This document provides information about snake bites and scorpion stings. It discusses the epidemiology, common types of snakes and scorpions, clinical effects of envenomation, signs and symptoms, grades of severity, appropriate investigations, first aid treatments, and initial hospital management. Snake bite is a medical emergency that can cause localized and systemic effects from neurotoxins, cardiotoxins, and other venom components. Scorpion stings also present varying degrees of severity and symptoms involving pain, swelling, seizures, and potentially life-threatening effects on the heart, lungs and brain. Appropriate first aid includes calling for emergency help, immobilizing the affected area, and bringing the victim promptly to the hospital for further treatment

1. Snake Bite And Scorpion Stings
Prepared by:
Abdulrahman Taha
Znar Abdulwahid Tamar
Mohammad Rashid
Supervised by:
Mr. Salim
Kurdistan Region
University of Duhok
Faculty of Medical Science
School of Nursing
Critical Care Nursing/4th stage

2. SnakeBiteAndScorpionStings

3. Contain
 Introduction about Snake bite & Scorpions stings
 Epidemiology of both
 Common Snake & Scorpion
 Snake Venom
 Clinical effects of venom
 Signs & symptoms
 Grade of envenomation
 What investigation to do ?
 First Aid & treatment
 Initial Hospital Management

4. Introduction
 A bite from a venomous snake can be deadly, and should always be treated as
a medical emergency. Even a bite from a harmless snake can be serious, leading
to an allergic reaction or an infection. Venomous snake bites can produce an
array of symptoms, including localized pain and swelling, convulsions, and
nausea—even paralysis.
 Scorpion stings are a major public health problem in many underdeveloped
tropical countries . Scorpions vary in size from 1-20 cm in length.
Venom is present in glands in the last tail segment and passes by a duct to a
stinger at the end of the tail.

5. Continue….
The venom is composed of varying
concentrations of neurotoxin,
cardiotoxin, nephrotoxin, hemolytic
toxin, histamine, serotonin,
tryptophan, and cytokine releasers.
The most important clinical effects of
envenomation are neuromuscular,
neuroautonomic, or local tissue
effects.

6. Epidemiology
 3 million bites and 1,50,000 deaths/year from venomous snake worldwide.
 Bites highest in temperate and tropical regions.
 3000 species of snakes, out of them only 10-15% of snakes are venomous
 1,500 species of scorpions, out of them 50 are dangerous to human.
 World wide :
annual stings > 1.2 million
> 3250 annual death
 United states:
 In 2008 ,1495 envenomation in children younger than 6 yrs.(NPDS data)
Of these, there was only one death. This is scorpion

7. Snake Bite

8. Common Snakes
(Cobras)
Neurotoxicity usually
predominates.

9. Common Snakes
 (Common kraits)
 These are very lethal snakes
 with a high mortality rate if not
treated with antivenom.

10. Common Snakes
 Russell’s viper
 Heat-sensing facial pits
(hence the name "pit vipers").

11. Common Snakes
 Echis-carinatus(Saw scaled viper)

12. Non Poisonous Snakes:
Head – Rounded
Fangs - Not present
Pupils – Rounded
Anal Plate - Double row
Bite Mark - Row of small teeth.
Poisonous Snakes
Head – Triangle
Fangs – Present
Pupils - Elliptical pupil
Anal Plate - Single row
Bite Mark - Fang Mark

13. Snake Venom
– A combination of proteins and enzymes
– 90% protein by dry weight & most of these are enzymes
– Have 25 different enzymes found in various venoms and
10 of these occur frequently in most venoms

14. Clinical effects of venom
Neurotoxicity
Systemic toxicity including hypotension and shock
Coagulopathy
Renal failure
Local tissue necrosis

15. Signs & Symptoms of snake bite
 Local pain and swelling
 Heavy eyelids
 weakness
 Difficulty in swallowing and speaking
 Bleeding from bite site
 Respiratory failure
 Internal bleeding
 shock
Heavy eyelids

17. Grades of envenomation
Grade Features
Non-envenomation Presence of fang marks without local/systemic reactions
Mild envenomation Local swelling & pain without systemic reaction
Moderate envenomation Severe pain, Edema spreading towards trunk,
Nausea, vomiting, Mild temperature
Sever envenomation edema spreads to the extremities and part of
trunk, Tachycardia, Hypotension, Subnormal
temperature.

18. First Aid for snake bite
 Call 122 immediately.
 Keep the victim calm and still. Movement can cause the venom to
move more quickly through the body. Consider making a splint to
restrict the movement of the affected area.
 Remove constricting clothing or jewelry. The area of the bite will
likely swell, so it is important to remove these items quickly.
 Carry or transport the victim by vehicle. This person should not be
allowed to walk.

20. Do not do any of the following:
 Do not use a tourniquet.
 Do not cut into the snake bite.
 No role of Ice application
 Washing the wound
 Do not give the victim any medications unless directed by a doctor
 Do not raise the area of the bite above the victim’s heart.
 Do not attempt to suck the venom out by mouth
 Do not use a pump suction device.

21. Treatments
 Local:
 ABC’s - oxygen prn
 calm patient
 immobilize extremity - splint
 treat shock prn
 draw circle around bite & note time
 Transport
 Specific: ANTISNAKE VENOM (ASV)
 Supportive care for specific syndromes

22. Initial Hospital Management
Place patient at rest and reassure the patient
Immobilize affected part of body
Clean wound
Give tetanus toxoid
Try to identify type of snake: website, list of snakes, picture
book
Have patient give urine

23. Scorpion Stings

24. Common Scorpions
 Scorpions come in a variety of colors - from tan to light brown to
black. Each has a long tail segment that contains a stinger.
 But two types of the Scorpion more dangerous in the world:
Bark ScorpionFattail Scorpion

25. Clinical effects of venom
 excessive salivation
 cardiac arrest
 Seizures
 Insulin secretion suppression
 sting is very painful causing radiating burning sensation
 Muscle spasm , convulsions, shock and
respiratory failure death
Locally: tissue inflammation and necrosis.

26. Signs & Symptoms
 Pain, which can be intense
 Numbness and tingling in the area around the sting
 Slight swelling in the area around the sting
 Muscle twitching or thrashing
 Unusual head, neck and eye movements
 Sweating & vomiting
 Hypertension or hypotension
 Tachycardia or arrhythmia
 Restlessness or inconsolable crying (in children)

27. Grades of envenomation
Grade Features
Grade I isolated pain.
Grade II Systemic manifestations: fever,
sweating , hypertension.
Grade III life threatening manifestations:
Shock, pulmonary edema, CNS
involvement.

28. What investigation to do?
CBC
RFT
Coagulation studies
Blood grouping & cross matching
Sr.electrolytes
Urinalysis
Blood sugar test

29. Treatment
1-Application of tourniquet above the site of bite to
decrease absorption of venom
2-Do not cut into the wound or apply suction.
3-wash with water
4-Ice pack
5-Immobilization of limb
6-Local anesthetics are better than opiates

30. Treatment
7-Treatment of shock
8-Analgesics
9-Fluid management: esp. for vomiting, sweating
10-Scorpion Venom Antiserum

32. Reference
 Buchanan JA, Varney SM, Mlynarchek SL, et al, “Immediate Adverse Events (AEs) After
Administration of Crotalidae Polyvalent Immune Fab,” Clin Toxicol, 2009, 47(7):703.
 Cannon R, Ruha AM, and Kashani J, “Acute Hypersensitivity Reactions Assocoated With
Administration of Crotalidae Polyvalent Immune Fab Antivenom”, Ann Emergency
Medicine, 2008, 51(4):407-11.
 www.slideshare.com
 www.prezi.com

33. The End

34. Thank you
for your
listening
Any Questions