In case with swelling on extremity, present severe pain, case with bleeding or have abnormal neurological sign that can not be explained, must be considered have noxious snakebite. Some snake type of cobra giving off poison to people eyes and can cause pain, swelling, and blind.

Specific signs depend on kinds of poison and usually present reaction such as shock, local swelling progress slowly extend out from bite place, bleeding performance, neurotoxicity signs and symptoms, and sign damage of muscle (muscle pain and black urine). The patient may have vomit and get headache.

First aid, immediately binding on proximal extremity bite place for reducing poison adsorption and extension, then clean the wound. If there is one of specific signs that explained before, go to the hospital having snake antitoxin. It is better not to make slice on the wound or doing torniquet. In the hospital, it will treat for the shock problem, save paralytic respiratory function by using mechanical ventilation, intubation, or another alternative is doing elective tracheostomy.

Systemic sign or severe local signs lead to giving snake antitoxin if available. Ephinefrin applied intramuscular or subcutaneous in shock case. Diphenhydramine 1,25mg/kg 6H applied intramuscular may overcome allergic reaction after using snake antitoxin. If there are urticaria, fever, cough, or hard to breathe and give subcutaneously ephinefrin 0,01 ml/kg 1:1000, giving antitoxin should be stopped and it can continue after stabilize patient condition.

It may be needed doing excision on necrotic tissue, fascia incision to lift limb compartments if required. When large necrosis happen, it may have skin grafting for the patient.

Another treatment for supporting patient condition are:

1. Giving liquid by oral or using nasogastric tube considered on daily need, and make report about liquid balance  input and output.
2. Taking analgetic drugs.
3. Elevating extremity if there is swelling.
4. Giving antitetanus as prophylactic treatment.
5. Using antibiotic for necrotic condition attend.
6. Doing evaluation and attention immediately the patient arrive in the hospital, and then notice the condition every one hour during 24 hours. That is done because of the poison can extend progressive fast.

(the doc b3ty)