Snake bite,first aid, anti-venom treatment and ward management
Sanjaya Gihan Weerasinghe
Snakes Bites in Sri Lanka
65000 snake bites annually
Fatality- 5 in 100000 population
Dramatic increase in Hospital
• Acceptance of Western Medical
• Case fatality rate has been
96 species of snakes in Sri Lanka.
Only 5 of the land snakes are considered
A 10 years old boy is presented with a swelling
in the R/S ankle complaining of a snake bite
•While the boy was playing in an abandoned
paddy field, he felt a sharp pain in the R/S ankle.
•When he checked there was bleeding from the
site of pain and there were bite marks.
•Boy didn’t see the snake.
• He was taken home immediately by his brother
lifting on arms.
• They didn’t do anything with the woundwashing, tying tourniquet,etc.
• By the time he reached home, the boy was,
vomited (food particles and few drops of fresh blood)
burning type of abdominal pain.
• Taken to ayurvedic prationer nearby.
• After 1 ½ hours after the incident,he was
brought to hospital in three wheeler.
• Bite site - Swelling ,Color change,Painful
• No Bleeding nor Bruising.
• No blister formation.
Bleeding from the
• By then he had neurological involvement .
abnormalities of taste and smell
paralysis of facial muscles
difficulty in swallowing
respiratory and generalised flaccid paralysis
In the Ward..
• A catheter was inserted.
• Haematuria was noticed.
•Remove all rings, Bracelets from
bitten parts of the body.
•Wash the bitten area with soap and
•Keep the stricken limb below the
•Immobilize the bitten limb with splint
•Get medical help as quick as possible.
•Don’t make any cut, scratch or
•Don’t suck at the wound
•Don’t apply ice packs to the
•Don’t use tight bands or
•Don’t drink alcohol, take herbal
medicine or Aspirin.
Transport to hospital
• Quickly, but safely and Comfortably
• Minimal Movements avoid systemic absorption
In the ETU
• Rapid Clinical Assessment & Resuscitation.
• Bite site was cleaned with soap and water.
• IV canulae was inserted.
• Blood was taken for 20WBCT
(20 minute whole blood clotting test)
• O.Paracetamol 500mg
• IV Ranitidine 25mg
• Patient was sent to the ward.
Detailed Clinical Assessment
• 3 Preliminary Qs
– In which part of the body?
– How long ago?
– Brought the snake? Can describe it?
Saw Scaled Viper
• Sandy brown in
• birds foot mark
over the head
• When disturbed, it
rubs the coils
against each other
producing a hissing
SC & BU
IP OP chart
20 mins Whole Blood Clotting Test
Incoagulable blood is diagnostic of a viper bite
and rules out an elapid bite
Snake Venom Antiserum
• Only specific antidote to snake venom
• most important decision in the management
• IV Immunoglobulin (IgG)
• “polyvalent anti-snake venom serum”
• Covers Cobra, Krait, Russell’s viper, Sawscaled viper.
• Not against Hump nosed viper.
Indications for Antivenom
• Signs of systemic envenomation (ARF,Dark
color urine,Generalized Rhabdomyolysis)
• Haemostatic abnormalities (20WBCT)
• Spontaneus Bleeding
• Neurotoxic signs
Administration of antivenom Serum
• 3 IV lines
• Keep adrenaline ready in a
syringe 0.5mg (1:1000)
• 10 ampoules of AVS
• Each dissolved in 10ml of
• 100ml AVS into 200ml of
• Slow IV infusion for 1 hour
• Watch for any reaction such as,
– Fever ,Chills
• If a Early Anaphylactoid reaction occurs ???
Stop AVS infusion
Give adrenaline 0.5mg (1:1000) IM
IV Chlorpheniramine 5mg
IV Hydrocortisone 200mg
• Restart AVS after the reaction settled
• In Shock ----> Sub lingual Adrenaline
• Persistant or Recurrent Incoagulability by
20WBCT after 6 hours
• Further Deterioration