Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Snake bite is one of the major public health problems in the tropics. It is also emerging as an occupational disease of agricultural workers. In view of their strong beliefs and many associated myths, people resort to magico –religious treatment for snake bite thus, causing delay in seeking proper treatment.
Snake bites is a particularly important public health problem in rural areas of tropical and subtropical countries situated in Africa, Asia, Oceania and Latin America.
Hopes everybody will be able to understand the signs and symptoms of snake bite and can know which are the most common poisonous snakes in India. This is for everybody not only medicos.
Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 1...rajendra deshpande
Snake Bite ,Rabies ,Scorpion bite are like urgency or Emergency type of conditions .This topics come under Toxicology or Agadtantra Subject of 2nd Year BAMS .This ppt will save the time to make notes from Huge books of Toxicology .This ppt is very useful for Ayurvedic students,Teachers,Doctors.Ready made information from this ppt will not only helpful for Examination point of view .But this ppt if Doctor download & save in his or her smart phone ,that will be like Ready Recknor in your practice .This ppt will help to diagnose ,to understand symptoms & signs & how to treat patient of Snake bite,Rabied dog bite ,Rat Bite,Scorpion bite . Download this ppt & send to many by what’s app Snake Bite ,Rabies ,Scorpion bite are like urgency or Emergency type of conditions .This topics come under Toxicology or Agadtantra Subject of 2nd Year BAMS .This ppt will save the time to make notes from Huge books of Toxicology .This ppt is very useful for Ayurvedic students,Teachers,Doctors.Ready made information from this ppt will not only helpful for Examination point of view .But this ppt if Doctor download & save in his or her smart phone ,that will be like Ready Recknor in your practice .This ppt will help to diagnose ,to understand symptoms & signs & how to treat patient of Snake bite,Rabied dog bite ,Rat Bite,Scorpion bite . Download this ppt & send to many by what’s app .
Scorpions are a common arthropod found all over the world.
If threatened, a scorpion may use its long, flexible tail to sting a potential predator.
Frequently, people unknowingly come into contact with these species and experience the painful sensation of envenomation
Snake bite and its management by first aid and antivenomShwetaKhadka
about snake bite ,venom,types of venom,first aid,antivenom,and management ,epidemiology ,dosage and route of antivenom administration , anaphylactic reaction due to antivenom , general symptoms of snake bite,immobilization process , formation of antivenom
This pptx is on recognition of different snakes, snake bite management particularly in children. At the end of the slide show you will definitely able to recognize and manage snake bites.
Snake bite is one of the major public health problems in the tropics. It is also emerging as an occupational disease of agricultural workers. In view of their strong beliefs and many associated myths, people resort to magico –religious treatment for snake bite thus, causing delay in seeking proper treatment.
Snake bites is a particularly important public health problem in rural areas of tropical and subtropical countries situated in Africa, Asia, Oceania and Latin America.
Hopes everybody will be able to understand the signs and symptoms of snake bite and can know which are the most common poisonous snakes in India. This is for everybody not only medicos.
Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 1...rajendra deshpande
Snake Bite ,Rabies ,Scorpion bite are like urgency or Emergency type of conditions .This topics come under Toxicology or Agadtantra Subject of 2nd Year BAMS .This ppt will save the time to make notes from Huge books of Toxicology .This ppt is very useful for Ayurvedic students,Teachers,Doctors.Ready made information from this ppt will not only helpful for Examination point of view .But this ppt if Doctor download & save in his or her smart phone ,that will be like Ready Recknor in your practice .This ppt will help to diagnose ,to understand symptoms & signs & how to treat patient of Snake bite,Rabied dog bite ,Rat Bite,Scorpion bite . Download this ppt & send to many by what’s app Snake Bite ,Rabies ,Scorpion bite are like urgency or Emergency type of conditions .This topics come under Toxicology or Agadtantra Subject of 2nd Year BAMS .This ppt will save the time to make notes from Huge books of Toxicology .This ppt is very useful for Ayurvedic students,Teachers,Doctors.Ready made information from this ppt will not only helpful for Examination point of view .But this ppt if Doctor download & save in his or her smart phone ,that will be like Ready Recknor in your practice .This ppt will help to diagnose ,to understand symptoms & signs & how to treat patient of Snake bite,Rabied dog bite ,Rat Bite,Scorpion bite . Download this ppt & send to many by what’s app .
Scorpions are a common arthropod found all over the world.
If threatened, a scorpion may use its long, flexible tail to sting a potential predator.
Frequently, people unknowingly come into contact with these species and experience the painful sensation of envenomation
Snake bite and its management by first aid and antivenomShwetaKhadka
about snake bite ,venom,types of venom,first aid,antivenom,and management ,epidemiology ,dosage and route of antivenom administration , anaphylactic reaction due to antivenom , general symptoms of snake bite,immobilization process , formation of antivenom
This pptx is on recognition of different snakes, snake bite management particularly in children. At the end of the slide show you will definitely able to recognize and manage snake bites.
Snake bite basics in a visually appealing format for general population, school and college students, medical students, paramedics, nurses, and pg residents. Snakes included only pertaining to indian subcontinent. Any medical data given is valid only for indian subcontinent.
"Venomous Encounters: Understanding the Physiology, Treatment, and Prevention...krjx9cpvdg
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.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Evaluation of antidepressant activity of clitoris ternatea in animals
Management of venomous snake bite
1. Management of snake bite
National Guideline 2014
Dr. Forhad Uddin Hasan Chowdhury (Maruf)
Assistant Registrar (Medicine )
Dhaka Medical College Hospital
2. INTRODUCTION
Snake bite is an important public
health hazard in Bangladesh
Estimated an annual incidence of
623/100,000
6,041 deaths annually.
Neurotoxic snakes like (Cobra,
Kraits) are causing significant
mortality and morbidity
Among the vipers green pit viper is
very common but there are few
cases of Russell's viper.
Rahman R,Faiz MA,Selim S,Rahman B, Bashar A,et el.Annual incidence of snake bite in rural Bangladesh.
PLoS Negl Trop Dis.2010 Oct;4(10):e860.
10. ► A bite by venomous snake which produces specific
symptoms or a syndrome is considered as venomous
snake bite.
► A venomous snake may not and do not always features
of envenoming
► 50% of bites by Russell’s viper , 30 % of bite by Cobras
and 5-10% of bites by saw scaled viper do not result in
any symptoms or signs of envenoming
► A victim may develop some features due to anxiety or
apprehension in case of bite by a venomous as well as
NV snake.
12. Site of bite, circumstances of bite, time of bite how did
it happen?
Site
Face and limbs- Green pit
Limbs- Cobra
Any site- Krait
Forearm- See snake
Time:
Night time bite especially in Krait bite
Non specific symptoms: Headache, Nausea, vomiting,
abdominal pain, loss of consciousness, difficulty in
vision, convulsions
13. Neurological symptoms: Muscle paralysis, difficulty in
moving jaw,toungue,eye, heaviness of eye lids (ptosis),
weakness of neck muscles (broken neck sign), difficulty
in swallowing, dribbling of saliva, nasal regurgitation,
nasal voice, difficulty in respiration, extreme generalized
weakness
Haematological symptoms: Spontaneous bleeding from
gum,vomiting of blood, Coughing out of blood, passage
of blood per urethra, persistent bleeding from bite site,
venepuncture site and inflicted wound if any.
14. Others: Severe muscle pain, dark urine, scanty urination,
collapse.
Concomitant medical illness: H/O allergy, Bronchial
asthma, kidney, heart disease, bleeding disorders,
neurological disease, limb swelling etc.
In female: Whether the victim is pregnant or not, whether
the victim menstruating or not.
15. H/O pre hospital treatment:
1. Home treatment.
2.Treatment from traditional healers (Ozha or Baiddya).
3.Application of tourniquet.
4.H/0 immunization against tetanus.
5.Treatment by initial attending physician.
17. 1.Rapid clinical assessment especially vitals: Pulse, BP,
Respiration, Temp
2.Systemic signs of envenoming: Chronology of onset
and progression of signs.
a. Neurotoxic sign:
• Ptosis(Partial or complete) usually symmetrical and
progressive
• Diplopia, external ophthalmoplegia
• Bulbar palsy
• Nasal voice
• Facial paralysis
• Inability to open the mouth and to protrude the toungue
• Paralysis of chest muscle and diaphragm (Shallow
breathing)
• Broken neck sign: Weak grip, diminished reflexes
18.
19. b.Signs of haematological abnormality:
• Persistent bleeding from bite site, venepuncture site and
or inflicted wound if any
• Multiple bruise or large blood collection
• Haemorrhagic blisters
• Bleeding from gingival sulci
• Haemoptysis
• Haematuria
• Epistaxis
20. Presentation of
pit viper bites
1.Local swelling
2.Spontaneous bleeding
from bite site
3.Haemorrhagic blister
4.Myotoxicity
5.Renal failure
6.Intracranial haemorrhage
21. c.Signs of Renal failure:
Scanty or no micturation,dark urine
Clinical uraemic syndrome: Nausea, vomiting, hiccups,
fetor, drowsiness,coma, flapping tremor, muscle
twitching, convulsion, pericardial friction rub, signs of
fluid over load
d.Signs of myotoxicity:
Muscle tenderness, weakness, respiratory failure,
black urine, renal failure
c.Signs of local envenoming:
Swelling, tenderness, bleeding, ulceration,necrosis,
local lymphnode enlargement
23. Identification of snake
• Identification of snake by description or by model,
photograph, brought snake, preserved specimen.
By local examination-
• Classic fang and teeth mark rarely occur and if present
indicate venomous snake bite
• Scratch usually indicates nonvenomous snake bite but
may rarely found in krait bite
• Snake may bite through clothing
28. Syndrome -4
NO LOCAL ENVENOMING
+
NEUROTOXIC FEATURES
+
WBCT <20 MINS
Bite in land while sleeping =
KRAIT
Bite in the sea= SEA SNAKE
29. Syndrome -5
PARALYSIS
+
DARK BROWN URINE
+
NO LOCAL SWELLING
+
WBCT <20 MINS
+
SEVERE MUSCLE PAIN
Bite in the sea=
SEA SNAKE
Bite in the land= KRAIT
30. KEEP IT IN MIND: Identification of snake the offending
snake from fang mark is impossible.
Local swelling and tissue damage:
• First sign of envenoming
• Exceptions kraits sometimes in cobras
• Blister necrosis
Other systemic examinations:
32. • Coagulation test- 20 min whole blood clotting test
• ECG
• CBC
• Blood urea, S.Creatinine
• Urine R/E and naked eye examination of urine
• APTT ,PT
• S.CPK
• ELISA
• Blood grouping and Rh typing
33. 20 min whole blood clotting test. (20 WBCT)
• Place a few mls of freshly sampled venous blood in a
small glass tube
• Leave undisturbed for 20 minutes at ambient
temperature, erect.
• Tip the tube once
• If the blood is still liquid (unclotted) and runs out, the
patient has hypofibrinogenaemia “incoagulable blood” as
a result of venom induced consumption coagulopathy.
• In perspective of Bangladesh, incoagulable blood is
diagnostic of a viper bite and rules out an elapid bite.
35. Recommended first aid
1. Reassurance
2. Immobilization
3. Lower limb- DO NOT WALK
4. Upper limb- DO NOT MOVE the limb
5. Should not be used for Viper Bites.
38. PLEASE KEEP IT IN MIND
• DO NOT WASTE TIME TO ANY OZHA
OR TRADITIONAL HEALERS
1.NOT scientific
2.Waste of time
3.May cause infection, bleeding, gangrene
4.Damage to artery , vein
5.Loss of life
6.Always Harmful
39. HARMFUL- NOT RECOMMENDED
1.Tight tourniquets
2.Incision at the bite site
3.Local suction
4.Cauterization by chemicals
5.Application of materials
6.Ingestion of herbal products to induce vomiting
7.Unnecessary delaying
40.
41.
42. Treatment in hospital
1.Rapid clinical assessment and resuscitation (ABC)
2.Detailed clinical assessment
(Local, Neurological, Haematological)
3.Identification of species
(Brought snake live, dead or description, photograph
20 min WBCT
Syndromic approach)
43. N.B-. DO NOT ATTEMPT TO KILL THE SNAKE ,
AS THIS MAY BE DANGEROUS. DO NOT
HANDLE THE SNAKE WITH BARE HANDS, AS
EVEN A SEVERED HEAD CAN BITE!
44. Treatment:
a.Antibiotic
b.Tetanus prophylaxis
c.Antivenom
d.NBM
Polyvalent Antivenom:
In our country now only Polyvalent antivenom from Vins
(lindia) is available in lyophilized powder form. Each vial
contain 10 mg of antivenom, which is effective against
systemic envenoming by Cobra, Krait, Russell's Viper and
Saw scaled viper only (there is no evidence of Saw scaled
viper in Bangladesh). So this type of antivenom should not
be used in bites by Green snake, Sea snakes and identified
non-venomous snake.
45. Antivenom treatment
Indication /criteria for using antivenom:
(Not indicated in Green snake and sea snake)
1.Neurotoxic signs.
2.Rapid extension of swelling (more than half of the bitten
limb). N.B- not due to green snake bite or tight
tourniquet.
3.AKI (not due to see snake).
4.Crdiovascular abnormalities
5.Bleeding abnormalities.
6.Haemoglobinuria/myoglobinuria not due to sea snake.
46. Anti snake venom therapy
• Dose:
Each dose consists of 10 vial of polyvalent antivenom
irrespective of age and sex of the victim.
• Time and administration:
Each vial is diluted with 10-ml. of distilled water. 10 such vials
(100 ml) is further diluled or mixed with 100 ml of fluid
(Dextrose water or saline). Then it is administered with
intravenous infusion within 40-60 min (60-70 drops/min).
• Observation and monitoring:
Continuous observation and frequent monitoring of vital signs
should be ensured during antivenom therapy and few hours
after its completion. Careful clinical assessment for appearance
of signs and symptoms of antivenom (A/V) reaction should be
performed.
48. Antivenom reaction:
Three types of reaction occurs
1.Early anaphylaxis
2.Pyrogenic reaction
3.Late reaction (serum sickness type)
49. 1.Early anaphylaxis:
• Usually develops within 10-180 min of starting of
antivenom
• C/F- Itching,urticaria,fever,angiooedema,dspnoea,
bronchospasm,laryngeal oedema, hypotension,
abdomina pain, vomiting, diarrhoea etc
Treatment of anaphylaxis
• Temporary suspension of antivenom administration
• Inj.Adrenalin (I/M) (1 amp=1ml=1mg)
For adults: 0.5ml (1/2 amp)
For children: 6-11 years 0.25 ml (1/4TH amp)
50. • Antihistamin (Inj.Chlorpheniramin)
Adult= 10 mg IV slowly after dilution
Child=0.2 mg/kg slow after dilution
• Inj.Hydrocortisone 100 mg for adults
(2mg/kg for children.)
• Inj.Ranitidine 50 mg IV slowly
1mg/kg for children.
(N.B- Should be given at the very 1st sign of reaction and
can be repeated every 5-10 mins intervalif condition is
deteriorating)
51. 2.Pyrogenic reaction:
• Usually develops 1-2 hours after treatment
• C/F- chills, fever, fall of BP, febrile convulsion in children
• Treatment- Tepid sponging,fanning,IV fluid, Paracetamol
suppository.
3.Late reaction (Serum sickness type):
• May develop 1-12 days (mean 7 days) after treatment.
• C/F-Fever ,itching,urticaria, arthralgia,myalgia,
lymphedenopathy, proteinuria etc.
• Treatment- Antihistamin, prednisolone (if no response to
antihistamin)
N.B- If any concomitant medical illness like COPD,
Bronchial asthma or pregnancy ½ of the dose of
adrenalin (1/4th amp) should be given S/C before giving
antivenom
52. Additional treatment:
Inj.Atropine (15µg/kg ) IV (1.5 amp for adult) 4 hourly &
Inj.Neostigmine (50-100 µgm/kg) S/C (2.5 amp for adult) in
each thigh 4 hourly until neurotoxic features improve
Respiratory support- Incase of respiratory failure
Blood transfusion: For patients with coagulopathy.
53. Endotracheal intubation is the most essential part of the
management of venomous snakebite with respiratory failure
56. Criteria for repeating the initial dose of antivenom:
Persisting or deteriorating signs of systemic antivenom.eg.
1.If no improvement or deterioration of neurotoxic features
(cobra or krait) 1-2 hours completion of antivenom.
2.Persistence or recurrence of blood incoagulopathy after 6
hours of antivenom teatment.
57. Drugs not recommended:
1. Antihistamine except for antivenom reaction
2. Corticosteroid except antivenom reaction
3. Sedative
4. Antifibrinolytic agent
5. Heparin
6. Traditional medicines (from ozahs)
58. Treatment of bitten part:
• Elevation of limb with rest
• Simple washing with antiseptic solution
• Broad spectrum antibiotic (especially when there is
features of contamination, multiple incisions)
• In case of local necrosis and gangrene:
Broad spectrum antibiotic
Surgical debridement and split thickness skin
grafting is indicated.
59. Follow up:
Local envenomation: The snake bite cases with Local
envenomation (commonly in cobra cases) need to follow up for at
least 5- 7 days to see the sequential changes of color changes,
blisters, ulceration, necrosis and desquamation. In viper bites, the
haemorrhagic manifestation should also follow up to see complete
recovery. A comprehensive approach with advice from surgeons
are important in this regard
Children : The neurotoxic snake bite cases should be followed up
to observe any neurological residual deficit present or not with also
attention to neurocognitive function.
Pregnancy: The pregnancy outcome after a venomous bite with
long term follow up of children is also needed to see the
neurological cognitive function
61. What should we do when no antivenom is
available?
Incase of neurotoxity:
• Assisted ventilation via ambu bag or mechanical
ventilation
• Inj.Atropine and Neostigmine:
In case of Haematological abnormality:
• Strict bed rest to avoid even minor trauma
• I/M injection must be avoided
• Fresh whole blood or FFP transfusion should be given
62. List of Essential Logistics for snake bite Management:
• One 10 cc syringe
• One 20 cc syringe
• Two 50 cc syringe
• IV infusion set- two sets
• IV blood transfusion set – One set
• IV canula (JMS): two sets
• IV Normal Saline -500 ml
• Indwelling catheter
• Urinary bag
64. • Antiseptic lotions or cream
• Gauze and coton (For wound care and sling)
• Insulin syringe (For collection of wound swab)
• Sterile vials (for collection of swab, blood etc)
• 10 cc dry test tube with holding stand (For 20 min WBCT)
• Sterile test tube (For blood sample)
• Endotracheal tube- 2 set (One for pt and one reserve)
• 5 cc syringe-2 ( for balloon inflation of ET tube and catheter)
• Umboo bag- one at least dedicated for snake bite
• Orogastric tube
• Laryngoscope
• Battery for laryngoscope
• Trolly with tray- dedicated for snake bite logistics