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Americas and Oceania. The morbidity and mortality resulting from bites are significant. Huge variation in management, coupled with many patients’ traditional cultural beliefs and lack of resources contribute to a huge disease burden from snake bites2. The World Health Organisation
(WHO) recently recognised snake bite as a neglected tropical disease and this has led to a global snake bite initiative to improve clinical outcome following snake bites3. The aim of this paper is to review current literature on the incidence, pathophysiology and management of snake bite. The aim is to help clinicians to a better understanding of the management of bites, especially when in situations with minimal resources and lack of anti-venom, which is where most snake bites occur. This review discusses a safe approach to clinical management in a field with limited evidence. A treatment guide to use of anti-venom is included to facilitate rapid decision making in stressful clinical situations. Surgeons in rural hospitals in low and middle income countries are often involved in the management of snake bite patients due to the nature of tissue damage caused by venom or wrong primary management, or because surgeons might be amongst the more senior staff available to help manage critically ill patients in such district hospitals. Most surgeons are outside their comfort zone, however, when they have to manage a snake bite patient, and this paper attempts to provide a structured approach to management.