“Do it R.I.G.H.T.”
R. Reassure the patient
I Immobilise in the same way as a fractured limb. Use
bandages or cloth to hold the splints, not to block the
blood supply or apply pressure. Do not apply any
compression in the form of tight ligatures, they don’t
work and can be dangerous!
G. H. Get to Hospital Immediately. Traditional remedies
have NO PROVEN benefit in treating snakebite.
T Tell the doctor of any systemic symptoms such as
ptosis that manifest on the way to hospital.
Traditional Methods To Be
Cutting and Suction
Washing the Wound
Electrical Therapy and Cryotherapy
Pressure Immobilization Method (PIM)
Other Useful Tests depending on availability
Haemoglobin/ PCV/ Platelet Count/ PT/
APTT/ FDP/ D-Dimer
Urine Tests for Proteinuria/ RBC/
Biochemistry for Serum Creatinine/ Urea/
Oxygen Saturation/ PR/BP/ RR/ Postural
Blood Pressure, ECG
Cobra Krait R. Viper S.S.Viper H.N.Viper
Local Pain/ Tissue Damage YES NO YES YES
Ptosis/ Neurological Signs YES YES YES! NO NO
Haemostatic abnorma liies NO NO! YES YES
Renal Complications NO NO YES NO YES
Response to Neostigmine YES NO? NO? NO NO
ASV Administration Criteria
Evidence of coagulopathy: Primarily
detected by 20WBCT or visible
spontaneous systemic bleeding, gums etc.
Evidence of neurotoxicity: ptosis, external
ophthalmoplegia, muscle paralysis inability
to lift the head etc.
Severe Current Local envenoming
Severe current, local swelling involving
more than half of the bitten limb (in the
absence of a tourniquet). In the case of
severe swelling after bites on the
digits(toes and especially fingers ) after a
bite from a known necrotic species.
rapid extension of swelling ( for example
beyond the wrist or ankle within a few
hours of bites on the hands or feet).
Swelling a number of hours old is
nogrounds for giving ASV.
Dose And Route
Neurotoxic/ Anti Haemostatic 8-10 Vials
Children receive the same dose as adults B/c
it is to neutralize venom which is same
amount in both.
1. Intravenous Injection: reconstituted or liquid
ASV is administered by slow intravenous injection.
(2ml/ min) each vvial is 10ml of reconstituents.
2. Infusion: liquid or reconstituted ASV is diluted in
5-10ml/kg of isotonic saline or glucose.
All AVS over 1 hr in constant speed.
In neurotoxic envenomation neostigmine test is
done with 1.5 -2.0 mg of neostigmine IM, together
with 0.6mg of atropine IV.
The paediatric neostigmine dose is 0.04mg/kg IM
and the dose of atropine in 0.05mg /kg.
Observe victim for 1 hour.
If the victim responds to the neostigmine test then
continue with 0.5mg of neostigmine IM ½ hourly
plus 0.6 mg of atropin IV over 8 hrs in continuous
If there is no improvement in symptoms after one
hour, the neostigmine should be stopped.
Fang mark 1.2 cm deep , 2.5 cm deep
Froth in mouth & nostrils
Changes in Nissle granules in brain
matter, acute granular degeneration of
Evidence of hemorrhage in
git, cerebrum, respiratory and urinary
tract, serosal surfaces of organs, sub
endocardial hemorrhage, regional
Venom Extraction From
Medico- Legal Importance
Accidental ; Most common
Suicidal ; Queen Cleopetra
Homicidal; Hannibal & Antiochus
defeated Romans in a naval battle.
clear and colourless toxalbumin that is
more toxic than the snake venom
The small quantity of venom is
The scorpion venom consists of a
SIGNS AND SYMPTOMS
site of a wheal is having a red wheal with a
hole in the centre and severe burning pain
radiates from the site.
The area is swollen, reddened .
Increased temperature with chills and
There is feeling of giddiness and fainting.
Excessive sweating and salivation
Muscular cramps and convulsions followed
Paresis and muscular weakness persists
Application of tourniquet or pressure bandage above
the site of bite and incising and washing the bitten
area with weak solution of potassium
permagnate, borax or ammonia.
The torniquet should be loosened for 1-2 minutes
after every 10-15 minutes.
Local infiltration of 5%cocaine, or lignocaine solution
in and around the bite relieves pain.
To treat shock, 5% of 500ml of dextrose saline should
be given i.v along with glucocorticoids
i.m.calcium gluconate 10 ml of 10% solution should
be given intravenously to combat muscular cramps.
To prevent pulmonary oedema, atropine sulphate
should be administered
Produce a painful local reaction, which recedes
An allergic phenomenon produced by them may kill
the patient because of prior sensitization.
Number of stings may be so great or the patient is so
young as to be killed with primary toxicity.
Signs and symptoms:
Nausea and vomiting
Cyanosis, convulsions and death.
The fatalities may result a short while after the
infliction of stings.
Hollow, venom filled, calcified spines
hemolysin, proteases, serotonins,
If spine is retained near vital structure
than chances of granuloma formation
which should get operated.
Predator carnivorous mollusks.
Neurotoxic venom delivered through
harpoon like darts.
Wound, perioral, generalised parasthesia.
In severe condition Bulbar Dysfunction &
Systemic Muscular Paralysis.
Australian Blue Ringed
Neurotoxin (maculotoxin) Na channel
blockage leads to peripheral nerve
Oral & facial numbness to total flaccid
Stingray ;- envenomation + traumatic
serotonin, phosphodiesterase, 5`nucleoti
Pain, Soft tissue swelling
Weakness, nausea, vomiting, diarrhea,
hypotension, syncope, paralysis & death.
Scorpion Fish ;- same as of stingray.
Stonefish, Scorpionfish, lionfish,
Cat fish ;- same as of stingray.
Hot water immersion
No to cryotherapy
Antivenom for stonefish & serious
scorpion fish .
Other supportive care.
• The venom apparatus is only
present in malesa
•Crural gland only secretes
venom in breeding season
• The use of the venom
apparatus is probably related to
combat with other males for
territory or females.
Venomous and Poisonous
Nycticebus coucang inhabits the
rainforests of southeast
Asia, Assam, Burma, Thailand, Indo
-China, certain Malayan states and
East Indian Islands.
• They have a brachial organ, a naked, gland-laden area of skin on surface
of the arm that is licked during grooming.
• When mixed with saliva, the toxin can repel some predators.
• Anaphylaxis has been observed following loris bites.
• N. coucang braAchial organ protein acts as an allergen.