Hera Lal’s 10 year old child present in casualty with snakebite since six hours. On examination no systemic signs are found & lab investigation are normal except localized swelling over the leg of < 5 cm. Next step in management would be –

**Core Concept**
Snake envenoming occurs when venom is injected into the body, causing various systemic and local effects. In this scenario, the child has no systemic signs and normal lab investigations, indicating minimal or no venom absorption.

**Why the Correct Answer is Right**
The management of snakebite involves assessing the severity of envenoming, which is often determined by the presence of systemic signs and laboratory abnormalities. Since Hera Lal's child has no systemic signs and normal lab investigations, the risk of severe envenoming is low. **The next step is to immobilize the affected limb and monitor for any signs of systemic toxicity**. This approach is in line with the World Health Organization's guidelines for the management of snakebite.

**Why Each Wrong Option is Incorrect**

**Option A:** Administering antivenom is not the next step, as there is no evidence of significant envenoming. Antivenom is typically reserved for patients with systemic signs or laboratory abnormalities.
**Option B:** Performing a fasciotomy is not indicated, as the swelling is localized and less than 5 cm. Fasciotomy is generally reserved for cases with significant compartment syndrome.

**Clinical Pearl / High-Yield Fact**
In the management of snakebite, it's essential to remember that the majority of snakebites are harmless, and most patients can be managed conservatively with monitoring and immobilization.

**Correct Answer: B. Perform wound cleaning and immobilize the affected limb.**

✓ Correct Answer: D. Observe the patient for progression of symptoms wait for antivenom therapy