Here’s what to do if bitten by a Black Mamba

The Black Mamba (Dendroaspis polylepis) is one of Africa’s most well-known and feared snake species.

Found in the warmer regions of South Africa, including parts of the Eastern Cape, KwaZulu-Natal, Mpumalanga, Limpopo, North West, and the Northern Cape, this highly venomous snake is capable of delivering a fatal bite if not treated promptly.

Given its speed, size, and potent neurotoxic venom, understanding Black Mamba behaviour and first aid protocols is essential.

Identifying the Black Mamba

Recognising a Black Mamba can be critical in responding effectively to a snakebite.

Key identifying features include:

•    Length: Often exceeding 2 metres in length
•    Head Shape: Distinctive coffin-shaped head
•    Colour: Dark grey, olive grey, or brown with a lighter grey belly, sometimes mottled
•    Scales: Smooth scales with round pupils
•    Activity: Primarily diurnal (active during the day) but may move at night
•    Habitat: Found on the ground and in trees, often using a permanent lair

Typical behaviour

•    Prefers to flee rather than confront threats
•    If cornered, it may lift a third of its body, spread a narrow hood, and open its mouth to reveal its characteristic black interior
•    Produces a loud hissing sound when threatened
•    Capable of striking multiple times in quick succession

Symptoms of a Black Mamba bite

Most Black Mamba bites occur on the extremities including the hands, feet, or ankles, but due to their size, they can strike as high as an adult’s chest.

Their venom is predominantly neurotoxic, affecting the nervous system rapidly.

Literature suggests venom yields range from 250–400mg, with as little as 10mg potentially being fatal.

Signs of envenomation include

•    Tingling or “pins and needles” around the bite and mouth
•    Metallic taste in the mouth
•    Mild swelling or redness (though swelling is usually minimal)
•    Drooping eyelids and dilated pupils
•    Increased salivation and difficulty swallowing
•    Slurred speech and muscle weakness
•    Nausea and vomiting
•    Breathing difficulties
•    Loss of bladder and bowel control
•    Paralysis, leading to the inability to support the head (“broken neck syndrome”)

If untreated, the victim may experience

•    Severe hypoxia (oxygen deprivation)
•    Respiratory failure
•    Cardiac failure

Dry bites have been recorded, but any suspected Black Mamba bite should be treated as an emergency, as symptoms can develop within an hour.

First Aid and pre-hospital management

A structured and effective response is crucial to improving survival outcomes.

The South African Snakebite Symposium , with contributions from experts on the National Snakebite Advisory Group including Access Professional Development, has established protocols for handling Black Mamba envenomation in prehospital settings.

Immediate First Aid Steps

•    Ensure personal safety: Move the victim away from the snake’s last known location to prevent further bites
•    Keep the victim calm: Anxiety and stress can elevate heart rate, accelerating venom spread
•    Apply a pressure bandage: Use an elastic bandage, not a crepe bandage, to slow venom movement
•    Tourniquets: Only use a tourniquet under specific conditions: if absolutely sure it was a Black Mamba bite, if a pressure bandage is unavailable, and if medical help is more than 90 minutes away. A wide medical tourniquet or belt should be used, never string, wire, or shoelaces. Once applied, it should remain in place until reaching a medical facility
•    Immobilize the affected limb: Keep the limb at heart level to prevent rapid venom spread
•    Arrange transport to a hospital: Call for an ambulance or seek immediate transport to a medical facility equipped with antivenom
•    Avoid tampering with the bite site: Do not attempt to suck, cut, or bleed the wound. Wipe excess venom off the skin if necessary
•    Remove restrictive items: Take off rings, watches, and tight clothing to avoid complications if swelling occurs
•    Mark and document the bite site: Use a marker to note the time and track any possible swelling progression every 30 minutes
•    Monitor breathing: If the victim’s breathing slows or they show signs of oxygen deprivation, be prepared to assist with rescue breathing or CPR if necessary

Pre-hospital Care for Emergency Medical Services

For paramedics and first responders, ensuring a patient’s airway remains open and oxygenation is maintained is the highest priority.

Emergency Care Practitioner (ECP) providers must be prepared to intervene with airway management techniques.

• Airway Management

• Assist breathing with a Bag-Valve-Mask (BVM) as required
• Avoid early intubation unless necessary, but do not delay once respiratory distress becomes evident
• Monitor SpO2 and ETCO2 levels; administer oxygen via nasal cannula or non-rebreather mask if SpO2 drops below 94%
• If respiratory rate falls below 8 breaths per minute, initiate ventilation support with a BVM while preparing for intubation

• Medication Protocol

• Induction agents: Ketamine (1–2 mg/kg) or Etomidate (0.1–0.3 mg/kg)
• Rocuronium (1–1.2 mg/kg) may be used for paralysis, but Succinylcholine should be avoided
• Post-intubation sedation: Ketamine (1–2 mg/kg/hr)

• Ventilator settings

• Mode: SIMV
• Tidal volume: 7ml/kg
• PIP: 12–14 cm H2O
• PEEP: 5 cm H2O
• I:E ratio: 1:2
• Rate: Adults (12–16 bpm), Paediatrics (20–25 bpm), Infants (25 bpm)

Conclusion

Black Mamba bites are medical emergencies requiring rapid and appropriate intervention. 

Access Professional Development, a key contributor to South Africa’s leading snakebite management protocols, emphasises the importance of early first aid, effective prehospital care, and timely transportation to a medical facility.

By following these guidelines, the risk of fatality can be significantly reduced.

For further information on Black Mambas and professional Snake Identification, Handling & Snakebite Treatment courses, get hold of Access Professional Development at 076 092 5932 or bernadette@accesspd.co.za

Have you ever been bitten by a snake?

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