Snake bite

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Snake bite

  1. 1. Snake Bite<br />
  2. 2. Incidence <br />In India, the annual mortality from snake bite is said to be between 25,000-30,000. More than 2000 deaths per year are reported from the state of Maharashtra alone.<br />There are about 216 species of snakes in India, of which 52 are known to be venomous. The major families of venomous snakes in India comprise elapids (cobra, king cobra and kraits) viperids (Russell’s viper, saw scaled viper or carpet viper, and pit vipers), and hydropids (sea snakes).<br />
  3. 3. Poisonous Snakes in India<br />Cobra - there are four species of Cobra found in India all of which belong to the family Naja.<br />They are – <br />Najanaja - common Indian cobra or spectacled cobra is seen throughout the country<br />Najakaouthia in the east and the north east regions<br /> Najaoxiana in the extreme north-west region<br />Najasagittifera in the Andaman islands.<br />
  4. 4. Krait - The common krait or Indian krait (Bungaruscaeruleus) is said to be the most venomous of all the species of snakes seen in India. They are mostly nocturnal. During the daytime they may rest in termite mounds, piles of brick, and sometimes within the house underneath beddings or pillows. Kraits are known to enter human dwellings quite commonly in search of prey, shelter and warmth. <br />
  5. 5. Russell’s viper - (Daboiarusselii: previously Viperarusselii) is commonly seen in many parts of India. It is generally 90-150 cm long, with a stout and rough-scaled body. <br />The head is triangular and much broader than the neck. Nostrils are relatively large, and the eyes have vertical pupils. <br />The colour of this snake is generally brown or yellowish brown. There are three rows of large brown or black, oval or round spots along the entire back. The head usually has a narrow, inverted ‘V’ shaped mark.<br />
  6. 6. Saw Scaled Viper – It (Echiscarinatus) is a small snake, growing up to 30-90 cm in length. The head appears more rounded than triangular, while the rest of the body is cylindrical, short, and stout. It has large eyes with vertical pupils. The entire body is covered with rough, serrated scales. This snake is usually pale brown in colour, with dark brown, brick red, or gray zigzag patterns on the back. An arrowhead-like or bird foot-like mark is present on the head.<br />
  7. 7. Snake Venom <br />Snake venom consists of –<br />a) Enzymes – Phospholipase A2 , Collagenase, <br /> L-amino oxidase, hyaluronidase, acetylcholinesterase, endopeptidases<br />b) Non –enzymatic polypeptides – Polysynaptic neurotoxin, presynaptic neurotoxin, cardiotoxin<br />c) Peptides –Pyroglutamylpeptide<br />d) Nucleosides –Adenosine, Guanosine<br />e) Lipids – Phospholipids, cholesterol<br />f) Amines – Histamine, serotonin<br />g) Metals – Copper, Zinc, Sodium , Magnesium<br />
  8. 8. Clinical Features<br />The most common symptoms of all snakebites are overwhelming fear, panic, and emotional instability, which may cause symptoms such as nausea and vomiting, diarrhoea, vertigo, fainting, tachycardia, and cold, clammy skin.<br />Dry snakebites can still cause severe injury to the victim. There are several reasons for this: a snakebite which is not treated properly may become infected (as is often reported by the victims of viper bites whose fangs are capable of inflicting deep puncture wounds), the bite may cause anaphylaxis in certain people, and the snake's saliva and fangs may harbor many dangerous microbial contaminants, including Clostridium tetani. If neglected, an infection may spread and potentially kill the victim.<br />Most snakebites, whether by a venomous snake or not, will have some type of local effect. There is minor pain and redness in over 90% of cases, although this varies depending on the site. <br />
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  10. 10. The venom of the cobra is neurotoxin and acts primarily by binding to the acetylcholine receptors preventing the action of acetylcholine preventing the opening of the sodium channels.<br />This causes neuromuscular blockade leading to paralysis.<br />The venom of the krait contains Bungarotoxin, a neurotoxin which inhibits the presynaptic release of acetylcholine.<br />Presynaptic nerve terminals exhibit signs of irreversible physical damage and are devoid ofsynaptic vesicles.<br />
  11. 11. Haemotoxins on the other hand act as anticoagulating factors. <br />Common initial symptoms of viper bites include lethargy, bleeding, weakness, nausea, and vomiting. Symptoms may become more life-threatening over time, developing into hypotension, tachypnoea, severe tachycardia, severe internal bleeding, altered sensorium, kidney failure and respiratory failure.<br />Most viper envenomations will cause coagulopathy, sometimes so severe that a person may bleed spontaneously from the mouth, nose, and even old, seemingly-healed wounds. Internal organs may bleed, including the brain and intestines and will cause ecchymosis (bruising) of the victim's skin.<br />Symptoms of neurotoxicity start early and many patients don’t have enough time to reach the hospital while haemotoxicity takes time and patients present at the hospital.<br />
  12. 12. Local Examination<br />During the initial evaluation, the bite site should be examined for signs of local envenomationi.eedema, petechiae, bullae, oozing from the wound and for regional lymphadenopathy.<br />Early wet Gangrene is a sign of Cobra or krait bite<br /> while slower dry gangrene is that of a viper bite.<br />Neurological Examination<br />Ptosis is the earliest sign followed by External ophthamoplegia<br />Weakness of muscles of deglutition<br />Cranial nerves are involved causing drowsiness, respiratory paralysis and coma<br />Muscles flexing the neck may be paralysed causing ‘Broken neck sign’<br />
  13. 13. Bleeding manifestations- <br />Bleeding at the site<br />Prolonged clotting time<br />Ecchymosis, Purpura. Epistaxis, bleeding from the gums<br />Cardiovascular changes<br />Arrhythmias<br />Hypotension, shock<br />Others<br />Parotid swelling, conjunctivaloedema, subconjunctivalhaemorrhages<br />
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  15. 15. Snake Bite Piercings<br /><ul><li> Snake bite piercings are a set of two lower lip piercings – one on either side. Snakebite piercings are usually done at the same time and they are pierced in the same way as a single lip piercing. Initial jewellery for snake bites piercings can be either ball closure rings or labret studs, both of which have their advantages. Whichever initial jewellery you choose for your snake bites, made sure that there is room to accommodate swelling.
  16. 16. Once your snakebites are healed you can choose between BCRs, labret studs, smooth segment rings and even body spirals. These piercings are usually quick to heal and are relatively easy to care for.</li></li></ul><li>
  17. 17. Thank you!!<br />

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