Snake bites are a major public health problem, with over 20,000 deaths annually from the approximately 421,000 envenomings that occur each year, especially in South and Southeast Asia and sub-Saharan Africa. The document discusses the differences between poisonous and non-poisonous snakes, symptoms of snake bites, treatment methods like antivenom therapy, and prevention strategies like wearing boots and public education. Management of snake bites involves first aid measures, antivenom administration, supportive care, and monitoring for local and systemic effects on muscles, nerves, blood, and cardiovascular system depending on the type of snake venom.

2. Dr. Hira Shoaib Hashmi
Lecturer, Dept. CHS

3. To know the difference between poisonous and non
poisonous snakes.
To know how to manage a patient with snake bite.
To learn how to prevent snake bite.
To know the areas in Pakistan where snake bite is
prevalent.

5. At least 421,000 envenomings and 20,000
deaths from snakebites occur each year,
especially in South and South East Asia and sub-
Saharan Africa.(1)
 3000 species
Broadly Divided into:
Poisonous Snakes
Non Poisonous Snakes

6. It is toxic saliva produced by parotid glands of snakes mostly water
with enzymatic proteins.
Constituents
Proteinases
Fibrinolysin
Phospholipase A,B,C & D
Neurotoxins
Cholinesterases
Haemolysins etc.
Produced from the time of birth and injected in response to a prey or
self defense
One in five snake bites are dry.
More venom injected when attacking prey.

7. A major public health problem because:
Agricultural country-70% population lives in rural areas and
works in fields
Lack of basic education
Snakes abundant
Weather conditions favorable
Peak incidence: June to August
• Due to floods and rain with migration to highlands
• Sleeping outside in summers
• Monsoon season is breeding season
• Snake cold blooded more active in summers
• Venom yield high in summers
Common in agricultural fields, Thar and Baluchistan.

8. Haemotoxic Venom:
Attacks blood vessels, serum escapes into
surroundings, clotting factors are activated. Severe
swelling, pain and discoloration and shock ensues with
DIC.
Neurotoxic venom:
Much less local symptoms, affects remote nerves,
cause tingling, drooping of eyelids and respiratory
arrest.
Myotoxic Venom:
Affects muscles with stiffness and paralysis
Appearance of myoglobin in urine

13. LOCAL S/S:
Considerable pain and swelling usually followed by
necrosis.
SYSTEMIC S/S:
Ptosis
Glossopharyngeal nerve paralysis
Dryness of throat
Cold clamy extremeties and sweating
Rapid pulse
Hypertension
Death due to resp. paralysis.

14. Mild Local pain
Mild Swelling
Muscle Weakness

15.  Sharp initial prick afterthat painless
 Stiffness in the muscles of back,neck and proximal part of limb in
one hour.

16.  LOCAL S/S:
 Swelliing around the bite site within minutes
 Severe pain at the bite site
 Blisters
 Discolouration
 SYSTEMIC S/S:
 Hematemesis
 Hemorrhage
 Haematuria
 Epistaxis
 Malena

17.  Finding fang marks
 S/S
 Lab Tests on aqueous washings from the bite site:
 Cholinesterase-Elapid Bites
 Thromboplastin-Viper bite
 Hyperkalemia on ECG – Sea Snake bite
 Prolonging of CLOTTING and BLEDDING TIME

18. IMMEDIATE/GENERAL MEASURES:
Allay anxiety and fright as death may occur due to
shock ensuing from fear
Bed Rest
GIVE FIRST AID
Immobilization
Torniquet application between the bite site on the limb
and heart admitiing to two fingers so that arterial flow is
not occluded.
Remove torniquet for one minute after every 30 mins
If bite on face neck or trunk, apply firm pressure
Acquire aseptic measures to avoid microbial
contamination of bite site
CUT AND SUCK METHOD
COLD PACK METHOD
ELECTROSHOCK TREATMENT
AUSTRAILIAN PRESSURE TECHNIQUE

20. GIVING POLYVALENT ANTIVENIN THERAPY:
 Antivenom is prepared by hyperimmunisation of horses
with venom of four common snakes COBRA, COMMON
KRAIT, RUSSELS’S AND SAW SCALED VIPER.
 Check sensitivity by giving a test dose(0.1ml) either I/D or
intraconjunctival.
 If S/S appear of sensitivity give Epinephrine.
 Proceed with either of the two ways:
 20-50ml antivenin diluted in 5 times normal saline
given as an I/V drip @15 drops/min over a period of
45 minutes
 1/3rd of total dosage s/c at bite site, 1/3rd I/M, 1/3rd
given as I/V.
 It is better to give more antivenin then less and in large
doses rather than a series of doses
 Amount needed inversely propotional to the body size

21. Adrenaline as needed esp in paralytic cases
Respiratory support
Blood transfusion
Antibiotics
Tetanus prophylaxis
Analgesics and sedatives: Codeine and meperidine
ideal. Morphine avoided
Heparin in case of D.I.C
Steroids (Hydrocortisone) for allergic manifestations
of antivenom
Antiemetics
Antiseizure medications
Antihistamines
Hydration therapy

23.  Wearing knee high boots.
 Torches should be used in snake infested areas while
working in fields.
 Residential areas surveyed for holes and kept clean.
 During camping military personnel are to examine their
boots, sleeping bags and beddings.
 Stay out of tall grass.
 Be alert while climbing rocks covered with vegitation.
 Leave snakes alone.
 Mass public eductaion regarding first aid measures and
health education.
 Antivenin with appropriate apparatus be provided in
secondary health centres in areas where snake bite is
prevalent.

25. 1. True about cobra poison
*Neurotoxic
*Myotoxic
*Cardiotoxic
*Vasculotoxic

26. 2.Cholinesterase is present in
*Elapid
*Viper
*Sea snakes
*All

27. 3.Muscle paralysis is caused by
*Sea snakes
*Mamba
*Krait
*python

28. 4. Most characteristic feature of elapidae snake
envenomation
*Bleeding manifestation
*Neuro-paralytic symptoms
*Rhabdomyolysis
*Cardiotoxicity

29. 1.http://www.who.int/neglected_diseases/integ
rated_media_snakebite/en/
2. Ilyaas Textbook-Public health and community
medicine
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