While very few envenomings to the tongue of patients were previously reported [13,14,15,16], this is a severe case of Russell’s viper envenoming to the patient’s tongue, which resulted because of worshipping a live snake based on the advice of an astrologist. Notably, the tongue was deeply incised as a means of first aid to counteract the envenomation effects. The patient experienced the usual envenomation effects (e.g., coagulopathy) of the Russell’s viper alongside the unusual side effects of the bite being located on the tongue. As indicated above, Russell’s viper venom contains a large amount of PLA2 and proteolytic enzymes that act on blood coagulation [18]. As a result, they induce rapid consumption coagulopathy and subsequently, severe bleeding. In this patient, the deep incision made on the tongue following the bite exacerbated bleeding, leading to airway obstruction. The laboratory investigations indicated prolonged coagulation parameters as well as a large increase in creatinine kinase levels, suggesting significant tissue damage in the tongue, which is a skeletal muscle. Notably, the platelet level did not reduce as expected in this case due to a large amount of bleeding. While the clinicians saved this patient and their tongue, this case emphasises the urgent need to create SBE awareness among rural communities and develop/enforce appropriate policies to mitigate such extreme actions. For many people, the appearance of snakes in dreams is perceived as a bad omen. Traditional beliefs surrounding snakes go back thousands of years and are prominent in the history and mythology of almost all cultures [5,20]. Snakes are regarded as the representatives of gods, divine beings, bringers of fortune or misfortune, and their statues are worshipped in many parts of the world [4,7]. However, worshipping live venomous snakes and their mishandling is associated with serious consequences. Therefore, these aspects need attention from relevant health and forest authorities. According to the Wildlife Protection Act of 1972, it is illegal to keep snakes and other wild animals in captivity without the relevant licenses in India [21], but these rules are often overlooked in the case of religious centres [6,8]. Policy surrounding the use of venomous snakes for religious reasons requires updating to avoid hugely dangerous ceremonies such as those documented here. Therefore, the law should be enforced when necessary to mitigate such dangerous actions of using snakes for live worship and educate the communities to improve their awareness about snakes and SBE. Moreover, many misbeliefs are associated with the use of inappropriate first aid, which exacerbates SBE-induced complications [12]. In several cases, medical staff not only have to treat the complications arising from SBE but also handle the damaging effects of inappropriate first aid or treatments [22]. Indeed, incisions as well as tourniquets, blood-sucking, and burning bite sites have been proven to not be an effective first aid for SBE, although they are still being practised [9,11]. In this case, the deep incision to the tongue and laceration of the lingual artery complicated the treatment by inducing excessive bleeding and additional swelling of the tongue. This prevented the initial attempts to manually ventilate the patient. Therefore, the patient had to be nasally intubated with the help of trained healthcare professionals. Moreover, surgical procedures had to be used to reconnect the incised tongue. The clinical guidelines for restoring respiration dictate a sequential treatment plan, becoming increasingly complicated and invasive with each failed attempt [23,24]. Indeed, the difficult airway guidelines proposed by the American Society of Anaesthesiologists [25] and other authorities were not useful in this case due to severe bleeding and swelling. The available standard airway management algorithms largely depend on the visualisation of glottis directly or indirectly [26], and they were not suitable in this case due to profuse bleeding. If the medical staff were not trained to tackle this critical issue and act promptly to intubate the patient nasally then the situation would have been even worse. Similarly, the SBE treatment protocols mainly focus on tackling the envenomation effects by administering suitable antivenoms and blood products. They do not provide guidelines for managing such rare complications, which could be compounded by inappropriate first aid. Overall, this is a unique case when compared to any of the previously reported SBEs in the tongue. A snake charmer who was bitten by a Taiwan–Chinese cobra (Naja naja atra) on their tongue displayed minimal swelling and envenomation effects without any breathing difficulties [13]. The administration of antivenom and other supportive care successfully treated them. In contrast, a 41-year-old man who was bitten by Crotalus atrox displayed upper airway obstruction due to oedema of the tongue but was successfully treated with nasotracheal intubation, antivenom and supportive care [14]. A European common adder bite in a 24-year-old man caused swelling and compromised airway resulting in respiratory failure which was tackled by acute tracheotomy and antivenom treatment [16]. Sadly, a snake catcher who was bitten by a cobra in the Philippines on their tongue died promptly [27]. In a state of India, a cobra was made to bite a devotee’s tongue in a festival to please the god [8]. While this person was spitting a large amount of blood, the news article confirms that they did not suffer any further envenomation effects.