This document summarizes information about snake bites in India. It notes that there are 216 snake species in India, 52 of which are poisonous, belonging to 4 families. It then describes the clinical features and symptoms of bites from different snake families, including local effects, systemic effects on organs like the heart and kidneys, and unusual late manifestations. The document outlines evaluation and management of snake bites, including first aid, antivenom therapy, and monitoring for signs of envenomation.
2. Introduction
In the world
3000 species, 500 poisonous
In India
216 species, 52 poisonous(There
are 4 major poisonous landsnakes)
Annual mortality in India
5.6 to 12.6 per 100000
3. Venomous Snakes in India
Elapidae
Cobra
Common Krait
Viperidae
Russell’s viper
Saw-scaled viper
Crotalidae
Pit viper
Hydrophidae
Sea snakes
29. Systemic Features – Elapid / Krait bite
Neurotoxicity
• Onset as early as 15 min with ptosis &
external ophthalmoplegia
• Rapid descending paralysis
• Life-threatening respiratory paralysis
• Effects completely reversible with antivenin /
anticholinesterases
• Spontaneously wears off in 1 – 7 days
Cardiotoxicity
• Direct myocardial toxicity
30. Systemic Features – Viper bite
Clotting defect & haemolysis
• Persistent bleeding from puncture sites
•Nephrotoxicity
Commonest with Russell’s viper
Cause - hypovolemia & ischaemia
31. Systemic Features – Sea snake bite
Myotoxicity
• Pain & tenderness in muscles develop 0.5
to 3.5 hours after bite
• Trismus common
• Rhabdomyolysis
Nephrotoxicity
Neurotoxicity
Generalized flaccid paralysis
Cardiotoxicity
32. UNUSUAL AND RARE MANIFESTATIONS OF
OPHITOXAEMIA
Delayed manifestations
• Bleeding as late as 4-6 days after the bite
• local blebs =venom depot
33. Long term effects of snake bite
• swelling and oedema resolve within 2 to 3
weeks.may persist up to 3 months
• Necrosis , gangrene
34. Recurrent manifestations
• Signs of systemic envenomation may recur hours or
even days after initially good response to antivenom.
•
• Daily evaluation of patients for at least 3-4 days
35. Management
First aid
• Reassure
• Immobilize
• Move to hospital as soon as possible
• Tourniquet / pressure immobilization
in severe elapid envenoming
(to delay onset of respiratory paralysis)
remove only after 1st
dose of antivenin
• Treat shock with colloids
• Maintain patent airway
40. Antivenin therapy
To give or not to give?
Benefits >>risks
Indications
• Local
Local swelling > half limb
Severe local blistering / bruising / necrosis
• Systemic
Bleeding / shock / cardiotoxicity/
Neurotoxicity / impaired consciousness
Generalized rhabdomyolysis
41. Antivenin
Lyophilized, polyvalent equine anti - serum
Effective against cobra, common krait, Russell’s
viper & saw-scaled viper
Dilute in 5ml / kg BW of NS / 5% D
Give slow i/v over 1 – 2 h
Dose
For viper bite
local swelling, no systemic signs 50ml
mild systemic signs 50 – 100 ml
severe poisoning 150 – 200ml
For cobra bite 100 – 200ml
42. Response to antivenin
• Rapid & dramatic
• Neurotoxic signs may improve within 30 min
spontaneous bleeding stops in 15 – 30 min
• Repeat antivenin q 6 h till progression of
paralysis stops / clotting profile normalizes