What the snakes do?
They don’t bite! ites s. Only
nak specie ous
They bite! ll s
of a omous venom mate
Some of them can not inject venom! by o
ites y enven
Some of them may inject but they… ll
50% s actua atient.
○ fail to do so! ie p
No time to succeed
○ Don’t want to do so
Some of them inject but half heartedly or don’t deliver the lethal dose
due to insufficient stock.
Few of them find themselves in “INDO-PAK final” and succeed to
perform like ‘Veeru’.
Problem starts here…
As the venom is in! and that’s in sufficient
What the venom does?
e oup .
t the ortality
ngs st m
ain he hig ar.
rem ith t /ye
tri ~5 ry c bite
oun te: ima
c a r
th r ake
y o eat sn
at m o not tr
gre ls d
India is one of the world’s leading producers
of snake venom antiserum .
mortality does not rest in snake venom
Patients are referred… to distant, better equipped
hospitals… and thus make journeys without the
cover of snake venom antiserum (ASV)…
Crucial factors in decresing mortality
Availability of treatment, particularly close
to the scene of the bite. (access)
Confidence in (DOCTORS) being able to
treat the patient. (knowledge)
Please note: delayed access &/or
treatment increases the cost of treatment
and decreases chances of survival.
A death en route (DEnR) case (ID: 1949356/ 17.06.08) investigation revealed the pitfall. A
case of snake bite was taken up by Dediapada ambulance on the way to a remote village.
Relatives were coming towards the ambulance with the patient on a motorcycle. When the
EMT took up the case he was out of the coverage area. The patient was having the early
signs of neurotoxic envenomation (ptosis, agitation etc.) but hemodynamically stable. A
tourniquet was applied by relatives on the limb proximal to the site of bite. Frank edema
and bluish discoloration of skin distal to the tourniquet applied was there. The EMT was not
aware of the possibility of sudden deterioration after removal of the applied tourniquet
(JIMA JUNE 2007). The patient was looking so healthy that the EMT did not find the need of
providing oxygen. He removed the tourniquet in the ambulance & the patient deteriorated
suddenly. The patient became breathless & cyanosed. EMT started CPR. He was in coverage
area but was not able to contact ERCP as his hands were not free & he had not applied the
“HANDSFREE”. Oxygen/OPA/NPA/Ambus’ were Not Used. The doctor of CHC Dediapada
declared the patient “DEAD”. It all happened within 30 minutes. A patient having earliest
signs of neurotoxic envenomation died within 30 minutes...can you believe?
you are sure
that there is
un neutralized, unbound venom
blood or tissue fluid
SNAKE BITE: EVIDENCE OF SYSTEMIC ENVENOMATION
test.pptx ) i.e., all cobras,
members of the viper kraits and rarely Russell’s
a 20WBCT indicating the signs will be visual,
initially involving muscles
incoagulable blood or
enervated by the cranial
evidence of spontaneous
bleeding from gums. ptosis,
difficulty in swallowing
In the case of neurotoxic envenoming,
once the snake venom antiserum has
been administered, the next step is to
administer a neostigmine test to
establish if the victim reacts to
Objective measures of neurological
as single breath count,
length of time upward gaze can be
Assessment of imminent respiratory
Ability to raise their head.