The correct answer is lymphatics. Venom is absorbed from the bitten site via the lymphatic vessels.

3. Every year 5 million people are bitten by a
snake in the world.
• Mortality ranges from 30,000 to 40,000
• Non poisonous snake may also bite but the
term snake poisoning refers to the bite of
poisonous snake only

4. Snakes are cold blooded vertebrates of the class reptilia
which also include
1. Crocodile
2. Alligators
3. Tortoises
4. Turtles

5. Geographic Distribution
Present All over the world
except Antarctica and isolated island groups.
Incidence
Every year 5 million people are bitten
by a snake in the world. Mortality ranges from
30,000 to 40,000 per year

6. Most snakes have evolved specialized glands
(salivary Glands) which produce venom.
• These are the venoms which
assist in prey acquisition,
digestion and defense
against predators.
• Venoms are complex mixtures of
enzymes, non enzyme proteins
and other non protein
substances.

7. • In Pakistan snake bite is common in both
agricultural area as well as mountains of
Baluchistan.
• Snake envomation is an acute public health
problem in Sindh especially in Tharr.

8. 1. Cobra
Naja Naja
2. Krait
a. Russel,s viper
b. saw scaled viper
c. sea snakes

9. In Pakistan the peak incidence of snake bite
occur in the month of June to August
This is because of
1. Floods and rain
2. Sleeping in open space
3.Hatching of kobra and Krait
in summer

10. • Toxic saliva secreted by modified parotid glands of a
venomous snake
• Amber colored when fresh
• Constituents Toxins
Enzymes
Miscellaneous : neurotoxins
cardio toxins
hemolysin etc
• Neurotoxin cobra, krait
• Hemotoxin viperidae
• Myotoxin sea snake
• Krait and russell’s viper is much more toxic than that of
cobra

11. Local
• Pain
• Swelling
• May be followed by necrosis
Systemic
• Ptosis
• Glossopharyngeal paralysis
• Rapid pulse
• Death due to respiratory paralysis

12. • Mild Local Pain
• Mild swelling
• Muscle Weakness

13. Local
• swelling at the site of bite
• Sever pain at the site
• Discoloration of skin around the site of bite
Systemic
• Hemorrhage
• Hematoma
• Epitaxis
• Malena

14. • Sharp initial prick & thereafter painless
• Stiffness Of muscles of neck , back &
proximal part Of the limbs

15. • Although snakes have are consider as one of the
worlds most dangerous and disgusting creatures on
the planet, they actually have some benefits:
1. They save farmers a minimum of seventy-five dollars
annually by ridding their fields of destructive rodents
2.Snakes eat harmful rodents (mice, rats, etc.) and insects that
may carry harmful diseases
3.Snakes also possess an oil that can be harvested that is
used to remedy pain in joints, such as rheumatoid arthritis
4. The fats and the oils extracted from the snakes have a high
content of Eicosapentaenoic acid (EPA), which has anti
inflammatory properties.

16. 1. Naag Naagan couple picture theory.
2. Snake as a Indian god.
3. Army crawl theory.
4. News paper 1988 and recently Afghanistan
man to snake conversion.
5. Once snake bite again every year bite
6. Onion theory umar coat 25km choor

18. • Aims of management
1. Retarding the absorption of venom.
2. Neutralization of venom that has been
absorbed.
3. Relief of symptoms and prevention of
complication.

19. History
• Time of bite
• Description of snake
• Sign and symptoms since bite
Examination
• Examination of bite site
• Neurological defects
• Repeated check up of natural orifices for

20. Diagnosis of bite
• Finding of fang marks
• Sign and symptoms arising ,giving indication of
snake bite.
• In sea snake bite hyperkalemia is detected by
ECG
• Clotting and bleeding time are also helpful.

21. The venom is detected from a dry swab of the bite site
using monoclonal antibody techniques
.
The 20-minute whole blood-clotting test is a useful bedside tool in
remote areas; a 2-3 ml sample of venous blood from the victim
is left undisturbed at ambient temperature for at least 20
minutes.
The vessel containing the blood is then tipped once & may be
compared with a normal control.
If it has not clotted, there is haemostatic disturbance from systemic
envenoming.
All patients should have a full blood count, urea/electrolytes, liver
function tests, creatine kinase, ECG.

22. Treatment
1. Relieve the anxiety
2. Tourniquet
3. Cut and suck technique
4. Cold pack method
5. Electric shock method
6.Use of specific anti venom

23. Supportive and symptomatic measures
1. Bed rest
2. Adrenaline injection
3. Artificial respiration
4. Antibiotics etc

25. • 1. The most useful bed-side test to suggest
snake bite envenemoation is:
• A. Prothrombin time.
• B.20 minute whole blood clotting test.
• C. ECG.
• D. Electrolytes.

26. Management of snake bite includes all except
• A.Immobilize the bitten part
.
• B. Apply a firm bandage
• C. Incision & sucking of the bitten site.
• D. Massage over the bitten site to relieve pain
and prevent edematous swelling
• E.Reassure the patient.

27. • Q. 10 year-old boy sustains a rattlesnake bite on his
left ankle. Pain and swelling of the bitten area become
rapidly intense. While the boy is transported to the
closest medical facility, which of the following is the
most appropriate initial step in management ?
A. Apply ice over the bitten area
B. Apply a tourniquet proximal to the bitten area
C. Apply iodine to the bitten area
D. Immobilize the bitten part in horizontal position
E. Perform incision and suction on the bite

28. Which type of vessels are involved in venom
absorption from bitten site?
1.Arteries
2.Veins
3.Capillaries
4.Lymphatics