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.
ALL ABOUT DROWNING AND NEAR DROWNING,
THEIR SYMPTOMS AND SIGNS
HOW TO MANAGE THEM AT SITE OF INCIDENT,EMERGENCY DEPARTMENT,ICU
PEDIATRIC DROWNING ALSO COVERED
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.
ALL ABOUT DROWNING AND NEAR DROWNING,
THEIR SYMPTOMS AND SIGNS
HOW TO MANAGE THEM AT SITE OF INCIDENT,EMERGENCY DEPARTMENT,ICU
PEDIATRIC DROWNING ALSO COVERED
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.
Presentation on snake bites and first aid. A comprehensive presentation on snake bite and the emergency response to it. Also cover precautions - how to avoid snake bites in the field. Useful for campers, doctors, students etc...
"Snake Bite Management in Indian Context" by Dr Subhash Ranjan NM,VSMsranjan
I have summed up this presentation with practical point of view. I have shot myself majority of the snakes and feel they should be understood by the community. Some of them are venomous (not poisonous)! The management is syndromic approach and I feel this ppt would be beneficial to medical students.
Medical toxicological aspects of snakes with emphasis on classification of snakes and their venom, identification of snakes, fatal dose, fatal period, signs and symptoms of snake bite, diagnosis of snake bite, management, post-mortem findings and medico-legal aspects especially of the common Indian snakes.
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.
Vasculitis syndrome an approach -and-basic principles of treatmentSachin Verma
Vasculitides are a hetrogenous group of conditions characterized by inflammation and necrosis of blood vessels.
A broad group of syndromes may result from this process,since any type,size, and location of vessel may be involved.
Type 2 dm gdm new updates & guidelinesSachin Verma
Type 2 diabetes is a multifactorial disorder characterised by progressive pancreatic beta-cell dysfunction and insulin- resistance, leading to relative insulin deficiency, chronic hyperglycaemia, and various complications.
The treatment options for this disorder, which aim at correcting one or other of the two major pathophysiological mechanisms, have been hamstrung by unacceptable side-effects, lack of patient acceptability, and loss of efficacy over time.
Tuberculosis suspect. Productive cough for more than 2 weeks, which may be accompanied by other respiratory symptoms and/or constitutional symptoms
Case of tuberculosis. A definite case of TB or one in which a health worker (clinician or other medical practitioner) has diagnosed TB and has decided to treat the patient with a full course of TB treatment.
Any person given treatment for TB should be recorded as a case. Incomplete “trial” TB treatment should not be given as a method for diagnosis.
Proteinuria – early indicator of renal disease
Increases the risk of renal impairment, hypertension & cardiovascular disease.
Proteinuria of 1+ or more persisting on 2 subsequent dipstick tests at weekly intervals – requires further investigations.
Causes of transient proteinuria to be excluded
Vertigo –the dizzy patient an evidence-based diagnosis and treatment strategySachin Verma
Vertigo is a symptom of illusory movement and not a diagnosis .It is due to asymmetry of vestibular system due to damage or dysfunction of the
Labyrinth and vestibular nerve, or
Central vestibular structures in the brainstem
Urine examination how to approach final.ppt1Sachin Verma
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.
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.
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.
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.
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. MANAGEMENT OF SNAKE
BITE
Dr. Sachin Verma MD, FICM, FCCS, ICFC
Fellowship in Intensive Care Medicine
Infection Control Fellows Course
Consultant Internal Medicine and Critical Care
Web:- http://www.medicinedoctorinchandigarh.com
Mob:- +91-7508677495
2. INTRODUCTION
• Poisoning by venomous snake bite is
a common acute life-threatening
medical emergency in India.
3. 61 507 bites and 1,124 deaths in 2006
76,948 bites and 1,359 deaths in 2007
[Government of India data:
pp 107–108 of http://cbhidghs.nic.in/writereaddata/mainlinkFile/Health%20
Status%20Indicators.pdf)
4.
5. ETIOLOGY
There are about 216 species of
snakes identifiable in India, of
which 52 are known to be
poisonous.
6. ETIOLOGY
• Major families of poisonous
snake in India includes –
- Elapidae Common cobra
(naja naja)
King Cobra
Common Krait
10. Colubridae
Largest snake family, and includes about
two-thirds of all current snake species.
most are nonvenomous and harmless, but
few groups can produce medically
significant bites, and have caused human
fatalities.
11.
12. SNAKE VENOMS
• Snake venoms contain more than 20 different
constituents. Mainly proteins including enzymes &
polypeptide toxins.
13. SNAKE VENOMS
• Procoagulant enzymes
• Haemorrhagins
• Cytolytic or necrotic toxins
• Haemolytic and myolytic
phospholipases A2
16. SYMPTOMS & SIGNS OF
SNAKE BITE
WHEN VENOM HAS NOT BEEN INJECTED
• Anxiety
• Vaso-vagal shock
17. WHEN VENOM HAS BEEN INJECTED
LOCAL SYMPTOMS & SIGNS IN THE BITTEN PART
• Fang marks
• Local pain
• Local bleeding
• Bruising
• Lymphangitis
• Lymph node enlargement
• Inflammation (swelling, redness, heat)
• Blistering
• Local infection, abscess formation
• Necrosis
18. SYMPTOMS & SIGNS OF SNAKE BITE
Fang marks made by Russell’s viper
19. SYMPTOMS & SIGNS OF SNAKE BITE
Local bleeding from fang marks made by pit viper
20. SYMPTOMS & SIGNS OF SNAKE BITE
Local swelling and blistering (a) with bruising,
following a bite by a pit viper (b) with early necrosis
21. SYMPTOMS & SIGNS OF SNAKE BITE
Tissue necrosis following a bite by a pit viper
23. Bleeding and clotting disorders
(Viperidae)
Bleeding from recent wounds (including
fang marks, venepunctures etc) and
from old partly-healed wounds.
• Spontaneous systemic bleeding
24. Neurological (Elapidae, Russell’s viper)
• Drowsiness, paraesthesiae,
• abnormalities of taste and smell,
• ptosis, external ophthalmoplegia,
• Muscle palsys
• aphonia,
• difficulty in swallowing secretions,
• respiratory and generalised flaccid paralysis
27. Endocrine (acute pituitary/adrenal
insufficiency)
• Acute phase: shock, hypoglycaemia
• Chronic phase (months to years after
the bite):
• loss of secondary sexual hair
amenorrhoea,
• testicular atrophy
• hypothyroidism etc.
32. LONG TERM COMPLICATIONS
(SEQUELAE) OF SNAKE BITE
• Chronic ulceration, infection, osteomyelitis or
arthritis.
• Malignant transformation in skin ulcers.
• Chronic renal failure
• Chronic panhypopituitarism or diabetes
insipidus.
• Chronic neurological deficit in patients of
intracranial haemorrhages.
33. Patient with symptoms and signs of panhypopituitarism
three years after envenoming by Russell’s viper. There is loss of
secondary sexual hair and testicular atrophy
34. (a) Deformity and dysfunction after a bite and subsequent necrosis
of the calf
35. Squamous cell carcinoma arising at the site of a chronic skin
ulcer with osteomyelitis 8 years after the bite.
36. Clinical syndromes of
snake-bite in South-East
Asia
Syndrome 1
Local envenoming (swelling etc.) with
bleeding/clotting disturbances =
Viperidae (all species)
37. Syndrome 2
Local envenoming with bleeding/clotting
disturbances, shock or AKI = Russell’s viper
(hump-nosed pit viper in Sri Lanka
and SW India)
with conjunctival oedema and acute pituitary
insufficiency =
Russell’s viper, Myanmar
with ptosis, external ophthalmoplegia, facial
paralysis etc and dark brown urine
= Russell’s viper, Sri Lanka and South
39. Syndrome 4
Paralysis with minimal or no local
envenoming
Bitten on land while sleeping on the
ground = krait
Bitten in the sea, estuary and some
freshwater lakes = sea snake
40. Syndrome 5
Paralysis with dark brown urine and AKI:
Bitten on land (with bleeding/clotting disturbance)
= Russell’s viper, Sri
Lanka or South India
Bitten on land while sleeping indoors = krait ,
Bangladesh, Thailand
Bitten in sea, estuary and some freshwater lakes
(no bleeding/clotting
disturbances) = sea snake
41. ASSESSMENT OF SEVERITY
No envenomation Absence of local or systemic reactions, Fang
marks +/-
Mild envenomation Fang marks (, moderate pain, minimal local
oedema (0-15cms), erythema+, ecchymosis
+/-, no systemic reactions
Moderate Fang marks+, severe pain, moderate local
envenomation edema (15-30cms), erythema & ecchymosis +,
systemic weakness, sweating, syncope,
nausea, vomiting, anemia or thrombocytopenia
Severe envenomation Fang marks+, severe pain, severe local edema
(>30cms), erythema & ecchymosis+,
hypotension, parasthesia, coma, pulmonary
edema, respiratory failure
42. MANAGEMENT OF SNAKE BITE
First aid treatment
Transport to hospital
Rapid clinical assessment and resuscitation
Detailed clinical assessment and species
diagnosis
Investigations/laboratory tests
Antivenom treatment
43. Observing the response to antivenom
Deciding whether further dose(s) of antivenom
are needed
Supportive/ancillary treatment
Treatment of the bitten part
Rehabilitation
Treatment of chronic complications
44. RECOMMENDED FIRST AID
METHODS
• Reassure the victim
• Immobilise the bitten limb with a splint or
sling
• Consider pressure-immobilisation for some
elapid bites
• Avoid any interference with the bite wound as
this may introduce infection, increase
absorption of the venom and increase local
bleeding.
45. •Application of a tourniquet to the bitten limb
•Cuting open the bitten area
•Sucking out venom, either by mouth or with a pump
•Immersion in warm water or sour milk, followed by the ap
of snake-stones
•.
•Application of potassium permanganate.
•
•Use of electroshock therapy
•NOT RECOMMENDED
47. INVESTIGATIONS/LABORATORY
TESTS
20 minute whole blood clotting test (20WBCT)
• Place a few ml of freshly sampled venous
blood in a small glass vessel.
• Leave undisturbed for 20 minutes at ambient
temperature
• Tip the vessel once
• If the blood is still liquid (unclotted) and runs
out, the patient has hypofibrinogenaemia
48.
49. OTHER TESTS
• haematocrit: a transient increase
indicates haemoconcentration resulting
from a generalised increase in capillary
permeability (eg in Russell’s viper bite).
• Decrease reflects blood loss or
intravascular haemolysis.
50. • Platelet count: this may be decreased in
victims of viper bites.
• White blood cell count: an early neutrophil
leucocytosis is evidence of systemic
envenoming from any species.
• Blood film: fragmented red cells (“helmet
cell”, schistocytes) are seen when there is
microangiopathic haemolysis.
51. INVESTIGATIONS/LABORATORY
OTHER TESTS TESTS
• Plasma/serum may be pinkish or
brownish if there is gross
haemoglobinaemia or myoglobinaemia.
•
• Biochemical abnormalities:
aminotransferases and muscle enzymes
(creatine kinase, aldolase etc) will be
elevated if there is severe local damage
or, particularly, if there is generalised
muscle damage (Russell’s viper bites, sea
snake bites).
52. Bilirubin is elevated following massive
extravasation of blood.
Renal function tests are raised in the renal
failure (Russell’s viper , saw-scaled viper
and sea snake bites.)
Hyperkalaemia may be seen following
extensive rhabdomyolysis in sea snake
bites.
53. OTHER TESTS
• Arterial blood gases
• Arterial oxygen Saturation
•
• Urine examination: the urine should be
tested for blood/ haemoglobin/myoglobin.
55. On arrival.
Deal with any life threatening symptoms on
presentation. i.e. Airway, Breathing and
Circulation.
If there is evidence of a bite, where the skin
has been broken, give Tetanus Toxoid
Routine use of anti-biotic is not necessary,
although it should be considered if there is
evidence of cellulitis or necrosis
56. Diagnosis Phase: General Principles
Where possible identify the snake responsible.
keep under observation for a minimum of 24 hours.
Determine if any traditional medicines have been used
Determine the exact time of the bite.
Question what the victim was doing at the time of bite.
57. ANTIVENOM TREATMENT
• Antivenom is immunoglobulin (usually the
enzyme refined F(ab)2 fragment of IgG)
purified from the serum or plasma of a horse or
sheep that has been immunised with the
venoms of one or more species of snake.
• Monovalent or monospecific antivenom
neutralises the venom of only one species of
snake. Polyvalent or polyspecific antivenom
neutralises the venoms of several different
species of snakes
60. INDICATIONS
Local envenoming
• Local swelling involving more than half of
the bitten limb (in the absence of a
tourniquet)
• Swelling after bites on the digits (toes and
especially fingers).
• Rapid extension of swelling
• Development of an enlarged tender lymph
node draining the bitten limb.
61. SELECTION OF ANTIVENOM
• Liquid antivenoms that have become opaque
should not be used as precipiated of protein
indicates loss of activity & increased risk of
reaction.
• Polyspecific/polyvalent antivenoms are
preferred in many countries because of
difficulty in identifying species responsible for
bites.
62. • 1 ml of polyvalent antivenom will
neutralise
• 0.6 mg of dried cobra venom
• 0.45 mg of dried krait venom
• 0.6 mg of dried Russel’s viper venom
• 0.45 mg of dried saw-scales viper venom.
63. DOSE OF ANTIVENOM
• Children must be given exactly the
same dose of antivenom as adults.
• Test dose of ASV is not essential
because even if victim is sensitive to
ASV, does not preclude its use.
Because there is no guarantee that
victim would not develop anaphylaxis
reaction after administration.
64. • Initial dose should depend on an estimate
of amount of envenomation.
• 5 vials given if signs are mild -primarily
local manifestations. (Minimal
envenomination)
• 10 vials if signs are moderate -bleeding
from gums, ptosis. (Moderate
envenomination)
• 15 vials if signs are severe -vascular
collapse, progressive paralysis. (Severe
65. ADMINSITRATION OF ANTIVENOM
ASV diluted in 100ml of isotonic saline or
glucose or 5-10 ml / kg body wt of isotonic
saline or glucose as an infusion.
All ASV to be administered over 1 Hour at
constant speed. The patient should be
closely monitered for two hours.
• Local administration of antivenom
at the site of bite is not
66. Observation of the response to antivenom:
(a) General: The patient feels better. Nausea,
headache and pains disappear very quickly.
(b) Spontaneous systemic bleeding (e.g. from
the gums): stops within 15-30 minutes.
(c) Blood coagulability (as measured by
20WBCT):
restored in 3-9 hours. Bleeding from new and
partly healed wounds usually stops much
sooner than this.
67. (d) In shocked patients: Blood pressure may
increase within the first 30-60 minutes and
arrhythmias may resolve.
(e) Neurotoxic envenoming of the post-synaptic
type (cobra bites) begin to improve as early as
30 minutes after antivenom, but usually takes
several hours.
(f) Active haemolysis and rhabdomyolysis may
cease within a few hours and the urine returns to
its normal colour.
68. Criteria for giving more antivenom:
Persistence or recurrence of blood
incoagulability after 6 hours or of bleeding
after 1-2 hours.
Deteriorating neurotoxic or cardiovascular
signs after 1-2 hours.
70. ANTICHOLINESTERASE THERAPY
• Post synaptic neurotoxins compete with
acetylcholine for available nicotinic Ach
receptor sites on adjacent skeletal muscle
cell synaptic clefts. This process tend to be
reversible.
• Anticholinesterases are the drugs that
inhibit the process of acetylcholine
breakdown & re-uptake.
71. LIMITATIONS
• No value in the treatment of
presynaptic neurotoxicity.
• No substitute for antivenom therapy
and mechanical ventilation.
• Only an adjunct treatment
72. CONTRAINDICATIONS TO USE
• If there is positive 20WBCT
(incoagulable blood).
• Previous allergy to the drug.
73. ASSESSMENT OF
SUITABILITY
• “Neostigmine Test”.
74. Neostigmine test
1.5 to 2 mg of neostigmine I M together with
0.6 mg of atropine I V .
The patient should be closely observed for 1 hou
Methods to asses effectiveness of neostigmine are
1. single breath count
2. mm of iris uncovered
3. Inter incisor distance
4. Length of time upwards gaze can be maintain
5. FEVi or FVC
75.
76. • If the victim responds to neostigmine test
• 0.5 mg of neostigmine IM half hourly
plus 0.6 mg atropine IV for 5 doses
• then 2 to 12 hourly according to
recovery.
• If there is no improvement in symptoms
after 1 hr, neostigmine should be stopped.
77. • Can be given in the form of
interavenous infusion at the rate of 25
µg/kg/hour until the neuroparalysis is
reversed.
78. No incision, suction, tourniquet, Splint + crepe bandage
On site
Ressure, transport in lateral decubitus
Hospital Tetanus toxoid, IV line, lateral position, anxiolytic
Mandatory observation 24 hrs
Local Systemic Cobra Krait Viper Sea snake
Swelling Local pain, swelling + - ++ -
Blisters Local bleeding + - ++ -
Necrosis Pain in regional nodes + + + -
Vomiting + + + +
Hypotension + + + -
Clean dressing