Snake Bite
Sanjaya Gihan Weerasinghe
Snakes Bites in Sri Lanka
•
•
•
•

65000 snake bites annually
800 deaths
Fatality- 5 in 100000 population
Dramatic increas...
96 species of snakes in Sri Lanka.
Only 5 of the land snakes are considered
potentially deadly.

Sanjaya Gihan
Sanjaya Gihan
Highly Venomous Snakes
•
•
•
•
•

Cobra (Naja naja)
Common krait (Bungarus caeruleus)
Sri Lanka krait (Bungarus ceylonicus...
Moderately Venomous Snakes
• Hump nosed viper (Hypnale hypnale)
• Green pit viper (Trimeresurus trigonocephalus)

Sanjaya ...
A 10 years old boy is presented with a swelling
in the R/S ankle complaining of a snake bite
12.15 pm
•While the boy was ...
• He was taken home immediately by his brother
lifting on arms.
• They didn’t do anything with the woundwashing, tying tou...
• After 1 ½ hours after the incident,he was
brought to hospital in three wheeler.
 On admission,
• Bite site - Swelling ,...
Bite Marks

Bleeding from the
Site

Necrosis
Blistering
Sanjaya Gihan
• By then he had neurological involvement .

 Ptosis
 External Opthalmoplegia
 Drowsiness

Sanjaya Gihan
Neurological
•
•
•
•
•
•
•
•
•

Drowsiness
Paraesthesiae
abnormalities of taste and smell
“heavy” eyelids
ptosis
external ...
In the Ward..
• A catheter was inserted.
• Haematuria was noticed.

Sanjaya Gihan
Gum Bleeding

Subconjunctival Haemorrhage
Sanjaya Gihan
Management of A Snake Bite

Sanjaya Gihan
Sanjaya Gihan
Sanjaya Gihan
First Aids
Dos
•Reassure.
•Remove all rings, Bracelets from
bitten parts of the body.
•Wash the bitten area with soap and
water.
•Kee...
Sanjaya Gihan
Do Nots
•Don’t panic
•Don’t make any cut, scratch or
incision
•Don’t suck at the wound
•Don’t apply ice packs to the
bitte...
Transport to hospital
• Quickly, but safely and Comfortably
• Minimal Movements avoid systemic absorption

Sanjaya Gihan
In the ETU
• Rapid Clinical Assessment & Resuscitation.
(ABC)
• Bite site was cleaned with soap and water.
• IV canulae wa...
Detailed Clinical Assessment
 History
• 3 Preliminary Qs
– In which part of the body?
– How long ago?
– Brought the snake...
Snake Identification
Sanjaya Gihan
Cobra
නන
න
•“Spectacle” like marking in
Dorsum of the Hood.
•When excited this fold
expands into a hood .

Sanjaya Gihan
Common/Indian Krait
නන නන
න නන
න
න
• Oily,shiny,Bluish black appearance
• Paired white bands on the dorsal surface

Sanjay...
Sri Lankan Krait
දද දදද
දද දද
• Blackish brown snake with white bands on the
body

Sanjaya Gihan
Russell’s Viper
දද ද
දද දද
දදද
• Highly poisonous 40% of deaths is due to this snake in
Sri Lanka
• Largest & most widely ...
• “V” shaped white
marking in the head.
• Has 3 rows of black
elliptical markings
running alone the
length.

Sanjaya Gihan
Sanjaya Gihan
Saw Scaled Viper
දද දදද
දද දද
ද
• Sandy brown in
colour
• birds foot mark
over the head
• When disturbed, it
rubs the coil...
Sanjaya Gihan
Hump Nosed Viper
දද දද/ දදදද දද ද
ද දදද
දදද ද
ද දද
ද
• Brown in colour
with dark brown
& black markings.
• Upturned hump.
...
Sanjaya Gihan
Green Pit Viper
දද දද
ද දදද
ද
• Bright green in colour with black markings

Sanjaya Gihan
Sanjaya Gihan
If the snake is identified as non venomous ,
patient can be discharged after a booster dose
of Tetanus toxoid.

Sanjaya Gi...
Sanjaya Gihan
Sanjaya Gihan
Investigations
•
•
•
•
•
•
•

20 WBCT
FBC
SC & BU
SE
SGOT/SGPT
Blood Grouping
IP OP chart
Sanjaya Gihan
20 mins Whole Blood Clotting Test

Incoagulable blood is diagnostic of a viper bite
Sanjaya Gihan
and rules out an elapid ...
Snake Venom Antiserum
• Only specific antidote to snake venom
• most important decision in the management
• IV Immunoglobu...
Indications for Antivenom
• Signs of systemic envenomation (ARF,Dark
color urine,Generalized Rhabdomyolysis)
• Haemostatic...
Administration of antivenom Serum
• 3 IV lines
• Keep adrenaline ready in a
syringe 0.5mg (1:1000)
• 10 ampoules of AVS
• ...
• Watch for any reaction such as,
– Fever ,Chills
– Itching,Urticaria
– Bronchospasms

• If a Early Anaphylactoid reaction...
•
•
•
•

Stop AVS infusion
Give adrenaline 0.5mg (1:1000) IM
IV Chlorpheniramine 5mg
IV Hydrocortisone 200mg

• Restart AV...
More Antivenom??
• Persistant or Recurrent Incoagulability by
20WBCT after 6 hours
• Further Deterioration

Sanjaya Gihan
Supportive/ancillary treatment
• In severely envenomed patients
– Assisted ventilation.
– renal dialysis.
– Wound Debridem...
Treatment of the bitten part
• The bitten limb is nursed in the most
• comfortable position, slightly elevated
• Bullae as...
Rehabilitation
• Restoration of normal function in the bitten
part.
• Conventional physiotherapy.

Sanjaya Gihan
Long Term Complications
•
•
•
•

Chronic Ulceration
Osteomyelitis
Chronic Renal Failure
Chronic Neurological deficit

Sanj...
Sanjaya Gihan
Thank You…!!

Sanjaya Gihan
Upcoming SlideShare
Loading in...5
×

Snake bite,first aid, anti-venom treatment and ward management

4,200

Published on

Basic Knowledge on Snakes Identification,Snake Bite,First aids (Dos and Do nots) and Management

Published in: Health & Medicine
1 Comment
8 Likes
Statistics
Notes
No Downloads
Views
Total Views
4,200
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
483
Comments
1
Likes
8
Embeds 0
No embeds

No notes for slide

Transcript of "Snake bite,first aid, anti-venom treatment and ward management "

  1. 1. Snake Bite Sanjaya Gihan Weerasinghe
  2. 2. Snakes Bites in Sri Lanka • • • • 65000 snake bites annually 800 deaths Fatality- 5 in 100000 population Dramatic increase in Hospital admissions • Acceptance of Western Medical therapy • Case fatality rate has been reduced Sanjaya Gihan
  3. 3. 96 species of snakes in Sri Lanka. Only 5 of the land snakes are considered potentially deadly. Sanjaya Gihan
  4. 4. Sanjaya Gihan
  5. 5. Highly Venomous Snakes • • • • • Cobra (Naja naja) Common krait (Bungarus caeruleus) Sri Lanka krait (Bungarus ceylonicus) Russells's viper (Daboia russelii) Saw scaled viper (Echis carinatus) Sanjaya Gihan
  6. 6. Moderately Venomous Snakes • Hump nosed viper (Hypnale hypnale) • Green pit viper (Trimeresurus trigonocephalus) Sanjaya Gihan
  7. 7. A 10 years old boy is presented with a swelling in the R/S ankle complaining of a snake bite 12.15 pm •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. Sanjaya Gihan
  8. 8. • 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,  drowsy  vomited (food particles and few drops of fresh blood)  burning type of abdominal pain. • Taken to ayurvedic prationer nearby. Sanjaya Gihan
  9. 9. • After 1 ½ hours after the incident,he was brought to hospital in three wheeler.  On admission, • Bite site - Swelling ,Color change,Painful • No Bleeding nor Bruising. • No blister formation. Sanjaya Gihan
  10. 10. Bite Marks Bleeding from the Site Necrosis Blistering Sanjaya Gihan
  11. 11. • By then he had neurological involvement .  Ptosis  External Opthalmoplegia  Drowsiness Sanjaya Gihan
  12. 12. Neurological • • • • • • • • • Drowsiness Paraesthesiae abnormalities of taste and smell “heavy” eyelids ptosis external ophthalmoplegia paralysis of facial muscles difficulty in swallowing respiratory and generalised flaccid paralysis Sanjaya Gihan
  13. 13. In the Ward.. • A catheter was inserted. • Haematuria was noticed. Sanjaya Gihan
  14. 14. Gum Bleeding Subconjunctival Haemorrhage Sanjaya Gihan
  15. 15. Management of A Snake Bite Sanjaya Gihan
  16. 16. Sanjaya Gihan
  17. 17. Sanjaya Gihan
  18. 18. First Aids
  19. 19. Dos •Reassure. •Remove all rings, Bracelets from bitten parts of the body. •Wash the bitten area with soap and water. •Keep the stricken limb below the heart. •Immobilize the bitten limb with splint or slings. •Get medical help as quick as possible. Sanjaya Gihan
  20. 20. Sanjaya Gihan
  21. 21. Do Nots •Don’t panic •Don’t make any cut, scratch or incision •Don’t suck at the wound •Don’t apply ice packs to the bitten area. •Don’t use tight bands or tourniquet. •Don’t drink alcohol, take herbal medicine or Aspirin. Sanjaya Gihan
  22. 22. Transport to hospital • Quickly, but safely and Comfortably • Minimal Movements avoid systemic absorption Sanjaya Gihan
  23. 23. In the ETU • Rapid Clinical Assessment & Resuscitation. (ABC) • 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. Sanjaya Gihan
  24. 24. Detailed Clinical Assessment  History • 3 Preliminary Qs – In which part of the body? – How long ago? – Brought the snake? Can describe it? Sanjaya Gihan
  25. 25. Snake Identification
  26. 26. Sanjaya Gihan
  27. 27. Cobra නන න •“Spectacle” like marking in Dorsum of the Hood. •When excited this fold expands into a hood . Sanjaya Gihan
  28. 28. Common/Indian Krait නන නන න නන න න • Oily,shiny,Bluish black appearance • Paired white bands on the dorsal surface Sanjaya Gihan
  29. 29. Sri Lankan Krait දද දදද දද දද • Blackish brown snake with white bands on the body Sanjaya Gihan
  30. 30. Russell’s Viper දද ද දද දද දදද • Highly poisonous 40% of deaths is due to this snake in Sri Lanka • Largest & most widely distributed viper in Sri Lanka. Sanjaya Gihan
  31. 31. • “V” shaped white marking in the head. • Has 3 rows of black elliptical markings running alone the length. Sanjaya Gihan
  32. 32. Sanjaya Gihan
  33. 33. Saw Scaled Viper දද දදද දද දද ද • Sandy brown in colour • birds foot mark over the head • When disturbed, it rubs the coils against each other producing a hissing noise (characteristic) Sanjaya Gihan
  34. 34. Sanjaya Gihan
  35. 35. Hump Nosed Viper දද දද/ දදදද දද ද ද දදද දදද ද ද දද ද • Brown in colour with dark brown & black markings. • Upturned hump. Sanjaya Gihan
  36. 36. Sanjaya Gihan
  37. 37. Green Pit Viper දද දද ද දදද ද • Bright green in colour with black markings Sanjaya Gihan
  38. 38. Sanjaya Gihan
  39. 39. If the snake is identified as non venomous , patient can be discharged after a booster dose of Tetanus toxoid. Sanjaya Gihan
  40. 40. Sanjaya Gihan
  41. 41. Sanjaya Gihan
  42. 42. Investigations • • • • • • • 20 WBCT FBC SC & BU SE SGOT/SGPT Blood Grouping IP OP chart Sanjaya Gihan
  43. 43. 20 mins Whole Blood Clotting Test Incoagulable blood is diagnostic of a viper bite Sanjaya Gihan and rules out an elapid bite
  44. 44. 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. Sanjaya Gihan
  45. 45. Indications for Antivenom • Signs of systemic envenomation (ARF,Dark color urine,Generalized Rhabdomyolysis) • Haemostatic abnormalities (20WBCT) • Spontaneus Bleeding • Neurotoxic signs Sanjaya Gihan
  46. 46. 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 water • 100ml AVS into 200ml of Normal Saline • Slow IV infusion for 1 hour Sanjaya Gihan
  47. 47. • Watch for any reaction such as, – Fever ,Chills – Itching,Urticaria – Bronchospasms • If a Early Anaphylactoid reaction occurs ??? Sanjaya Gihan
  48. 48. • • • • 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 Sanjaya Gihan
  49. 49. More Antivenom?? • Persistant or Recurrent Incoagulability by 20WBCT after 6 hours • Further Deterioration Sanjaya Gihan
  50. 50. Supportive/ancillary treatment • In severely envenomed patients – Assisted ventilation. – renal dialysis. – Wound Debridement. – Fasciotomy. Sanjaya Gihan
  51. 51. Treatment of the bitten part • The bitten limb is nursed in the most • comfortable position, slightly elevated • Bullae aspirated only if likely to rupture Sanjaya Gihan
  52. 52. Rehabilitation • Restoration of normal function in the bitten part. • Conventional physiotherapy. Sanjaya Gihan
  53. 53. Long Term Complications • • • • Chronic Ulceration Osteomyelitis Chronic Renal Failure Chronic Neurological deficit Sanjaya Gihan
  54. 54. Sanjaya Gihan
  55. 55. Thank You…!! Sanjaya Gihan
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×