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MANAAGEMENT OF SNAKE BITE by Dr Ubogun.pptx
- 1. MANAGEMENT OF SNAKE BITE PRESENTATION BY DR. UBOGUN O. EFE M.D
- 2. OUTLINE INTRODUCTION EPIDEMIOLOGY CLINICAL PRESENTATION MANAGEMENT PREVENTION DIFFERENTIAL DIAGNOSIS CONCLUSION
- 3. INTRODUCTION Most snakes are harmless. snakes play important environmental roles in the fragile ecosystems of the nation’s wildlife areas. However snakebite is a medical emergency and a common life threatening condition all over the world especially in many tropical countries.
- 4. EPIDERMIOLOGY Rural Occupational hazard (farming, herding & walking) Men > women (2:1) Day time Lower limb mostly except in children 7-15% of bites occur in children less than 10yrs 497/100000 in Nigeria 12% national mortality 8.5% attend hospital in Nigeria Northern Nigeria > Southern Nigeria. Middle Belt. Echis ocellatus causes about 66% of venomous bites in Nigeria
- 5. CLASSIFICATION OF SNAKES Snakes are generally classified as venomous and nonvenomous snakes Major families of venomous snakes include VIPERIDAE, ELAPIDAE, COLUBRIDAE and HYDROPHIDAE.
- 6. CLASSIFICATION OF VENOMOUS SNAKES VIPERIDAE (Viperids) – subfamily CROTALIDAE (pit vipers) * Largest family of venomous snakes * e.g True vipers (Russel viper, carpet viper) adders (puff adder). Pit vipers (rattlesnakes, cotton mouth moccasin, copperhead snake) Fangs – long, curved, hollow to tip, erectile, mobile, anterior, * Head triangular, nostril pit (heat-sensory organ), elliptical pupils
- 7. CLASSIFICATION OF VENOMOUS SNAKES ELAPIDAE (Elapids) * Next largest family * e.g cobras, mambas, kraits, coral snakes Fangs – short, fixed grooved, fleshy covering, anterior * Head covered with large scales
- 8. CLASSIFICATION OF VENOMOUS SNAKES COLUBRIDAE (Colubrids) * e.g Boomslang, Bird snakes Fangs grooved, posteriorly placed called grooved back fanged snakes.
- 9. CLASSIFICATION OF VENOMOUS SNAKES HYDROPHIDAE * e.g sea snakes – live permanently in water * Common in Asian pacific waters * Fangs short, fixed, erect, anterior
- 10. Viperine fang, long and mobile Elapid fangs-short, non-mobile and covered with a fold of gum Fangs of a colubrid (boomslang) situated posteriorly
- 14. CLINICAL PRESENTATION Fright effects Local effects- pain swelling blistering lymphangitis bleeding gangrene
- 15. CLINICAL PRESENTATION Neurotoxic effects- ptosis glossopharyngeal palsy respiratory paralysis
- 16. CLINICAL PRESENTATION Myotoxic effects- myalgias, paresis, myoglobinuria hyperkalaemia
- 17. CLINICAL PRESENTATION Hemotoxic effects- Hemolysis abnormal bleeding shock
- 18. CLINICAL PRESENTATION Cardiovascular effects- hypotension dizziness shock pulmonary edema cardiac arrhythmia cardiac arrest
- 20. FIRST AID Reassurance Protect from further bites Immobilisation of affected part (keep below heart). Pressure immobilization maybe done. No food or drinks DO NOT: incise, suction, apply tourniquet, apply potassium permanganate, immerse in warm water or sour milk, apply herbal medications.
- 22. In Hospital care Rapid initial assessment ABC of resuscitation Investigations ; 20 minutes whole blood clotting test, FBC, Blood film, E/U/C, Urinalysis, ABG, ELISA Identify snake resposnsible if possible
- 23. 4A’S ANTIVENOM ANTITETANUS ANTIBIOTICS ANALGESICS
- 24. ANTIVENOM Not for every bite (only signs of envenomation) i.e presence of hematologic, neurotoxic and other evidences of envenomation. Crotalidae polyvalent immune fab Dose same for children and adult. Follow manufacturer’s instruction Hypersensitivity reactions Given iv Dose given is in correlation to the severity of envenomation Mild – 5vials, moderate – 10vials, severe – 15vials
- 26. SUPPORTIVE CARE Transfusion with whole blood Volume expanders in shock Respiratory support Renal failure Administration of anti-tetanus toxin Routine antibiotics not indicated. Give if there is evidence of necrosis or cellulitis. Paracetamol is choice of analgesic. Avoid aspirin and NSAIDS.
- 27. PREVENTION Health education Pest control Protective shoes and clothing Tread heavily Use flash light at night Do not put hand into hole Flip over rocks and logs Handle ‘dead’ snakes with care Know the common species of venomous snakes in environment
- 28. DIFFERENTIALS Scorpion sting Warp sting Acute serum sickness
- 29. CONCLUSION Snake bite is not a death sentence. Promt and adequate medical care should be offered to all snake bite victims. following therapy, adequate counselling should be offered to victims to prevent further snake bites.
- 32. REFERENCE