Snake bites can cause local and systemic effects from venom. Locally, fang marks and swelling may occur. Systemically, symptoms may include pain, fever, dizziness, low blood pressure, and organ damage to the kidneys, lungs, or brain. Treatment involves reassurance, immobilizing the bite area, visiting a hospital, and potential antivenom therapy. Antivenom is given for signs of coagulopathy, paralysis, or swelling extending beyond half the bitten limb. Precautions like wearing boots in tall grass can reduce risk of snake bites.

1. Management of snake bite

2. Snake:
Snake is limbless,scaly,elongated reptiles of sub order
serpentes comprising of venomous and non venomous
species inhabiting tropical and temperate region
Snake To Crawl (or)To Creep.
Snake Venom:
-Highly Modified Saliva.
-Contain Zootoxins.
-Immobilize & Digest Prey.
-(or) serve as Defense Mechanism against Predators
(or)other threats.
Venom contains protiens,enzymes and other
substances with toxic and lethal properties.

3. Clinical Manifestations:
Fang Marks,
Bleeding,
Discoloration,
Burning
sensation,
Bleeding spots,
Sweat,
Numbness,
Tingling,
Swelling.
Severe Pain,
Fever,
Dizziness,
Fainting,
Severe Shock,
Rapid Pulse, Low
B.P.
Blurred Vision,
Convulsion,
Numbness
Excessive Sweat,
Skin
Discoloration,
Nausea, Vomiting.
Symptoms:

4. COMPLICATIONS:
Renal damage,
Respiratory damage,
Cerebral haemorrhages,
Paralysis,infection,
Chroniculceration,
Hyperkalaemia,
Hypocalcemia,
Rhabdomyolysis,
Myonecrosis.
Cardio vascular
syndrome.

5. Lab tests:
20 WBCT,CBC,
THROMBOCYTOPENIA,
PROLONED CLOTTING
TIME,ELEVATED FDP,
DEPRESSED
FIBRINOGEN LEVELS,
HYPERKALEMIA,
HYPOCALCEMIA,
METABOLIC ACIDOSIS,
URINE TESTS,
PROTENURIA,
HAEMATURIA,
MYOGLOBINUREA,
RENAL TESTS
ELISA TESTS.
Electro Cardio Gram,
Chest X-Ray,
E.E.G.
Diagnostic Tests:

6. Snake Bite Injury:
When a snake bite,it may excrete venom but this depend on type of
snake & venom causing injury to victim.
Venom is excreted through modified parotid salivary gland.
Snake bite
Elapid bite
Viperid
bite
Hydrophid
bite.
Venom
Venom
Hematoxin Neurotoxin Myotoxin
Toxin

8. General Management
First aid is Recommended based on Do it Right Decision.
1) Reassurance of Patient :
Explain: 70% bites are non venomous & only 30% are venomous.
And 50% bites of venomous species are only envenomated to patient.
2) Immobilization:
Use bandages,torniquets,splints,cloth to hold the
affected site proximally and bind it.
Do not apply any compression,nor block blood supply as it is dangerous.
3) GH-go to hospital immediately.
Traditional remedies are non benefit.
4) Tell-the doctor if any systemic symptoms experienced by patient.
First Aid:
DO’S
I. Assurance of pt.
II. Immobilization
III. Application of Torniquet.
DON’T’s
I. Incision,Suction.
II. Apply of Ice,Massage.
III. Electric shock.
IV. Chemical Treatment,
V. Bevarages-coffee,Alcohol.

9. TREATMENT:
1) Surgery:
Tracheotomy for paralysis patient.
2) Mechanical ventillation,Endotracheal Intubation for Res[piratory
failure patient.
3) Pressure Dresssings applied for venepuncture site to prevent Oozing.
Pharmacological Treatment:
1) Paracetamol-For Fever, Mild and Moderate Pain.
2) Narcotic Analgesic-For CNS Depression& Severe Pain.
3) Anti Snake Venom Therapy.
4) Allergy-Antihistamins / Corticosteroids.
5) Vomiting-Head down to avoid aspiration,Chlorpromazine(iv)
6) Infection-Prophylactic Antibiotics.
Avoid-Aspirin and other NSAIDS- cause Gastric Bleeding &
Incoagable Blood Pt’s in snake bite victims.

10. 1)1St Antivenom:
1895-French physician(Albert calmette)-for treatment
of Indian Cobra bites.
2) Adm :
IV or Infusion only.
3) Indications:
Spontaneous systemic bleeding.
WBCT>20 min,
Thrmbocytopenia,shock,
Paralysis,
Hypercalcemia,
Swelling more than a half of bitten limb.
4) Side effects:
Anaphylactic Reaction,Allergic Reaction like
Urticaria,cough,Nausea,Vomiting,Headache,fever,etc..

11. Dose:
In Infusion-2ml/min rate.
Mild case:5vial
Moderate:5-10vial.
Severe-10-20vial.
Additional infusion-5-10 vial until swelling is decreased/stopped.
Timing:
Ideally adminster within 4hr but effective if given within 24 hrs.
Treatment for Adverse effects established by
ASV therapy:
1)Adrenaline:
0.5mg-adults
0.01mg/kg-child(sc)
2)Antihistamine-
For Allergy-5days.
chlorphenaramine maleate(10mg)adult.
0.3mg/kg-child.
3)Corticosteroids:
Prednisolone-5mg/6hrs.
4)Pyrogenic rxn-
Fever-PCM(5mg/kg)

12. a)For Coagulopathy:
Fresh Frozen Plasma,
Cryoprecipitate-fibrinogn,factorVIII.
Fresh Whole blood.
Platelet concentrate.
b)Bulbar Paralysis& Resp.Failure:
ASV alone not sufficient.
Tracheotomy,
Inj.Neostigimine
Glycopyrrolate-0.25mg.
c)Antibiotic prophylaxis for Infections.

13. 1. Clean the bite site with Povidine-Iodine solution.
2. Do not apply dressing.
3. Leave blister alone.
4. If there is local necrosis-apply saline dressings.
5. Vaccination for Tetanus Toxoid.
6. Rehydration & Nutrition.
7. PCM for fever.
8. Infection-Pencillin/Erythromycin treatment.
9. Shock-ASV therapy given.
10.Renal failure-Diuretics given-Furosemide(upto 100mg,IV)
Dialysis performed for Critical cases.
11. Neurotoxicity-Atropine(0.6mg adult)
(0.05mg/kg-child)
Neostigimine inj.(1.5mg)
12. Resp.Failjure:
Keep airways clear,Head low,Jaw elevated.
Mechanical Ventillation.

14. A. Do wear shoes & prefer Leather boots & long trousers
in going on thick grass.
B. Carry Electric torch/Flash lighjt at Night.
C. Take care when colecting fire wood at
debris,rocks,etc.-as snake hide there.
D. Take care when climbing Trees & rocks with dense
folage.
E. Take care when swimming in lakes with lots of weeds.
A. Do use repellantsin basements,store rooms etc..to get
away rodents & snakes.
Eg: DDT,Formaldehyde,etc..

15. G.. Do not make sudden movements near snake.
H. Do not go near snake even if it ios deadf.They act
sometimes dead to avoid attack.
I. Do not keep Venomous snakes as Pets/performing
animals.
J. Do not sleep on ground at night as snake may
attract toward your warm body.
K. Do not walk in sea especially in coral reefs near
sand.

16. 1. Modern MedicalToxicology,VV.Pillay,4th Edition,page-157.
2. Gold, Barry S.; Richard C. Dart; Robert A. Barish (1 April 2002).
"Bites of venomous snakes".The New England Journal of
Medicine 347 page.
3. Kurecki B, Brownlee H (1987). "Venomous snakebites in the
United States". Journal of Family Practice 25 (4): 386–92.
4. PatrickWalker, J; Morrison, R; Stewart, R; Gore, D (January
2013). "Venomous bites and stings".Current problems in surgery
50 (1): 9–44.