pháp
• Garô: Garô là biện pháp làm tắc nghẽn hoàn toàn động mạch. Nó gây đau và rất nguy hiểm và không thể duy trì lâu (không quá 40 phút), chân tay rất dễ bị thiếu máu nguy hiểm. Nhiều trường hợp sau đó phải cắt cụt chân tay vì garô. Ngoài ra khi đến bệnh viện, bác sĩ tháo băng garo ra thì chất độc sẽ cùng lúc ùa về tim khiến bệnh nhân bị sốc, đe dọa tính mạng.
• Chích, rạch, châm, chọc tại vùng vết cắn: các biện pháp này không có lợi ích, rõ ràng gây hại thêm cho bệnh nhân (tổn thương thêm mạch máu, dây thần kinh,… nhiễm trùng nặng thêm).
• Hút nọc độc: Không có lợi ích.
• Chườm đá (chườm lạnh): Đã được chứng minh là có thể gây hại.
• Sử dụng các loại thuốc dân gian, cổ truyền, chữa bằng mẹo: Không có ích lợi, khi đắp có thể gây nhiễm trùng, khi uống có thể gây hại cho nạn nhân.
• Cố gắng bắt hoặc giết rắn: Nếu rắn đã chết hoặc bắt được rắn phải đem vào cùng với bệnh nhân đến bệnh viện để Bác sĩ nhận dạng.
4. Đề phòng rắn cắn
• Biết về loại rắn trong vùng, biết khu vực rắn thích sống hoặc ẩn nấp.
• Đi ủng, giày cao cổ và mặc quần dài, đặc biệt khi đi trong đêm tối, đặc biệt phải đội thêm mũ rộng vành nếu đi trong rừng hoặc đi ở khu vực nhiều cây cỏ.
• Càng tránh xa rắn thì càng tốt, đầu rắn đã chết vẫn có thể cắn người. Không bắt rắn, đuổi hoặc dồn ép rắn trong khu vực khép kín.
• Không sống ở gần các nơi rắn thích cư trú hoặc thích đến như: các đống gạch vụn, đống đồ đổ nát, đống rác, nơi nuôi các động vật của gia đình.
• Để tránh bị rắn biển cắn, người dân không nên bắt rắn ở trong lưới hoặc dây câu.
• Dùng đèn nếu ở trong bóng tối hoặc vào ban đêm.
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