Venomous snakes of Saudi Arabia and the Middle East: a keynote for travellers.

Geographically Saudi Arabia and the Middle East include Asian Turkey, Syria, Lebanon, Jordan, Israel, Palestine, the Arabian Peninsula, Iraq, Iran and the previous Southern Asiatic Soviet Republics. The snake fauna contains species in common with northern Africa, Europe and central Asia and towards the east there is infiltration of species characteristic of tropical Asia. A classification of the venomous snakes of this area together with their distribution in the different countries is presented. The epidemiology of snake bites, pathophysiology of toxicity and the clinical features of envenoming by the different species of snakes are discussed. Management of snake bite victims including first aid, treatment at the hospital, clues from signs and symptoms that can help in the identification of the causative snake and antivenom treatment is stressed. Traditional manipulations like local incision and suction, use of caustics, oxidizing agents and cryotherapy and the injudicious use of tourniquets are evaluated and criticized. Finally the preventive control of snake bites for travellers in areas infested with venomous snakes is presented and discussed.