short ppt on snake bite

1. MICROTEACHING
DR. NIKHIL M. KAMDI (JR1)
DEPARTMENT OF PHARMACOLOGY,
GMCH NAGPUR
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SNAKE BITE

2. OVERVIEW
Introduction
Non-Venomous and venomous snakes
Clinical Features
Management of snake bite
Adverse reactions to anti-snake venom
Summary
References
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3. INTRODUCTION
 Acute life threatening time limiting medical emergency
Preventable public health hazard faced by rural population
India contributes maximum to the snake envenomation caused morbidity and mortality
Total number of bites more than 5-6 lakhs
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4. NON-VENOMOUS SNAKES
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Common krait
Russell’s viper Saw scaled viper
VENOMOUS SNAKES
Indian cobra

6. CLINICAL FEATURES
Suspected snake bite
Overt bite
History of bite
Nonvenomous (70%) / Venomous (30%)
Occult bite
No History of bite
Krait • Neuroparalytic symptoms
with no local signs
• Severe abdominal pain,
vomiting
Asymptomatic Dry bite Symptomatic
Predominant symptom
manifestation
Anxiety, Palpitations,
Tachycardia,
Paresthesia
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7. Suspected snake bite
Overt bite
History of bite
Venomous (30%)
Symptomatic
Predominant symptom manifestation
Progressive painful swelling Neurotoxic Vasculotoxic Myotoxic
• Local necrosis
• Ecchymosis
• Blistering
• Painful Swelling
• Compartment syndrome
Viper Cobra
Krait
• Ptosis
• Diplopia
• Dysarthia
• Dysphonia
• Dyspnoea
• Dysphagia
• Paralysis
Russel’s Viper
Saw Scale Viper
• Bleeding
• DIC
• Shock
• Acute Kidney
Injury
Sea Snake
• Muscle ache
• Muscle Swelling
• Involuntary contractions
of muscles
• Compartment syndrome
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8. MANAGEMENT OF SNAKE BITE
Investigations: 20 Minute Whole Blood Clotting Test (20 WBCT), CBC, Coagulation
profile, stool microscopy & other routine tests.
Treatment:
R- Reassure the Patient
I – Immobilize : Which prevent faster spread of venom
GH – Get to the hospital immediately
T- Tell the doctor of any systemic symptoms that manifest on way to hospital
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9.  DO NOT APPLY TORNIQUET : To avoid pressure necrosis
 NO CUTTING / ELECTROCUTERY of that area
 In case of vasculotoxic envenomation:-
 Anti-snake venom
 supportive treatment
 Dialysis
 Blood transfusion
 Myotoxic envenomation: surgical intervention
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10. Neurotoxic Envenomation:-
Causes bulbar & respiratory paralysis
Neostigmine reverse respiratory failure & neurotoxic symptoms
 Atropine 0.6mg followed by neostigmine (1.5mg) to be given IV and repeat dose of
neostigmine 0.5 mg with atropine every 30 minutes for 5 doses
Ventilatory support may require
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11. ANTI-SNAKE VENOM (ASV)
ASV is the mainstay of treatment
ASV in India is polyvalent: effective against four common species
Russell’s viper
Cobra
Common Krait
 Saw Scaled viper
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Each milliliter of reconstituted antivenom has the potency to neutralize the venom of
the following snakes:
 0.6 mg of dried Indian cobra venom
 0.6 mg of dried Russell’s viper venom
 0.45 mg of dried saw-scaled viper venom
 0.45 mg of dried common krait venom

12. Lyophilized Liquid
Advantages:
1. Long Shelf Life (5 Years)
2. Requires no cold chain
1.Speed of reconstitution immediate
Disadvantages:
1. Speed of reconstitution of 30-60
minutes
1. Short Shelf Life (2 years)
2. Requires a cold chain
ASV comes in two forms:
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13. ASV given by IV route & given slowly
10 vials of ASV dissolved in 100 ml of distilled water & added to 400 ml of normal
saline or dextrose solution
Total required dose will be between 10 vials to 25 vials
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14. ADVERSE REACTIONS TO ANTI-SNAKE VENOM
 Early anaphylactic reactions:
Tachycardia, urticaria, dyspnoea, laryngeal edema, bronchospasm, hypotension
Infusion should stop temporarily
Managed by IM or IV epinephrine, IV glucocorticoids, IV antihistamines
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15. CONTD ADVERSE DRUG REACTION….
Late serum sickness:
occurs 1-2 weeks of after antivenom administration
Myalgia, arthralgias, fever, lymphadenopathy, renal dysfunction
Managed by oral systemic glucocorticoids, oral antihistamines
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16. SUMMARY
India contributes to maximum number of snake bite cases
 Most common Indian venomous snakes : cobra, krait, russell's viper, saw scaled viper
 Predominant manifestations : progressive painful swelling, neurotoxic, vasculotoxic,
myotoxic
Management of snake bite : 1.first Aid treatment, anti-snake venom, neostigmine
2.supportive treatment, dialysis, blood transfusion, ventilation
Adverse reactions to ASV : 1. Early anaphylactic
2.Late serum sickness
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17. REFERENCES
 Jameson ,Harrison’s principle of internal medicine, 20th ed, Volume 2, Chapter no
451,Disorders caused by venomous snakebites, 3313-3318
 Chakraborty A, Training module for management of snake bite & common poisons,
Chapter no. 9, Diagnosis of Snakebite & Envenomation, 8-15
 Tripathi KD , Essentials of Medical Pharmacology , 8th ed , Section 2 , chapter 7 ,
Cholinergic transmission and Cholinergic drugs , 119-122
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18. THANK YOU
NEXT PG
ACTIVITY
MICROTEACHING:-DOSE RESPONSE CURVE
DR. LAXMIKANT PHUTANE
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