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Snake Bite

The document discusses snake bites, including common types of venomous snakes, symptoms of envenomation, diagnosis using tests like the whole blood clotting time, treatment with antivenom, and supportive care. Treatment involves administration of antivenom via slow infusion and managing anaphylaxis, with additional supportive measures for specific symptoms.

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41 views22 pages

Snake Bite

The document discusses snake bites, including common types of venomous snakes, symptoms of envenomation, diagnosis using tests like the whole blood clotting time, treatment with antivenom, and supportive care. Treatment involves administration of antivenom via slow infusion and managing anaphylaxis, with additional supportive measures for specific symptoms.

Uploaded by

xcyborg007
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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SNAKE BITE

INTRODUCTION
 In India approximately every minute one
person is bitten by a snake and every two
hours one case of snake bite dies.
 Majority bites are noticed in extremities.
 In hospital mortality varies from 5 to 10% and
the causes are acute renal failure,
respiratory failure,sepsis, bleeding and
others.
CLASSIFICATION OF SNAKES
 More than 3000 species of snakes in the
world.
 Poisonous- cobra group( elapidae)

viper group(viperidae)
sea snake group( hydrophidae)
 Non poisonous
 Snakes picture

COBRA ( NAJA NAJA)


SAW SCALED VIPER ELAPIDAE
COMMON KRAIT

RUSSEL VIPER
FEATURES OF ENVENOMATION OF VIPERIDAE:

 Swelling and local pain


 Tender regional lymph nodes.
 Bleeding from gingiva and epistaxis,
petechiae, purpura or ecchymosis.
 Abdominal tenderness.
 Low back pain_ impending renal failure
 haematuria\ hemoglobinuria
 Neurological signs: assymetric pupils- ICH,
external ophthalmoplegia, ptosis, dysphagia,
paralysis.
 DVT and compartment syndrome.
FEATURES OF ENVENOMATION
OF ELAPIDAE
 Swelling and local pain( cobra)
 Local necrosis(cobra)
 Descending paralysis, initially of muscles
innervated by cranial nerves, commencing
with ptosis, external ophthalmoplegia,
dysphagia and dysphonation.
 Numbness around lips, bulbar paralysis and
respiratory failure.
 Paradoxical respiration as a result of
diaphragm and intercostal muscle paralysis.
FEATURE COBR KRAIT RUSSEL SAW HUMP
A VIPER SCALED NOSED
VIPER VIPER

LOCAL PAIN\ YES NO YES YES YES


TISSUE DAMAGE

PTOSIS/ YES YES YES NO NO


NEUROLOGIC
SIGNS

HEMOSTATIC NO NO YES YES YES


ABNORMALITY

RENAL NO NO YES NO YES


COMPLICATIONS

RESPONSE TO YES NO NO NO NO
NEOSTIGMINE

RESPONSE TO ASV YES YES YES YES NO


DIAGNOSIS

 20 minute whole blood clotting time- most


reliable.
 2-3ml of fresh venous blood is placed in a
new, clean , dry glass tube, left untouched
and unshaken at ambient temperature for 20
minutes. The tube is gently tipped off, if the
blood is still liquid then the patient has non
coagulable blood.
OTHER TESTS
 Hemoglobin
 PCV
 Platelet
 PT/APTT/FDP/D-Dimer.
 Peripheral smear
 Urine test for hemoglobin or myoglobin
 Biochemistry for serum
creatinine/urea/potassium/CPK.
 Duplex scan of the affected limb for venous
thrombosis.
TREATMENT
 First aid:
 Do it “RIGHT”.
 R- Reassure the patient.
 (70% of all snake bites are non venomous. Only 50% of
bites by venomous species actually envenomate the
patient)
 I- Immobilise in the same way as a fractured limb
 (use bandages or cloth to hold the splint, not to block
blood supply. Do not apply any compression in the form
of tight ligatures.
 G.H- Get to the hospital immediately.
 T- tell the doctor, for any symptoms which manifests
after the bite
ANTISNAKE
Indications:
VENOM
Systemic envenomation:
 WBCT more than 20 mins, hemostatic abnormalities like
spontaneous syestemic bleeding or thrombocytopenia.
 Neurotoxic signs like ptosis, external ophthalmoplegia,
paralysis etc.
 Cardiovascular abnormalities: hypotension, shock,
cardiac arrythmia, abnormal ECG.
 Acute renal failure: oliguria/ anuria/ rising blood
creatitine/urea, dark brown urine/rhabdomyolysis( muscle
aches and pains/ hyperkalemia.
 Persistent abdominal pain and vomiting.
 Supporting lab evidence.
Local envenomation.
 Local swelling involving more than half of the
bitten limb( in the absence of torniquet)
 Rapid extension of swelling( beyond wrist or
ankle within few hours of bite.)
 Tender regional lymph nodes.

 NO ASV TEST DOSE NEEDS TO BE


ADMINISTERED!
ADMINISTRATION OF ASV
 Reconstituted or liquid ASV is administered by slow
iv infusion over a period of one hour. The iv fluid
should be 5 – 10 ml/kg.
 First add 1 vial of diluted ASV in 500 ml of NS and
give 10-15 drops/min. Look for signs of reaction for
15 mins. If nothing is there add other 7 units in NS
and continue.
 Paediatric dose= adult dose.
ASV REACTION
 Anaphylaxis is life threatening.
 Signs:
 Itching
 Urticaria
 Dry cough
 Fever
 Nausea
 Vomiting
 Abdominal colic
 Diarrhea
 Tachycardia
 Hypotension
 Brocho spasm and angio edema
 Rigors
 Convlusions in children
MANAGING ANAPHYLAXIS

 Discontinue ASV.
 O.5mg of 1:1000 adrenaline im given.
 Paediatric dose is 0.01mg/kg body weight of
adrenaline IM.
 Wait for 10 mins, if patient not improved
second dose of adrenaline given.
 Can be repeated for a third and final dose.
 Once the patient is recovered ASV is
restarted
REPEATING ASV
 Neurotoxicity:
 Symptoms not reduced / worsened.
 Respiratory failure.
 Dose:
 5 vials of ASV should be given within 2 hours.
In case of respiratory failure, and already
received 2 doses , ventilator support is given.
ASV therapy need not be continued.
 HEMOTOXICITY:
 PROLONGED CLOTTING TIME MORE THAN 20
MINUTES AFTER 6 HOURS.
 DOSE:
 5 VIALS OF ASV SHOULD BE GIVEN
EVERYTIME.
SUPPORTIVE THEARPY
 In case of neurotoxic snake bite, neostigmine 1.5 mg im,
preceeded by 0.6 mg of atropine iv should be given.
 Paediatric dose: 0.04mg\kg of neostigmine.
 Every 10 mins observation of:

 Iris uncovered
 Interincisior distance
 Length of time upward gaze is maintained.
 Fev( if available)
 If any improvement continue 0.5mg neostigmine every
30 mins along with 1 amp of atropine in 500 ml NS over a
period of 8 hours.
 Vascular surgeon opinion in case of DVT / compartment
syndrome
 Nephrologists opinion in case of ARF.
SNAKE BITE IN SPECIAL SITUATIONS
 ASV DOSAGE IN VICTIMS REQUIRING LIFE SAVING SURGERY.
 In such cases coagulation must be restored hence higher
dose of asv upto 25 vials can be given.
 VICTIMS WHO ARRIVE LATE
 ASV Will neutalise venom only if it is unattacched. Perform
clotting time ,look for any complications . it is wise to
administer 8 to 10 vials of ASV.
 SNAKE BITES AGAIN
 Treat as fresh case.
 SNAKE BITE IN PREGNANCY:
 Treated as same way as other victims. No dose adjustment.
Should be alert and rule out retro placental clot.

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