Snake bite management discusses snake bites, their epidemiology, clinical effects, diagnosis, and treatment. Some key points:
- Snake bites can be life-threatening due to toxins and cause 600,000 envenomings and 81,000-138,000 deaths annually worldwide. In Nepal, 20,000 people are bitten yearly resulting in over 1,000 deaths.
- Clinical effects depend on snake species but include local swelling, bleeding, necrosis, and systemic effects like nausea, vomiting, paralysis. Diagnosis considers symptoms, signs of coagulopathy on tests like 20WBCT, and syndrome based on features.
- Treatment involves first aid, resuscitation, antivenom, and
This document summarizes guidelines for treating snake bites with anti-snake venom (ASV) from various species of snakes found in India. It describes: the types of snakes that cause bites; symptoms of envenomation; criteria for ASV administration; dosing protocols for different types of envenomation; monitoring patients and treating reactions; and considerations for special groups like children and pregnant women. The guidelines provide evidence-based recommendations on optimizing ASV therapy to treat snake bites while minimizing risks.
This document provides information about snake bites. It begins with an introduction describing ophitoxaemia and the types of snakes that are venomous.
It then discusses the epidemiology of snake bites, noting they are a risk for various occupations. India reports 35,000-40,000 deaths per year from snake bites.
The document describes the important families of medically relevant snakes in Southeast Asia and characteristics of their venom delivery systems. It explains the various types of toxins in snake venom and the symptoms and signs of envenomation.
Finally, it covers the clinical management of snake bites including first aid, transportation to a hospital, treatments, antivenoms, and monitoring for complications. grading scales
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.
This document discusses ascites and ascitic tap or paracentesis. Ascites is an excessive accumulation of fluid in the abdominal cavity. An ascitic tap or paracentesis is a procedure to drain excess fluid from the abdominal cavity. It can be done for diagnostic or therapeutic reasons. The document outlines the equipment, techniques, risks, and aftercare for an ascitic tap. Precautions like aseptic technique are important to prevent infection.
This document provides information on snake bites, including epidemiology, causes, pathophysiology, signs and symptoms, management, and prevention. It notes that snake bites affect millions globally each year, causing tens of thousands of deaths annually in India alone. The document discusses the venom and toxins of snakes, as well as the local and systemic effects of envenomation. It provides guidance on first aid, clinical assessment, investigations, antivenom treatment, and supportive care for snake bite victims.
Tachy Arrhythmias - Approach to ManagementArun Vasireddy
Tachyarrhythmias are disorders of heart rhythm which may present with a tachycardia i.e. a heart rate >100 bpm.
This article provides an overview of tachyarrhythmias in general and goes on to cover the most common tachyarrhythmias in more detail. The acute management of tachyarrhythmias, in an emergency setting, will be covered in the 'Acute' section of the fastbleep website.
Tachyarrhythmias are clinically important as they can precipitate cardiac arrest, cardiac failure, thromboembolic disease and syncopal events. As such, they crop up time and time again in exam papers and on the wards.
Tachyarrhythmias are classified based on whether they have broad or narrow QRS complexes on the ECG. Broad is defined as >0.12s (or more than 3 small squares on the standard ECG). Narrow is equal to or less than 0.12s. Broad QRS complexes are slower ventricular depolarisations that arise from the ventricles. Narrow complexes are ventricular depolarisations initiated from above the ventricles (known as supraventricular). One important exception is when there is a supraventricular depolarisation conducted through a diseased AV node. This will produce wide QRS complexes despite the rhythm being supraventricular in origin.
This document summarizes guidelines for treating snake bites with anti-snake venom (ASV) from various species of snakes found in India. It describes: the types of snakes that cause bites; symptoms of envenomation; criteria for ASV administration; dosing protocols for different types of envenomation; monitoring patients and treating reactions; and considerations for special groups like children and pregnant women. The guidelines provide evidence-based recommendations on optimizing ASV therapy to treat snake bites while minimizing risks.
This document provides information about snake bites. It begins with an introduction describing ophitoxaemia and the types of snakes that are venomous.
It then discusses the epidemiology of snake bites, noting they are a risk for various occupations. India reports 35,000-40,000 deaths per year from snake bites.
The document describes the important families of medically relevant snakes in Southeast Asia and characteristics of their venom delivery systems. It explains the various types of toxins in snake venom and the symptoms and signs of envenomation.
Finally, it covers the clinical management of snake bites including first aid, transportation to a hospital, treatments, antivenoms, and monitoring for complications. grading scales
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.
This document discusses ascites and ascitic tap or paracentesis. Ascites is an excessive accumulation of fluid in the abdominal cavity. An ascitic tap or paracentesis is a procedure to drain excess fluid from the abdominal cavity. It can be done for diagnostic or therapeutic reasons. The document outlines the equipment, techniques, risks, and aftercare for an ascitic tap. Precautions like aseptic technique are important to prevent infection.
This document provides information on snake bites, including epidemiology, causes, pathophysiology, signs and symptoms, management, and prevention. It notes that snake bites affect millions globally each year, causing tens of thousands of deaths annually in India alone. The document discusses the venom and toxins of snakes, as well as the local and systemic effects of envenomation. It provides guidance on first aid, clinical assessment, investigations, antivenom treatment, and supportive care for snake bite victims.
Tachy Arrhythmias - Approach to ManagementArun Vasireddy
Tachyarrhythmias are disorders of heart rhythm which may present with a tachycardia i.e. a heart rate >100 bpm.
This article provides an overview of tachyarrhythmias in general and goes on to cover the most common tachyarrhythmias in more detail. The acute management of tachyarrhythmias, in an emergency setting, will be covered in the 'Acute' section of the fastbleep website.
Tachyarrhythmias are clinically important as they can precipitate cardiac arrest, cardiac failure, thromboembolic disease and syncopal events. As such, they crop up time and time again in exam papers and on the wards.
Tachyarrhythmias are classified based on whether they have broad or narrow QRS complexes on the ECG. Broad is defined as >0.12s (or more than 3 small squares on the standard ECG). Narrow is equal to or less than 0.12s. Broad QRS complexes are slower ventricular depolarisations that arise from the ventricles. Narrow complexes are ventricular depolarisations initiated from above the ventricles (known as supraventricular). One important exception is when there is a supraventricular depolarisation conducted through a diseased AV node. This will produce wide QRS complexes despite the rhythm being supraventricular in origin.
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.
This document provides guidance on snake bites in India. It discusses that snake bites are a major public health issue, killing over 11,000 people annually. The most common venomous snakes in India are Russell's viper, hump-nosed viper, cobra, and krait. It outlines the clinical presentation of envenomings from different snakes, including neuroparalytic effects from cobras and kraits, bleeding disorders from vipers, and muscle damage from sea snakes. The document emphasizes rapid assessment, resuscitation, detailed examination to identify the snake species, laboratory tests, and antivenom treatment for snake bites in India.
Snake bites are a major public health issue in India, with estimates of 200,000 bites and 15,000-20,000 deaths annually. The document discusses the epidemiology, types of venomous snakes, clinical effects of envenomation, and management of snake bites. Management involves first aid measures like immobilization of the bite area, administration of antivenom serum, and supportive care. Antivenom serum is most effective when given within 4 hours of the bite to neutralize the venom, and mechanical ventilation may be needed if respiratory failure occurs from neurotoxic or systemic effects of the venom.
SHOCK - PATHOPHYSIOLOGY, TYPES, APPROACH, TREATMENT.DR K TARUN RAO
1. Shock is defined as a state of poor tissue perfusion and cellular metabolism due to circulatory failure and hypoperfusion.
2. The main causes of shock include hypovolemic, cardiogenic, septic, anaphylactic, neurogenic, and respiratory etiologies.
3. The pathophysiology of shock involves a low cardiac output state leading to vasoconstriction and redistribution of blood flow away from non-vital organs to preserve perfusion of vital organs. Persistent shock can progress to cellular damage, organ dysfunction, and death.
A 14-year-old boy presented to the emergency department with symptoms of an autonomic storm after being bitten by a scorpion. He was diagnosed with scorpion sting in autonomic storm. He was given prazosin, hydrocortisone, and other supportive treatments. His condition stabilized and he was discharged after 6 days. Scorpion stings can cause local effects and a systemic autonomic storm response due to neurotoxins that affect sodium channels and induce catecholamine release. Prazosin is an effective treatment as it blocks alpha receptors and counters the effects of venom.
A 55-year-old male presented with pain and swelling in his left foot and lower leg along with abdominal pain and drowsiness. Examination revealed tachycardia, hypotension, tachypnea, and abdominal tenderness. Laboratory findings were consistent with diabetic ketoacidosis (DKA): hyperglycemia, ketonemia, and metabolic acidosis. The patient was diagnosed with DKA likely precipitated by infection and treated with insulin, intravenous fluids, potassium supplementation, and monitoring of electrolytes and glucose levels.
This document discusses supraventricular tachycardia (SVT), which are tachyarrhythmias originating from the atria or atrioventricular node that cause a rapid heart rate. SVTs are classified as either atrial or AV tachyarrhythmias based on their site of origin. Common causes include inherited conditions, structural heart abnormalities, coronary artery disease, and hyperthyroidism. Diagnosis involves an electrocardiogram (ECG), Holter or event monitor, exercise test, or electrophysiology study. Treatment depends on whether it is acute or long term, and may include vagal maneuvers, calcium channel blockers, cardioversion, or medications like digoxin, beta blockers,
This document provides information about scorpion stings, including:
1) Scorpions have a lobster-like body with claws, legs, and a segmented tail ending in a stinger containing venom glands. Their venom causes uncontrolled nerve firing through sodium channel effects.
2) Symptoms range from localized pain to cranial nerve dysfunction and autonomic/muscular symptoms. Severe cases can lead to complications like respiratory failure.
3) Treatment involves wound care, pain management, antivenom if available, and supportive care like intubation, IV fluids and medication for symptoms. Outcomes are generally good with treatment.
Intubation is a common medical procedure where a flexible plastic tube is inserted into the throat to aid breathing during anesthesia or an airway emergency. It can be performed through the nose or mouth and is used to open the airway, remove blockages, or help breathing. While most people recover quickly with no effects, risks include sore throat, damage to tissues, infection, or rare cases of PTSD. People should discuss risks with their doctor before any planned intubation.
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw
Redback spiders are the most common cause of spider envenomation in Australia, resulting in 5-10,000 bites per year. While the symptoms can be distressing, including inconsolable crying in children and priapism, redback bites are rarely life-threatening. Funnel-web spiders are the most dangerous spiders in Australia; their bites can cause symptoms ranging from local pain and swelling to autonomic effects like sweating and vomiting as well as cardiac or neurological issues. While white-tailed spider bites are often blamed, the venom has not been proven to cause tissue necrosis. Most spider bites result in only localized symptoms, but funnel-web bites require antivenom treatment in the emergency department.
The document discusses cardiac arrest, which is defined as a sudden stop in blood circulation caused by the heart failing to contract. Potential causes of cardiac arrest are then listed in categories such as cardiac, respiratory, circulatory, and metabolic issues or toxic/environmental factors. Specific conditions are also outlined in lists of "6 H's" and "5 T's". The document concludes by describing shockable and non-shockable heart rhythms in cardiac arrest and the steps to take during a code blue situation, including initiating CPR, securing an airway, IV medications, and record keeping.
- Oliguria is defined as urine output <400cc/day and can be caused by pre-renal, intrinsic renal, or post-renal factors.
- An initial assessment of oliguria includes verifying urine output, flushing any Foley catheter, obtaining a bladder scan if no catheter, and reviewing the patient's chart and conducting a physical exam to identify potential causes.
- Life-threatening complications of oliguria like hyperkalemia and acidosis must be promptly recognized and managed while the underlying cause is treated. Fluid boluses can be tried for pre-renal causes but lasix should generally be avoided until the etiology is clear.
High Output Cardiac Failure
The tissues, not the heart, determine cardiac output by controlling local blood flow through vasodilation in response to changes in oxygen and carbon dioxide levels. As vascular resistance decreases, stroke volume increases, maintaining blood pressure. A high cardiac output becomes "high output failure" when blood pressure cannot be maintained against low systemic vascular resistance, or oxygen delivery is insufficient. The diagnostic triad is high cardiac output, low blood pressure, and very low systemic vascular resistance. Treatment focuses on balancing oxygen delivery and demand by optimizing preload, contractility, and afterload through fluid administration and inotropic support tailored to individual hemodynamic parameters.
Medical emergency on scorpion sting new 4Indhu Reddy
The document discusses scorpion venom classification and clinical manifestations of scorpion envenomation. It notes that scorpion venom is composed of various toxins and enzymes that act on ion channels in excitable cells like neurons and muscles. The toxins are classified based on their target ion channels and structural properties. Major toxins target voltage-gated sodium channels and potassium channels. The clinical effects of a sting depend on the scorpion species and venom dose, and can range from local pain to a potentially fatal "autonomic storm" involving excessive sympathetic and parasympathetic stimulation. Treatment involves pain management, antivenom, and supportive care depending on the severity of symptoms.
Snakebite is a significant public health issue in India, causing approximately 50,000 deaths per year. The document discusses snakebite as an occupational hazard, particularly for agricultural workers. It provides details on the types of poisonous snakes found in India, the symptoms and complications of snakebites, and the current treatment protocol. The protocol involves first aid, diagnosis, and treatment with antivenom immunotherapy. Improving access to timely medical care and antivenom could help reduce the high snakebite mortality in India.
1. The document discusses snake classification, types of venomous snakes in India, signs and symptoms of snake bites, and management of snake bites.
2. Poisonous snakes are classified based on the type of venom secreted into three families - Elapidae which secretes neurotoxic venom, Viperidae which secretes haemotoxic venom, and Hydrophidae which secretes myotoxic venom.
3. Common poisonous snakes in India include cobras, kraits, Russell's vipers, and sea snakes. Bites from kraits and Russell's vipers are more toxic than cobra bites.
4. Management of snake bites involves local treatment, administration of antivenom, and supportive care depending
Snakebite is a major public health issue, causing over 100,000 deaths worldwide each year. India accounts for nearly half of snakebite deaths globally, with the highest numbers occurring in rural areas. The "Big Four" venomous snakes that cause the majority of bites in India are the common krait, Indian cobra, Russell's viper, and saw-scaled viper. Proper first aid and timely administration of antivenom are critical to reducing mortality. Symptoms of envenoming depend on the snake species and amount of venom injected, and may include local tissue damage, bleeding disorders, organ dysfunction and systemic effects. Diagnosis involves examining the bite site and signs/symptoms, and lab tests can
- The document provides guidance on treating snake and scorpion bites in children in India. It discusses:
- Four important poisonous snakes in India and first aid steps of "Do it R.I.G.H.T." which includes reassuring the patient and getting to the hospital immediately.
- Diagnosis, investigations, administration of anti-snake venom including dosage and handling adverse reactions. Repeat doses are given every 6 hours until coagulation is restored.
- Scorpion sting pathophysiology involves an autonomic storm and effects on multiple organs. Prazosin is the primary treatment and should be given within 4 hours of the sting.
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.
This document provides guidance on snake bites in India. It discusses that snake bites are a major public health issue, killing over 11,000 people annually. The most common venomous snakes in India are Russell's viper, hump-nosed viper, cobra, and krait. It outlines the clinical presentation of envenomings from different snakes, including neuroparalytic effects from cobras and kraits, bleeding disorders from vipers, and muscle damage from sea snakes. The document emphasizes rapid assessment, resuscitation, detailed examination to identify the snake species, laboratory tests, and antivenom treatment for snake bites in India.
Snake bites are a major public health issue in India, with estimates of 200,000 bites and 15,000-20,000 deaths annually. The document discusses the epidemiology, types of venomous snakes, clinical effects of envenomation, and management of snake bites. Management involves first aid measures like immobilization of the bite area, administration of antivenom serum, and supportive care. Antivenom serum is most effective when given within 4 hours of the bite to neutralize the venom, and mechanical ventilation may be needed if respiratory failure occurs from neurotoxic or systemic effects of the venom.
SHOCK - PATHOPHYSIOLOGY, TYPES, APPROACH, TREATMENT.DR K TARUN RAO
1. Shock is defined as a state of poor tissue perfusion and cellular metabolism due to circulatory failure and hypoperfusion.
2. The main causes of shock include hypovolemic, cardiogenic, septic, anaphylactic, neurogenic, and respiratory etiologies.
3. The pathophysiology of shock involves a low cardiac output state leading to vasoconstriction and redistribution of blood flow away from non-vital organs to preserve perfusion of vital organs. Persistent shock can progress to cellular damage, organ dysfunction, and death.
A 14-year-old boy presented to the emergency department with symptoms of an autonomic storm after being bitten by a scorpion. He was diagnosed with scorpion sting in autonomic storm. He was given prazosin, hydrocortisone, and other supportive treatments. His condition stabilized and he was discharged after 6 days. Scorpion stings can cause local effects and a systemic autonomic storm response due to neurotoxins that affect sodium channels and induce catecholamine release. Prazosin is an effective treatment as it blocks alpha receptors and counters the effects of venom.
A 55-year-old male presented with pain and swelling in his left foot and lower leg along with abdominal pain and drowsiness. Examination revealed tachycardia, hypotension, tachypnea, and abdominal tenderness. Laboratory findings were consistent with diabetic ketoacidosis (DKA): hyperglycemia, ketonemia, and metabolic acidosis. The patient was diagnosed with DKA likely precipitated by infection and treated with insulin, intravenous fluids, potassium supplementation, and monitoring of electrolytes and glucose levels.
This document discusses supraventricular tachycardia (SVT), which are tachyarrhythmias originating from the atria or atrioventricular node that cause a rapid heart rate. SVTs are classified as either atrial or AV tachyarrhythmias based on their site of origin. Common causes include inherited conditions, structural heart abnormalities, coronary artery disease, and hyperthyroidism. Diagnosis involves an electrocardiogram (ECG), Holter or event monitor, exercise test, or electrophysiology study. Treatment depends on whether it is acute or long term, and may include vagal maneuvers, calcium channel blockers, cardioversion, or medications like digoxin, beta blockers,
This document provides information about scorpion stings, including:
1) Scorpions have a lobster-like body with claws, legs, and a segmented tail ending in a stinger containing venom glands. Their venom causes uncontrolled nerve firing through sodium channel effects.
2) Symptoms range from localized pain to cranial nerve dysfunction and autonomic/muscular symptoms. Severe cases can lead to complications like respiratory failure.
3) Treatment involves wound care, pain management, antivenom if available, and supportive care like intubation, IV fluids and medication for symptoms. Outcomes are generally good with treatment.
Intubation is a common medical procedure where a flexible plastic tube is inserted into the throat to aid breathing during anesthesia or an airway emergency. It can be performed through the nose or mouth and is used to open the airway, remove blockages, or help breathing. While most people recover quickly with no effects, risks include sore throat, damage to tissues, infection, or rare cases of PTSD. People should discuss risks with their doctor before any planned intubation.
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw
Redback spiders are the most common cause of spider envenomation in Australia, resulting in 5-10,000 bites per year. While the symptoms can be distressing, including inconsolable crying in children and priapism, redback bites are rarely life-threatening. Funnel-web spiders are the most dangerous spiders in Australia; their bites can cause symptoms ranging from local pain and swelling to autonomic effects like sweating and vomiting as well as cardiac or neurological issues. While white-tailed spider bites are often blamed, the venom has not been proven to cause tissue necrosis. Most spider bites result in only localized symptoms, but funnel-web bites require antivenom treatment in the emergency department.
The document discusses cardiac arrest, which is defined as a sudden stop in blood circulation caused by the heart failing to contract. Potential causes of cardiac arrest are then listed in categories such as cardiac, respiratory, circulatory, and metabolic issues or toxic/environmental factors. Specific conditions are also outlined in lists of "6 H's" and "5 T's". The document concludes by describing shockable and non-shockable heart rhythms in cardiac arrest and the steps to take during a code blue situation, including initiating CPR, securing an airway, IV medications, and record keeping.
- Oliguria is defined as urine output <400cc/day and can be caused by pre-renal, intrinsic renal, or post-renal factors.
- An initial assessment of oliguria includes verifying urine output, flushing any Foley catheter, obtaining a bladder scan if no catheter, and reviewing the patient's chart and conducting a physical exam to identify potential causes.
- Life-threatening complications of oliguria like hyperkalemia and acidosis must be promptly recognized and managed while the underlying cause is treated. Fluid boluses can be tried for pre-renal causes but lasix should generally be avoided until the etiology is clear.
High Output Cardiac Failure
The tissues, not the heart, determine cardiac output by controlling local blood flow through vasodilation in response to changes in oxygen and carbon dioxide levels. As vascular resistance decreases, stroke volume increases, maintaining blood pressure. A high cardiac output becomes "high output failure" when blood pressure cannot be maintained against low systemic vascular resistance, or oxygen delivery is insufficient. The diagnostic triad is high cardiac output, low blood pressure, and very low systemic vascular resistance. Treatment focuses on balancing oxygen delivery and demand by optimizing preload, contractility, and afterload through fluid administration and inotropic support tailored to individual hemodynamic parameters.
Medical emergency on scorpion sting new 4Indhu Reddy
The document discusses scorpion venom classification and clinical manifestations of scorpion envenomation. It notes that scorpion venom is composed of various toxins and enzymes that act on ion channels in excitable cells like neurons and muscles. The toxins are classified based on their target ion channels and structural properties. Major toxins target voltage-gated sodium channels and potassium channels. The clinical effects of a sting depend on the scorpion species and venom dose, and can range from local pain to a potentially fatal "autonomic storm" involving excessive sympathetic and parasympathetic stimulation. Treatment involves pain management, antivenom, and supportive care depending on the severity of symptoms.
Snakebite is a significant public health issue in India, causing approximately 50,000 deaths per year. The document discusses snakebite as an occupational hazard, particularly for agricultural workers. It provides details on the types of poisonous snakes found in India, the symptoms and complications of snakebites, and the current treatment protocol. The protocol involves first aid, diagnosis, and treatment with antivenom immunotherapy. Improving access to timely medical care and antivenom could help reduce the high snakebite mortality in India.
1. The document discusses snake classification, types of venomous snakes in India, signs and symptoms of snake bites, and management of snake bites.
2. Poisonous snakes are classified based on the type of venom secreted into three families - Elapidae which secretes neurotoxic venom, Viperidae which secretes haemotoxic venom, and Hydrophidae which secretes myotoxic venom.
3. Common poisonous snakes in India include cobras, kraits, Russell's vipers, and sea snakes. Bites from kraits and Russell's vipers are more toxic than cobra bites.
4. Management of snake bites involves local treatment, administration of antivenom, and supportive care depending
Snakebite is a major public health issue, causing over 100,000 deaths worldwide each year. India accounts for nearly half of snakebite deaths globally, with the highest numbers occurring in rural areas. The "Big Four" venomous snakes that cause the majority of bites in India are the common krait, Indian cobra, Russell's viper, and saw-scaled viper. Proper first aid and timely administration of antivenom are critical to reducing mortality. Symptoms of envenoming depend on the snake species and amount of venom injected, and may include local tissue damage, bleeding disorders, organ dysfunction and systemic effects. Diagnosis involves examining the bite site and signs/symptoms, and lab tests can
- The document provides guidance on treating snake and scorpion bites in children in India. It discusses:
- Four important poisonous snakes in India and first aid steps of "Do it R.I.G.H.T." which includes reassuring the patient and getting to the hospital immediately.
- Diagnosis, investigations, administration of anti-snake venom including dosage and handling adverse reactions. Repeat doses are given every 6 hours until coagulation is restored.
- Scorpion sting pathophysiology involves an autonomic storm and effects on multiple organs. Prazosin is the primary treatment and should be given within 4 hours of the sting.
Snake bites are a major public health issue in rural India, with over 100,000 envenomations reported annually. The most common poisonous snakes in India include cobras, kraits, Russell's vipers, saw-scaled vipers, and hump-nosed vipers. Effective first aid and treatment involves immobilizing the bitten area, seeking prompt medical care, diagnosing envenomation symptoms, and administering antivenom as needed to counteract the effects of snake venom.
Snake bites can be fatal, causing around 30-40 thousand deaths per year in tropical countries. Poisonous snakes use venom glands and hollow fangs to inject victims. Cobra venom causes symptoms within minutes like blurred vision and paralysis, while krait and viper venom have longer onset but can cause bleeding, organ damage, and death from shock. First aid involves cleaning the wound, immobilizing the limb, and rushing the victim to the hospital. There, antivenom treatment, supportive care, and monitoring for anaphylaxis are given to counter the effects of the venom and save the victim's life.
Details about snake bites their impact and remediesrajputshivamdeep
Snake bites can be fatal, causing around 30-40 thousand deaths per year in tropical countries. Poisonous snakes use venom glands and hollow fangs to inject victims. Cobra venom causes symptoms within minutes like blurred vision and paralysis, while krait and viper venom have slower onsets and cause symptoms like swelling, bleeding, and tissue damage. Treatment involves cleaning wounds, immobilizing limbs, and administering antivenom drugs intravenously based on symptom severity. Supportive care addresses infection, bleeding, and organ damage. Identifying snake species aids determining appropriate treatment and prognosis.
Snakes and scorpions can inject venom through bites or stings that is dangerous and sometimes fatal. There are over 50,000 deaths from snake bites worldwide each year. Venoms vary and can be neurotoxic, vasculotoxic, or myotoxic. Immediate medical help is needed for bites. Scorpion venom can also be neurotoxic or haemolytic, causing local or systemic effects like paralysis, cardiac issues, or death in severe cases. Treatment involves immobilization, antivenom, supportive care, and monitoring for complications.
Snake bite ppt by
Dr Sujith Chadala,
Consultant Physician Diabetologist
Ankura Hospitals, Banjara hills, Nanakaramguda,Hyderabad,
Yello Clinics Diagnostics, Kokapet, Hyderabad.
MD,IDCCM,PGPC, CCEBDM,FIDM.Snake envenimation,AntiSnake Venom,Fistaid to Snakebite,Management of Snake bite,Complications of Snakebite,Cobra bite,Viper bite,Krait bite, Complications of Snakebite, ASV indications,20min Whole blood clotting time,Antibiotic in snake bite,average yield per venom, Hemotoxicity of snake bite,Neurotoxicity of snake bite,ASV test dose,ASV administration,ASV reactions,ASv route,ASV in children and pregnant, Hemodialysis in Snakebite,compartment syndrome in Snakebite,local bite management,maximum ASV vials,blood transfusions in snake bite,early and late ASV reactions,discharge criteria in snake bite,Snake bite local tissue care,Snakebite Management,fluids in snakebite,ASV reactions management,Neostigmine test,Intubation in snake bite,ABC management in snakebite,timing of ASV,saw scaled viper bite,ASV forms,fluid resuscitation,vasopressors,torniquet,ICU, Russell's viper,sea snakes,snakebite mortality,pit viper,Kingcobra,Neurotoxins,snake venom composition,hemotological complications of snake bite,neurological complications of Snakebite,local complications of snakebite,generalised complications of snakebite ,Snakebite guidelines,WHO snakebite guidelines, cardiovascular complications of snake bite,renal complications of snakebite,electrotherapy,pressure immobilisation
Snakebite is a medical emergency in rural India caused mainly by four venomous snake species. Poisonous snakes can be identified by small head scales, large belly scales, a compressed tail, and two fangs. The most common types are cobras, kraits, Russell's vipers, and saw-scaled vipers. Snake venom causes neurotoxicity or vasculotoxicity depending on the species. First aid involves reassuring the patient, immobilizing the bite area, seeking immediate medical help, and avoiding tourniquets. At the hospital, antivenom is administered along with treatment of symptoms like local swelling, neurotoxicity, and anticoagulant effects. Complications can include paralysis, bleeding disorders,
This document discusses the case of an 18-year-old male who presents with pain in his left leg from below the knee that has been ongoing for one year. He was bitten by a snake while working in fields one year ago. The bite area became infected, swollen, and formed pus. Differential diagnoses for his leg pain include musculoskeletal issues, trauma, DVT, neuropathy, and necrotizing fasciitis. Snake bite management involves reassuring the patient, immobilizing the area, going to the hospital immediately, and informing doctors of any symptoms. In the hospital, anti-snake venom is the main treatment along with supportive care.
VIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENTfareedresidency
This document provides information about viper snake bites in India. It discusses that India has the highest rate of snakebite mortality in the world, with around 83,000 bites and 11,000 deaths annually. The four most dangerous and venomous snakes that cause most bites are the common cobra, Russell's viper, saw-scaled viper, and common krait. It then goes on to describe the identification, venom composition, symptoms of envenoming, management, and treatment of snake bites, with a focus on proper first aid and administration of antivenom.
Snake bite poisoning is a common emergency in rural hospitals. Poisonous snakes inject venom through fangs that contain complex proteins and enzymes. There are three main families of poisonous snakes: vipers, elapids, and sea snakes. Viper bites cause local swelling and bleeding disorders while elapid bites induce vomiting and neurological effects. Sea snake bites affect muscles. Investigations evaluate bleeding, organ function, and venom effects. Management involves wound care, IV fluids, monitoring for toxicity, and antivenom for severe or progressive cases. Antivenom neutralizes venom but side effects require precautions like test doses, antihistamines, and adrenaline.
Snakebites can result in local tissue damage and systemic poisoning. The most common types are from vipers, cobras, and mambas in Africa. Viper bites cause bleeding problems while cobra and mamba bites cause neurotoxicity. Symptoms include swelling, bleeding, difficulty breathing, and low blood pressure. Diagnosis is based on fang marks and signs of poisoning. Treatment involves immobilizing the bitten area, giving antivenom which is most effective within 6 hours, and monitoring for allergic reactions. Additional care may include surgery, oxygen, IV fluids and ventilation support.
This document presents a case study of a 7-year-old boy who was bitten by a snake on his left foot. He experienced swelling and pain that progressed up his left leg. He was initially treated with IV fluids, analgesics, and antivenom at a local hospital before being referred for possible antivenom allergy.
On examination, he had swelling up to his knee with tenderness and blebs. Investigations showed elevated white blood cell count. He developed worsening swelling and pus, and was diagnosed with necrotizing fasciitis. He underwent wound debridement and antibiotics were changed. Cultures grew Klebsiella pneumoniae. He was treated surgically and with antibiotics.
This document summarizes the epidemiology, signs and symptoms, clinical syndromes, investigations, and management of snake bites. It notes that India has the highest snakebite mortality in the world, with estimates of 83,000 bites and 11,000 deaths annually. Signs and symptoms vary depending on the type of snake but can include local swelling, pain, bleeding, shock, paralysis, and kidney injury. Investigations include blood clotting tests and urine analysis. Antivenom treatment is the primary therapy and should be given for systemic signs of envenoming like bleeding, paralysis, shock, or kidney injury.
This document discusses snakebite management in pediatrics. It outlines that only 200 of over 3,000 known snake species are poisonous to humans, with the majority belonging to 3 families. Symptoms and progression of envenomation depend on the snake type. Treatment involves immobilization, testing for coagulopathy, monitoring symptoms, and administering antivenom if indicated based on severity. Adverse reactions to antivenom can be managed with adrenaline, steroids, and antihistamines. Repeat antivenom doses are based on symptom progression and test results over subsequent hours. Prognosis is good with early antivenom use.
This is a slide presentation for group discussion on snake bites. We were given some situation and the task was to gather resources and discuss on how to address the given situation. Suitable for medical students, housemen and s general knowledge on snake bites. Credit also goes to my groupmates in preparing the presentation.
This document discusses snake venom poisoning and its management. It begins by classifying snakes and identifying the 5 families that contain venomous species. It then describes the differences between poisonous and non-poisonous snakes. The document outlines the components of snake venom and their effects. Signs and symptoms of envenomation are provided for different snake families. Diagnosis involves identifying the snake species based on symptoms, circumstances, or antigen detection. Treatment primarily involves administering antivenom, with dosages varying based on severity of symptoms. Adjuvant treatments like neostigmine may also be used depending on the neurotoxin involved.
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low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
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2. Snake bite
• Potentially life-threatening disease caused
• by toxins in the bite of a venomous snake.
• by having venom sprayed into the eyes by some species.
• Occupational hazard affecting farmers, plantation workers, herders and
fishermen.
• Neglected tropical disease.
3. Epidemiology
• Out of more than 3000 species of snakes in the world, some 600 are
venomous and over 200 are considered to be medically important.
• According to the World Health Organization,
• more than 5 million snakebites occur worldwide each year
• approximately 2.5 million envenomations and
• 81,000 to 138,000 deaths
4. • In Nepal, WHO estimates that 20,000 people are bitten by snakes each year,
resulting in over 1000 deaths
• So far, 89 snake species have been recorded in Nepal .
• Among this great diversity of snakes, we know with certainty of 17 species
of snake that are found in Nepal.
5.
6.
7.
8.
9. • Not all bites by venomous snakes are accompanied by the injection of
venom.
• Approximately 20% of pit viper bites and higher percentages of other
snakebites (up to 75% for sea snakes) are “dry” bites; i.e., no venom is
released.
• Significant envenomation probably occurs in ~50% of all venomous
snakebites.
10. Venoms
• Complex chemical mixture of enzymes, polypeptides, non-enzymatic proteins,
nucleotides, and other substances
• Neurotoxins-
• Phospholipase A2 (PLA2) toxins (mostly beta-neurotoxins).
• Postsynaptic neurotoxins (alpha-neurotoxins).
• Hematotoxins- factor V activators, factor X activators, prothrombin activators, and
thrombin-like enzymes or fibrinogenase.
• Cytotoxins- phosphodiesterases, hyaluronidases, peptidases, metalloproteinases etc.
11.
12. ASK
• Where were you bitten?
• What were you doing/ when were you bitten?
• Did anyone take the picture? What did it look like?
• How the bite occurred and whether there was more than one bite?
• Any signs or symptoms and the timing of onset?
• Initial treatment and first aid that was provided, including timing of first aid
13. Local effects
• Bite marks:
• Single puncture, dual puncture or marks of multiple tooth marks, only
scratch mark.
• Krait bite may leave no mark at all.
• Site : arm or lower limb , may occur in trunk or other parts also.
14. Local effects
Cobra
• Swelling and local pain
with or without erythema
or discoloration at the bite
site.
• Blistering, bullae
formation and local
necrosis are also common.
• If it is infected, there may
be abscess formation.
Krait
• Usually do not cause signs
of local envenoming and
can be virtually painless.
Viper
• Swelling, blistering,
bleeding, and necrosis at
the bite site, sometimes
extending to the whole
limb.
• Persistent bleeding from
fang marks, wounds or
any injured parts of the
body.
• Swelling or tenderness of
regional lymph node.
16. Systemic manifestations
Hematotoxic
• Bleeding may from
venipuncture site, gums,
• Epistaxis
• Hemoptysis
• Melena, rectal bleeding
• Hematuria, bleeding from
vagina
• Subconjunctival
hemorrhage
• Petechiae, purpura,
ecchymosis
Neurotoxic
• Ptosis
• Ophthalmoplegia
• Pupillary dilatation- often
non- responsive to light
• Inability (or limitation) to
open mouth
• Numbness around lips and
mouths
Neurotoxic
• Tongue extrusion- inability
to protrude the tongue
beyond incisors teeth.
• Inability to swallow
• Broken neck sign
• Skeletal muscle weakness.
• Loss of gag reflex
• Paradoxical breathing
• Respiratory failure
17. LONG TERM COMPLICATIONS (SEQUELAE)
• Chronic ulceration, infection, osteomyelitis or arthritis
• Physical disability
• Chronic kidney disease due to bilateral renal cortical necrosis
• Chronic pan-hypopituitarism may occur in Russell’s viper envenoming
• Sequelae of intracranial bleeding in hematotoxic envenoming
• Delayed psychological morbidity like depression and anxiety, impaired
functioning, post-traumatic stress disorder
19. Diagnosis
Hematotoxic
•20-minute whole blood clotting test (20WBCT)
•Bleeding time (BT) and clotting time (CT)
•Prothrombin time and International normalization ratio (INR)
•FDP, fibrinogen, d-dimer
•Kidney function test and liver function test
•Complete blood count, blood group
•Urine for RBCs or myoglobin
•Creatine kinase
20. 20 WBCT
• Place 3 ml of freshly sampled venous blood in a small, new, dry, glass tube.
• Leave the tube standing undisturbed for 20 minutes at ambient temperature.
• A positive 20WBCT is a reasonable indication for antivenom administration,
but a negative 20WBCT does not mean that antivenom should be withheld,
especially if other clinical findings of coagulopathy (eg, blood oozing at
puncture sites, bleeding gums, or epistaxis) are present.
21. SYNDROME FEATURES
SYNDROME 1 Local swelling or other features of local envenoming with paralysis with NO features of
bleeding or clotting disturbances.
COBRA or KING COBRA
SYNDROME 2 Nocturnal bite while sleeping on ground and paralysis with NO/or minimal local sign of
envenoming.
KRAIT
SYNDROME 3 Neurotoxicity with dark brown urine, severe muscle pain, without local swelling, bleeding or
clotting disturbances and with or without renal failure. Bitten on land while sleeping indoors.
KRAIT (B. niger)
SYNDROME 4 Marked swelling (sometime with blisters and necrosis) with incoagulable blood and /or
spontaneous systemic bleeding. RUSSELL’S VIPER (Daboia russelii)
SYNDROME 5 Marked swelling on bitten limb/part often with blisters (sometime with severe pain) without
bleeding or clotting disturbances. PITVIPERS (Ovophis monticola, Trimeresurus sp.: T.
albolabris, and T. popeiorum).
22. TREATMENT OF SNAKEBITE ENVENOMING
• First aid treatment and transport to the hospital
• Rapid clinical assessment and resuscitation
• Antivenom treatment
• Supportive/ancillary treatment
• Treatment of the bitten part
23. Recommended first aid treatment
REASSURANCE
• Most are nonvenomous snakes. Many are dry bites.
• Treatable condition.
IMMOBILIZAT
ION
• With a splint or sling.
• Pressure immobilization in case of purely neurotoxic snake bite
• Pressure pad immobilization
• Remove rings, jewelries, tight fittings and clothing
RAPID
TRANSPORT
• To decrease the delay in accessing the emergency care and reduce mortility
24. CAUTION
• Tight arterial tourniquet must never be recommended
• Delay the release of tight tourniquets if patient has already applied this popular
method of first-aid
• These practices must be discouraged
• Cutting and sucking of bite site.
• Application of snake stone (Jharmauro).
• Application of electric current.
• Application of various chemicals, cow dung etc
25. Rapid clinical assessment and resuscitation
• Airway
• Breathing
• Circulation
• Disability of the nervous system
• Exposure and environmental control
26. Antivenom treatment
• Phisalix and Bertrand and Calmette simultaneously, but independently,
presented their observations in the year 1894 on the antitoxic properties of
the serum of rabbits and guinea-pigs immunized against cobra and viper
venoms, respectively.
• The first horse-derived antivenom sera that he prepared were already in
clinical use in 1895 by Haffkine in India and by Lépinay in Viet Nam. The
latter reported the first successful use of antivenin serum therapy in patients
in 1896.
27. Antivenom in Nepal
• Imported from India and is polyvalent.
• Effective against the four common species of snakes;
• Russell's Viper (Daboia russelii),
• Common Cobra (Naja naja),
• Common Krait (Bungarus caeruleus) and
• Saw Scaled Viper (Echis carinatus).
28. Indications for administering antivenom
Evidence of Neurotoxicity Ptosis, ophthalmoplegia, broken neck sign, respiratory difficulty, etc.
Evidence of Coagulopathy Evidence of coagulopathy primarily detected by 20 WBCT or visible
spontaneous systemic bleeding, bleeding gums, etc., including
myoglobinuria and hemoglobinuria, deranged PT/INR, etc
Rapid extension of local swelling (more than half of limb) which is not due
to tight tourniquet application.
Evidence of Cardiovascular
Collapse
Shock and hypotension (in case of Russell’s viper bite).
Evidence Of Acute Kidney Injury AKI is an indication for antivenom therapy.
29. Contradications
• No absolute contraindication to antivenom treatment,
• But patients who have reacted to horse (equine) or sheep (ovine) serum in
the past (for example after treatment with equine anti-tetanus serum, equine
anti-rabies serum or equine or bovine antivenom) and those with a strong
history of atopic diseases (especially severe asthma) are at high risk of severe
reactions and
• Should therefore be given antivenom only if they have signs of systemic
envenoming.
30. How long after the bite can antivenom be
expected to be effective?
• Antivenom treatment should be given as soon as it is indicated.
• It may reverse systemic envenoming even when this has persisted for several
days or, in the case of haemostatic abnormalities, for two or more weeks.
31. Route of administration
• Each vial is diluted with 10 ml. of sterile water as supplied with the antivenom.
32. • Randomized, controlled, double-blind trial in Nepal (Damak & Charali
snakebite treatment centres and Bharatpur Hospital)
• To compare the efficacy of a ten vials initial dose versus a two vials initial
dose of Polyvalent Anti-Snake Venom Serum in the treatment of snake bite
• Result : Similar efficacy and safety of low vs high initial dose regimen of
anti-venom in patients with neurotoxic envenoming in Nepal .Recovery is
faster with high initial dose
33.
34.
35. Response to treatment
• General symptoms may disappear vary quickly.
• Spontaneous systemic bleeding usually stops within 15-30 min.
• Blood pressure may increase within 30-60 min.
• Neurotoxicity may improve as early as 30 min.
• Blood coagulability is usually restored in 3-9 hrs.
36. Reasons for failure to respond to antivenom
• Excessive delay in administration of antivenom
• Patient with established respiratory failure.
• If antivenom administered does not contain neutralizing antibodies against
the venom of biting species.
• Insufficient dose of antivenom.
• Inactive or poor quality antivenom.
37. Prophylactic adrenaline
• Prophylactic adrenaline should be routinely used before initiation of anti-
venom treatment to prevent anti-venom reaction except in older patients
with evidence or suspicion of underlying ischemic heart disease or
cerebrovascular disease.
38. Antivenom reactions
• within 3 hours of antivenom initiation.
• itching, urticaria, fever, angio-edema, dyspnea, laryngeal edema,
hypotension etc. .
Early
anaphylactic
reactions
• Usually develops 1-2 hrs. after treatment initiation.
• Chills, rigors, fever, fall of blood pressure, febrile convulsion may
develop in children.
Pyrogenic
reaction
• May develop 1- 12 (mean 7) days after treatment.
• Fever, itching, recurrent urticaria, arthralgia, myalgia, lymphadenopathy,
proteinuria etc.
Late reaction
(serum
sickness type)
39. Treatment of Early Anaphylaxis
Reaction/Anaphylaxis
• INTERRUPT antivenom
• IM adrenaline
• IV chlorpheniramine
• IV fluids
• Oxygen
• IV hydrocortisone
• Nebulized salbutamol
40. IF ANTIVENOM HAS TO BE RESTARTED
• Consider transfer to ICU.
• Continue IV hydrocortisone.
• IV adrenaline infusion will be required and should be started before giving
antivenom.
• Stop infusion 30 minutes after resolution of all symptoms and signs.
41. Treatment
Pyrogenic reaction
• Do not interrupt antivenom
unless hypotension is present.
• Give injection paracetamol.
• Treat hypotension with rapid
infusion of normal saline.
Serum sickness
• Anti-histaminic Pheniramine
maleate
• If no response to
antihistaminic Prednisolone
43. When antivenom is not available or not effective
• Neostigmine: 0.5 mg SC/IV/IM (0.02mg/kg). Repeat 4 hourly until
neurotoxicity improves (maximum 10 mg/24hrs)/ Edrophonium
• Atropine: 0.6mg IV / Glycopyrolate
• FFP and cryoprecipitate or whole blood
44. TREATMENT OF THE BITTEN PART
• Elevation of limb with rest.
• Simple washing with antiseptic solution like chlorhexidine, povidone iodine
etc.
• Broad-spectrum antibiotic if features of infection.
• In case of local necrosis and gangrene: Surgical debridement.
• Tetanus toxoid IM injection should be given. If patient presents with
coagulopathy, it should be postponed until after resolution of coagulopathy.
45. Recent advances
• A 2016 study by Lewin et al. demonstrated that nanomolar and picomolar
concentrations of varespladib effectively inhibit the phospholipase A2 (PLA2)
activities of selected snake venoms from various continents.
• In 2019, the U.S. Food and Drug Administration (FDA) granted
varespladib orphan drug status for its potential to treat snakebite.
• Other examples of promising small molecule inhibitors include the matrix
metalloproteinase inhibitors batimastat and marimastat. The molecules prolonged
survival, but did not provide full protection.
• In the field of recombinant antivenoms, attention to the use of camelid VHHs (also
known as nanobodies) as therapeutic agents has increased.
46. ADDovenom: Novel Snakebite Therapy Platform of
Unparalleled Efficacy, Safety and Affordability
• Based on a new disruptive protein-based
nanoscaffold called ADDomer – a megadalton-
sized, thermostable synthetic virus-like particle
with 60 high-affinity binding sites to neutralise
and eliminate venom toxins from the
bloodstream.
47. PREVENTION OF SNAKEBITE
• Community based education.
• Keep household clean by cutting grasses, bushes, and plants, remove heaps of
rubbish, building materials etc. from near and around house.
• Bamboo, wood piles should be removed from household so that snake cannot hide.
• Close door, windows properly.
• Try to avoid sleeping on floor. If it is unavoidable, then mosquito net should be
used and tucked well under the mattress or sleeping mat. It not only prevents from
krait bite but also from mosquito bite.
• Keep your granary away from the house, it may attract rodents that snakes will hunt
48. PREVENTION OF SNAKEBITE
• Use high shoes or boots while walking in paddy field, bushes, long grasses.
• In dark, use light or strike the path using stick.
• Never play with snakes, or irritate them even if they are dead. Never provoke them,
they usually do not bite if not irritated or provoked.
• Never insert hands into long grasses, tree holes or mud holes. Take care while
pulling straw.
• Shoes and cloths should be check before wearing, in an area where snakes are
abundant.
Editor's Notes
Spiting cobras
The venomous snakes of the world belong to the families
Viperidae (subfamily Viperinae: Old World vipers; subfamily Crotalinae: New World and Asian pit vipers),
Elapidae (including cobras, coral snakes, sea snakes, kraits, and all Australian venomous snakes),
Lamprophiidae (subfamily Atractaspidinae: burrowing asps), and
Colubridae (a large family in which most species are nonvenomous Disorders Caused by Venomous Snakebites and Marine Animal Exposures and only a few are dangerously toxic to humans).
Their venom contains toxins which can either inhibit the release of acetylcholine (pre-synaptic toxins) or bind and block its receptor (postsynaptic toxins).
Cobra venom is composed mainly of postsynaptic toxins that block muscle-type nicotinic acetylcholine receptors and are responsible for a curare-like paralysis,
while krait venoms also contain large quantities of pre-synaptic toxins that inhibit the release of acetylcholine by destroying nerve endings.
Any recent ethanol or recreational drug use that may modify the patient's presentation
Pertinent past medical history, such as current medications (especially anticoagulants or beta blockers), any prior snakebites for which antivenom was given, or allergy to animals used in antivenom production.
However, it is not much helpful to diagnose venomous versus non-venomous snakebite. Venomous snake can have single puncture if one tooth is broken or nonvenomous may have distinct two punctures if they have large teeth. n
Degree of swelling, including circumferential measurement at the point of greatest swelling and demarcation of the extent of swelling from the bite site for reference during repeated examinations.
Abdominal pain is particularly common in krait bite. Acute pain abdomen in suspected nocturnal snakebite may be the only initial clue to krait envenoming.
patients cannot hold his/her neck straight when sitting up (active or passive) from supine position. This is due to weakness of the flexor muscles of neck.
- limb weakness, flaccid paralysis and loss of deep tendon reflexes
and unexplained residual physical disability as reported from Sri Lanka
Complete blood count, blood group etc.: Increased total WBC count indicate systemic envenoming. Hemoconcentration may occur due to systemic bleeding and platelet count may decrease in case of viper envenoming.
coagulopathy
+ve (non-clotting) 20WBCT or
INR >1.2 or
patient’s prothrombin time >4-5 seconds longer than laboratory control value] or
thrombocytopenia [< 1.0 lakh per microlitre of blood)
Any cloth or bandage may be used for this, as done for fracture limb. Any form of movement causing muscle contraction like walking, undressing will increase absorption and spread of venom by squeezing veins and lymphatics.
avoid any interference with the bite wound to prevent infection, increase absorption of venom and increase local bleeding
REASSURANCE
Most are nonvenomous snakes. Many are dry bites.
Treatable condition.
IMMOBILIZATION
With a splint or sling.
Pressure immobilization in case of purely neurotoxic snake bite
Pressure pad immobilization
Remove rings, jewelries, tight fittings and clothing
This dangerous practice may lead to gangrene, necrosis and loss of the limb. It may also provide patient a false sense of security leading to delay in seeking hospital care.
Ideally, the tight tourniquet should only be released when patient is in hospital under medical care and the facilities for resuscitation is ready. Treatment should be started before such release of tight tourniquet.
Torniquet should be released slowly only after resustication and treatment should be started before such release of tight tourniquet.
Prophylactic adrenaline should be routinely used before initiation of antivenom treatment to prevent antivenom reaction except in older patients with evidence or suspicion of underlying ischemic heart disease or cerebrovascular disease.
Clinical trial in Nepal has shown that the mean dose of antivenom required to treat neurotoxic envenoming is 12.5 ± 3.9 vial per patients. However, it may range from as low as five vials to 20 vials, rarely, as high as 30 vials.
Do not use more than 20 vials of antivenom. Administration of higher dose antivenom is unlikely to be useful, if the patient has not responded to initial bolus or around 20 vials of antivenom.
In a placebo-controlled trial of 105 Sri Lankan patients who received IV polyvalent antivenom, fewer adverse reactions occurred in those patients who received pretreatment with 0.25 mg subcutaneous epinephrine when compared with placebo (11 versus 43 percent, respectively)
The dose of IV adrenaline infusion is:
Add 1 mg of adrenaline to 100 ml normal saline (this contains 1 mg in 100 mL = 1000 mcg in 100 mL = 10 mcg in 1 mL = 10 mcg/mL).
If the patient is still hypotensive/has signs of anaphylaxis, start at 0.5-1 mL/kg/h depending on how severe the reaction is.
If the patient is normotensive and stable, start at 0.25 mL/kg/h.
Titrate up or down according to response and side effects.
: 25 mg twice a day * 3 days Children: 0.25 mg/kg/day in divided doses* 3 days
prednisolone: 5 mg, 6 hourly * 7 days Children: 0.7 mg/kg/day in divided doses* 7 days
Based upon small trials, observational studies, and case reports, administration of anticholinesterases (eg, edrophonium (2 mg over 15 to 30 seconds. Then, after 45 seconds, give 8 mg if no response.), where available, or neostigmine 0.02 mg/kg) can identify whether paralysis is due to snakes with purely or predominantly post-synaptic venom effects (eg, cobras, some coral snakes).
Observe for improvement in ptosis, upward eye gaze, and respiratory weakness over 30 to 60 minutes.
Before attempting administration of edrophonium or neostigmine, intravenous atropine 0.6 mg (0.02 mg/kg in children, maximum 0.6 mg) or glycopyrrolate (0.2 mg per 1 mg neostigmine dose) should be drawn up
Patients with unknown snakebites in regions with neurotoxic snake species may warrant prolonged observation (up to 24 hours post-bite).
Snake venoms that cause isolated coagulopathy will usually do so within 12 hours after envenomation.
In locations where snakebite can cause systemic myolysis, observation up to 24 hours and pre-discharge measurement of creatine kinase may be warranted.
In general, it is wise to observe suspected snakebite patients overnight, rather than discharge them in the evening or at night, as local resources allow.