Arman's snake bite

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Arman Hawari

Health & Medicine Technology

Dr Arman Bin Hawari Emergency & Trauma Department www.kecemasan2u.com

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Emergency & Trauma Department Hospital Sultanah Bahiyah www.kecemasan2u.com Common Snakes in Malaysia iNTRoDuCTioN

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Emergency & Trauma Department Hospital Sultanah Bahiyah www.kecemasan2u.com Clinical : General Approach: Becareful of dead snakes brought, 1 st aid Airway, breathing, circulation Identify the systemic symptoms Examination of bitten part: Compartment syndrome Fang marks-? Clues of adult vs juvenile Demarcate local reactions Signs of neurotoxicity: Ask the patient to raise the hand, and count loudly in reverse from hundred and look up… CLiNiCaL

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Emergency & Trauma Department Hospital Sultanah Bahiyah www.kecemasan2u.com 1 st Aid-pressure immobilization for elapids Not recommended for vipers 1 st aiD

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Snake bites epitomize a multifaceted intersection between humans and reptiles, often culminating in dire consequences. The intricate dynamics of venom delivery mechanisms and their intricate interplay with the human physiology underscore the urgency of comprehensively understanding and addressing this complex issue. Venomous snakes, equipped with specialized fangs honed by evolution, wield venom as a potent weapon. This venom, a sophisticated blend of toxins, serves diverse purposes, including immobilizing prey, aiding in digestion, and self-defense. The composition of snake venom varies markedly across species, each venom boasting a unique concoction of enzymes, peptides, and proteins meticulously tailored to disrupt physiological functions in their unsuspecting victims. The ramifications of a snake bite can be profound and diverse, spanning from localized tissue damage and systemic toxicity to potentially life-threatening complications. The severity of envenomation hinges on myriad factors, including the potency of the venom, the volume injected, the site of the bite, and the health status of the victim. Neurotoxic venoms, for instance, can precipitate paralysis and respiratory failure, while hemotoxic venoms may induce extensive tissue necrosis and coagulopathies, underscoring the pernicious diversity of snakebite outcomes. Timely recognition and appropriate management are pivotal in mitigating the impact of snake bites. Immediate implementation of first aid measures, such as immobilizing the affected limb, maintaining the victim's composure, and promptly seeking medical assistance, can substantially ameliorate outcomes. In regions where venomous snakes hold sway, access to antivenom and proficient healthcare professionals assumes paramount importance for efficacious treatment. Nonetheless, the challenges posed by snake bites transcend the confines of mere medical intervention. Socioeconomic determinants, encompassing factors like limited healthcare accessibility, inadequate infrastructure, and geographical remoteness, can markedly exacerbate the burden of snakebite-related morbidity and mortality, particularly among marginalized populations. Preventive strategies wield considerable influence in curtailing the incidence of snake bites and attenuating their repercussions. Educational initiatives geared toward disseminating knowledge about snake behavior, imparting proficiency in first aid techniques, and advocating preventive measures like donning protective attire and circumventing high-risk locales constitute indispensable pillars of snakebite prevention. Furthermore, endeavors aimed at conserving snake habitats and fostering cohabitation between humans and serpents are pivotal for long-term snakebite mitigation. By fostering an understanding of the ecological roles of snakes and championing their conservation, societies can engender an environment conducive to harmonious coexistence between humans and reptiles.

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Snake bite is a common but under-reported medical emergency accounting for 0.5% of all deaths with greater risk of fatal envenomation in children. In India, four species of venomous snake are most common but better classification of medically significant species is warranted. Snake venom is a mixture of peptides with enzymatic & toxic properties which mediate activation of cytokine cascades along with organ specific toxicities, manifesting into local and systemic symptoms. The syndromic approach of attributing a constellation of signs & symptoms to a particular family of venomous snake has clinical acceptance but overlaps exist. Management of snake bite victim starts with a first aid measures of reassurance, immobilization and quick transfer to hospital. Measures such as application of tourniquet, incision and suction are harmful & should not be done. On arrival at hospital, triage and stabilization of Airway, Breathing & Circulation (ABC) is done followed by a focused assessment to ascertain the severity of envenomation. Antivenom treatment is the mainstay of snake bite management. ASV should be started only when specific indications such as signs of neurotoxicity, coagulopathy, hypotension, hematuria are present. Indiscriminate use of ASV is strongly condemned.Currently 8-10 vials of ASV as initial dose with a maximum of 25 vials is recommended. There is no role of test dose of ASV. Measures to treat any ASV induced anaphylaxis should be ready prior to start of ASV treatment. Supportive treatment is as important in determining the final outcome of envenomation as ASV

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