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.
Scorpions are a common arthropod found all over the world.
If threatened, a scorpion may use its long, flexible tail to sting a potential predator.
Frequently, people unknowingly come into contact with these species and experience the painful sensation of envenomation
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.
Scorpions are a common arthropod found all over the world.
If threatened, a scorpion may use its long, flexible tail to sting a potential predator.
Frequently, people unknowingly come into contact with these species and experience the painful sensation of envenomation
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.
infanticide are quite common in India because of illiteracy as well as the female child unwanted . Now a days female sexual assault and murder is getting common in north Indian society
Sulphuric acid as a corrosive poison. the characteristics, fatal dose, fatal time, sign and symptoms, post-mortem appearance and medicolegal importance are discussed
Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 1...rajendra deshpande
Snake Bite ,Rabies ,Scorpion bite are like urgency or Emergency type of conditions .This topics come under Toxicology or Agadtantra Subject of 2nd Year BAMS .This ppt will save the time to make notes from Huge books of Toxicology .This ppt is very useful for Ayurvedic students,Teachers,Doctors.Ready made information from this ppt will not only helpful for Examination point of view .But this ppt if Doctor download & save in his or her smart phone ,that will be like Ready Recknor in your practice .This ppt will help to diagnose ,to understand symptoms & signs & how to treat patient of Snake bite,Rabied dog bite ,Rat Bite,Scorpion bite . Download this ppt & send to many by what’s app Snake Bite ,Rabies ,Scorpion bite are like urgency or Emergency type of conditions .This topics come under Toxicology or Agadtantra Subject of 2nd Year BAMS .This ppt will save the time to make notes from Huge books of Toxicology .This ppt is very useful for Ayurvedic students,Teachers,Doctors.Ready made information from this ppt will not only helpful for Examination point of view .But this ppt if Doctor download & save in his or her smart phone ,that will be like Ready Recknor in your practice .This ppt will help to diagnose ,to understand symptoms & signs & how to treat patient of Snake bite,Rabied dog bite ,Rat Bite,Scorpion bite . Download this ppt & send to many by what’s app .
infanticide are quite common in India because of illiteracy as well as the female child unwanted . Now a days female sexual assault and murder is getting common in north Indian society
Sulphuric acid as a corrosive poison. the characteristics, fatal dose, fatal time, sign and symptoms, post-mortem appearance and medicolegal importance are discussed
Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 1...rajendra deshpande
Snake Bite ,Rabies ,Scorpion bite are like urgency or Emergency type of conditions .This topics come under Toxicology or Agadtantra Subject of 2nd Year BAMS .This ppt will save the time to make notes from Huge books of Toxicology .This ppt is very useful for Ayurvedic students,Teachers,Doctors.Ready made information from this ppt will not only helpful for Examination point of view .But this ppt if Doctor download & save in his or her smart phone ,that will be like Ready Recknor in your practice .This ppt will help to diagnose ,to understand symptoms & signs & how to treat patient of Snake bite,Rabied dog bite ,Rat Bite,Scorpion bite . Download this ppt & send to many by what’s app Snake Bite ,Rabies ,Scorpion bite are like urgency or Emergency type of conditions .This topics come under Toxicology or Agadtantra Subject of 2nd Year BAMS .This ppt will save the time to make notes from Huge books of Toxicology .This ppt is very useful for Ayurvedic students,Teachers,Doctors.Ready made information from this ppt will not only helpful for Examination point of view .But this ppt if Doctor download & save in his or her smart phone ,that will be like Ready Recknor in your practice .This ppt will help to diagnose ,to understand symptoms & signs & how to treat patient of Snake bite,Rabied dog bite ,Rat Bite,Scorpion bite . Download this ppt & send to many by what’s app .
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.
Clinical features & Management of ARTHROPODS STING AND BITES.pptxvuyyuribhaargavi
Envenomation is the process by which venom is injected by the bite or sting of a venomous animal such as a snake, scorpion, spider, or insect. Arthropods can infest human skin ex: head lice.
Arthropods can inflict bites and stings. They can carry diseases such as malaria, yellow fever and filariasis. Order of insects belongs to stings are:
a) Hymenoptera - bees, wasps, hornets, fire ants.
b)Scorpionida- scorpions.
Hymenoptera venom contains
Biogenic amines (histamine, 5-HT and acetylcholine),
enzymes (phospholipase A and hyaluronidase)
toxic peptides (kinins in wasps, mast cell degranulating peptides in bees).
Clinical features & Treatment
1) Local reaction:
Clinical features
Local pain
Edema
Airway obstruction
By wasps - severe cutaneous infection & cellulitis (serious bacterial infection, skin is swollen and inflamed)
Treatment:
Remove stings
Local application – 20% Aluminium sulfate
Antihistamines – Diphenhydramine (500mg), Chlorpheniramine (4mg)
2) Allergic reaction – Tingling sensation, flushing, vomiting, Urticarial skin rash, pedal edema. Sometimes fever, malaise, renal failure.
Treatment: 0.1% adrenaline
Antihistamins, Corticosteroids
Cardiac monitoring, Analgesics, Haemodialysis- for renal failure.
Toxic reaction: Multiple stings
vasodilation, Hypotension, Fatigue, Diarrhoea, Headache
seizures, Delayed toxic reaction:
Renal failure, coagulopathy.
Treatment : Parenteral antihistamins.
Large dose corticosteroids.
Bronchodilators
Haemo dialysis.
Vit k for coagulopathy
SCORPION:
Scorpions differ in colour from straw yellow or light brown, to black.
Tail of the scorpion terminates into Bulbous enlargement called telson, which contains the stinger and venom apparatus.
venom
The main toxins include phospholipase, acetylcholinesterase, hyaluronidase, serotonin, and neurotoxins.
The venom of Buthus species of India contains phospholipase A, which causes gastrointestinal and pulmonary haemorrhages, and disseminated intravascular coagulation ( presence of severe abnormal blood clots in blood vessel)
Mode of Action
Affects Na+ channels with prolongation of Action Potentials.
Depolarisation of Nerves of both Adenergic & PSNS
Clinical features:
Local: Rapidly developing local pain, swelling, edema, lymadenopathy.
Systemic: Autonomic stimulation, Mydriasis, Profuse sweating, Excessive salivation
Urticaria, Hypertension, Convulsions, Priapism, nausea, Pulmonary oedema may develop within 2 to 3 hours leading to death, Intracerebral haemorrhage,
TREATMENT:
1) During transport to hospital:
Immobilize the affected extremity. Do NOT apply tourniquet.
Local application of ice is beneficial in relieving pain. Prolonged cryotherapy is however contraindicated.
A negative-pressure suction device may be used, if available
2)On Arrival at Hospital:
Rep. failure- Mechanical Ventilation, administer oxygen.
Pain- PCM/Morphine tabs.
Allergy- Antihistamines.
Nifidepine 10 to 20 mg (adults)
prazocin HCL, Dopamine, Diazepam, Metoclopramide, Antivenom therapy
Essential Drugs Dosage and Formulations (Medical Booklet Series by Dr. Aryan ...Dr. Aryan (Anish Dhakal)
This is the 22nd part of medical booklet series created by Dr. Aryan in order to familiarize doctors and medical students about the basic doses of drugs. Many students remember the mechanism of actions and other details of drug very well and regard doses as unnecessary. While you prescribe, this becomes one of the most important aspect. This study material is focused to resolve such issues.
Osteoarthritis is a chronic degenerative disorder of synovial joints in which there is progressive softening and erosion/disintegration of the articular cartilage. In the presentation, I will deal in detail about the condition in every dimension with the most recent evidence.
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Dermatology Review Booklet by Dr. Aryan (Medical Booklet Series by Dr. Aryan ...Dr. Aryan (Anish Dhakal)
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Management of hypertensive condition in 2020 according to AHA/ASA guidelines. We will discuss the presentation, clinical assessment, investigations, and management of hypertension along with major randomized controlled trials and guidelines.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
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In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
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Health Education on prevention of hypertensionRadhika kulvi
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CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
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Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
2. SNAKES
• Poisonous :
• Cobra, Russell viper, saw
scaled viper, pit viper and
Krait
• Non poisonous:
• Rat snake, vine snake,
sand boa and mud snake
3. SNAKE BITES
• Around 30-40 thousand death per year
• More prevalent in rural than urban areas, commonly seen in summers, mostly
at night
• Most of the bites
• in tropical countries: lower extremities since
• non-tropical countries: on fingers and hands due to deliberate handling of snakes
5. SNAKE VENOM
• Poisonous secretion (saliva)
• Faint transparent yellow and viscous, when fresh
• Proteinous in nature, which are glycopolypeptides that are enzymatic in action
• Contents:
5
11. VENOMOUS SNAKEBITE
(OPHITOXAEMIA/ ENVENOMATION)
• Incidence:
• Usually accidental. Rarely, homicidal or suicidal
• Entry:
• Inoculation
• Spitting
• Degree of toxicity
• Toxic principle in venom
• Quantity
• Types of fang
• Channeled (viperine): complete transfer
• Grooved (elapid): less transfer
12. SIGNS AND SYMPTOMS
• Most common symptom is fear
- semi consciousness, cold clammy skin, hypotension, rapid breathing
• Shock
• Local signs: fang marks, pain, bleeding, inflammation
13. NEUROTOXIC
• Local action:
• Severe burning at bite site, rapid edema and inflammatory changes followed by
oozing of serum
• Systemic action:
• Within 15-30 minutes or 2 hours of bite
• Neurotoxic effect: giddiness, weakness, lethargy, etc.
14. HEMOTOXIC
• Local actions:
• Severe pain at bite site followed by swelling, ecchymosis, cellulitis and severe
hemorrhage
• Systemic action:
• Due to hemolytic effect
• If the patient survives,
• suppuration, sloughing with infection at the bite site,
• hemorrhage from mucosa of rectum, other natural orifice, etc.
• Gangrene of the parts involved
16. SIGNS AND SYMPTOMS
-COBRA
• One or two puncture marks
• Local symptoms start within 6–8 minutes (min)
• Reddish wheal at site of bite, tender bite site
• Early symptoms:
• vomiting, heaviness of eyelids, blurring of vision, parasthesia around mouth,
hypersalivation
• Soft tissue swelling (progressive)
• Alteration of mental status
• Ptosis
• Progressive paralysis
• Chest pain and tightness
16
17. SIGNS AND SYMPTOMS
-KRAIT
• Similar to cobra, but less rapid
• Abdominal pain, ptosis, dysarthria, dysphagia, chest pain, respiratory paralysis and
death may occur.
• No nausea and froth, but drowsiness is more.
• Common krait hunt nocturnally and are quick to bite people sleeping on the floor
• Often without waking their victims since the venom is painless.
• Victims wake up later, paralyzed or die in their sleep.
17
18. SIGNS AND SYMPTOMS
-VIPER
• One or two fang marks
• More local reaction is seen along with pain and oozing.
• Serous and serosanginous blisters sometimes appear
• Progressive tissue swelling
• Extensive local necrosis leading to gangrene
• Bilateral parotid swelling (viper head), conjunctival edema and subconjunctival
hemorrhage
• Bleeding from bite site and rectum, Petechial hemorrhages, epistaxis, gum
bleeding, hemoptysis, hemetemesis, hematuria,
• Death: d/t circulatory failure and hemorrhagic complications
18
19. SIGNS AND SYMPTOMS
-SEA SNAKE
• Painless bite, minimal or no local swelling
• Headache, sweating, thirst
• Generalized rhabdomyolysis
• Myoglobinuria may be seen within 3 hours after the bite
20. SNAKE VENOM OPHTHALMIA
• If the spat venom enters the eyes -
- immediate and intense burning
- stinging pain
- profuse watering of eyes
- production of whitish discharge
- congested conjunctiva
- swollen eyelids
21. DIAGNOSIS
• History
• time elapsed since the bite is important to determine if the process is confined locally or if
systemic signs have developed.
• Description of the snake to determine its species.
• Examination (including neurologic examination)
• Urinary venom may be detected even after treatment with anti-venom
• Radioimmunoassay: most sensitive and specific
• Enzyme immunoassay
• ELISA
• 20 min whole blood clotting test (WBCT)
• A normal 20 WBCT and clot lysis would exclude viperidae species.
23. PRINCIPLE
• To reduce the anxiety and fear
• Prevention of the spread of venom (first aid measures)
• Anti-venom treatment
• General measures
24. FIRST AID
• Reassurance of the victim
• Do not tamper bite wound
• Clean the wound with soap and water , or iodine
• Apply firm pressure over the area (delay absorption of venom)
• Pressure immobilization
• Immobilize the limb
• Avoid local incision, suction (bleeding and nerve injury) and cryotherapy
• Avoid tourniquets
• Make the patient lie on one side in recovery position
• Transport to medical facility immediately
25. PRESSURE IMMOBILIZATION
• Recommended for bites by neurotoxic elapid snakes, including sea snakes
• Should NOT be used for viper bites because of the danger of increasing the local effects of the
necrotic venom.
Broad firm bandage (Sutherland wrap) applied around limb; pressure of 50-70 mm Hg maintained,
enough to occlude superficial venous and lymphatic return
26. AT HOSPITAL
• Primary survey
• Release of a tight tourniquet or compression bandage may result in the
dramatic development of severe systemic envenoming
Ideally, compression bandages should not be released until the patient is in
hospital, resuscitation facilities are available and anti-venom treatment has been
started
27.
28. ANTI-VENOM TREATMENT
• Two types:
• Monovalent/ monospecific anti-snake venom
• specific antibody to neutralize that venom
• Polyvalent/ polyspecific anti-snake venom (PAV)
• Neutralizes venoms of several species; effective against common poisonous snakes
• Useful when given within 4 hours of bite
• Each vial neutralize about 6-8 mg of venom
• Half life: about 90 hours
• Patients should be observed for at least 1 hour after starting antivenom
29. ANTI-VENOM TREATMENT
• Administration
• IV 5ml/minute, or dilute in isotonic fluid, infused over 30 to 60 minutes
• Minimal symptoms: local swelling without systemic reactions, 5 vials
• Moderate symptoms: progressing beyond bite site with systemic reaction, 10 vials
• Severe symptoms: marked local reactions, severe symptoms, 10 to 15 vials
• Children require the same dose as in adults
30. ANTI-VENOM REACTIONS
• Early reactions (Anaphylactic):
• itching, urticaria, glottic edema, wheezing, cough,palpitation, nausea, vomiting
• Adrenaline (0.5 to 1 ml of 0.1% solution, SC; children: 0.01 mg/kg), antihistamines
• Pyrogenic reactions:
• In 1-2 hours; chills, shivering, sweating, vomiting, etc.
• Hypothermia blanket, sponging and antipyretic drugs
• Late reactions:
• About 7 days after treatment
• Antihistamines
• Steroids in more severe cases
31. SUPPORTIVE TREATMENT
• Antibiotics: if wound infection
• Tetanus injection
• Paracetamol for pain
• If clotting abnormalities, Heparin
• Ventilatory support for respiratory failure
• Surgical debridement of blebs, vesicles and superficial necrosis
31
32. POSTMORTEM FINDING
• Clothing may show amber-colored fluid which
becomes yellowish on drying
• Venom over skin: present as yellow crystals
• Venomous : Two or occasionally one fang marks
with marks of smaller teeth
• Non-poisonous snakes: leave a set of semicircular
teeth marks
• Bite marks
• 1-1.5 cm deep in colubrine
• 2.5 cm deep in viperine bites.
33. POSTMORTEM FINDING
• Cobra/Krait bite: bite site contains fluid and hemolysed blood causing staining
of vessels
• Viper bite: discoloration, swelling and cellulitis around the mark and
hemorrhage
• Hemorrhage into bowel and lungs
• Purpuric spots on pericardium
• Inflamed kidneys with tubular necrosis, interstitial nephritis, congestion,
subcapsular pinpoint hemorrhage
• Regional lymph nodes: swollen and hemorrhagic
34. MEDICO-LEGAL ASPECTS
• Poisoning is mostly accidental
• Occasionally, murder by throwing a poisonous snake on to someone
• Very rarely used for suicide
• Cattle poisoning
35. REFERENCES
• The Essentials of Forensic Medicine and Toxicology, Reddy, 34th edition
• Textbook of Forensic Medicine and Toxicology, Rao, 2nd edition
• Review of Forensic Medicine and Toxicology, Biswas 3rd edition
Gland: 2 in number, lies just below and behind the eyes
Fangs: 2 in number, curved teeth lying in maxillary bone, like hypodermic needle
Duct: arises from the gland, to carry venom from the gland to the fangs
Muscles, especially of the neck, trunk and proximal part of the limbs may
become tender and painful on active or passive
movement, and later may become paralyzed with
ptosis as in elapid envenoming.11
20WBCT:
Place a few ml of freshly sampled venous blood in a clean, dry, glass tube/bottle.
• Leave it undisturbed for 20 min at room temperature.
• Tip the tube once.
• If the blood is still unclotted and runs out, the patient has hypofibrinogenaemia ('incoagulable blood') as a
result of venom-induced consumption coagulopathy.
Lyophilized: Drying it from frozen state under high vaccum
Lyophilized: Drying it from frozen state under high vaccum