Snake bite and its management

2. Dr. Hira Shoaib Hashmi
Lecturer, Dept. CHS

3. To know the difference between poisonous and non
poisonous snakes.
To know how to manage a patient with snake bite.
To learn how to prevent snake bite.
To know the areas in Pakistan where snake bite is
prevalent.

5. At least 421,000 envenomings and 20,000
deaths from snakebites occur each year,
especially in South and South East Asia and sub-
Saharan Africa.(1)
 3000 species
Broadly Divided into:
Poisonous Snakes
Non Poisonous Snakes

6. It is toxic saliva produced by parotid glands of snakes mostly water
with enzymatic proteins.
Constituents
Proteinases
Fibrinolysin
Phospholipase A,B,C & D
Neurotoxins
Cholinesterases
Haemolysins etc.
Produced from the time of birth and injected in response to a prey or
self defense
One in five snake bites are dry.
More venom injected when attacking prey.

7. A major public health problem because:
Agricultural country-70% population lives in rural areas and
works in fields
Lack of basic education
Snakes abundant
Weather conditions favorable
Peak incidence: June to August
• Due to floods and rain with migration to highlands
• Sleeping outside in summers
• Monsoon season is breeding season
• Snake cold blooded more active in summers
• Venom yield high in summers
Common in agricultural fields, Thar and Baluchistan.

8. Haemotoxic Venom:
Attacks blood vessels, serum escapes into
surroundings, clotting factors are activated. Severe
swelling, pain and discoloration and shock ensues with
DIC.
Neurotoxic venom:
Much less local symptoms, affects remote nerves,
cause tingling, drooping of eyelids and respiratory
arrest.
Myotoxic Venom:
Affects muscles with stiffness and paralysis
Appearance of myoglobin in urine

13. LOCAL S/S:
Considerable pain and swelling usually followed by
necrosis.
SYSTEMIC S/S:
Ptosis
Glossopharyngeal nerve paralysis
Dryness of throat
Cold clamy extremeties and sweating
Rapid pulse
Hypertension
Death due to resp. paralysis.

14. Mild Local pain
Mild Swelling
Muscle Weakness

15.  Sharp initial prick afterthat painless
 Stiffness in the muscles of back,neck and proximal part of limb in
one hour.

16.  LOCAL S/S:
 Swelliing around the bite site within minutes
 Severe pain at the bite site
 Blisters
 Discolouration
 SYSTEMIC S/S:
 Hematemesis
 Hemorrhage
 Haematuria
 Epistaxis
 Malena

17.  Finding fang marks
 S/S
 Lab Tests on aqueous washings from the bite site:
 Cholinesterase-Elapid Bites
 Thromboplastin-Viper bite
 Hyperkalemia on ECG – Sea Snake bite
 Prolonging of CLOTTING and BLEDDING TIME

18. IMMEDIATE/GENERAL MEASURES:
Allay anxiety and fright as death may occur due to
shock ensuing from fear
Bed Rest
GIVE FIRST AID
Immobilization
Torniquet application between the bite site on the limb
and heart admitiing to two fingers so that arterial flow is
not occluded.
Remove torniquet for one minute after every 30 mins
If bite on face neck or trunk, apply firm pressure
Acquire aseptic measures to avoid microbial
contamination of bite site
CUT AND SUCK METHOD
COLD PACK METHOD
ELECTROSHOCK TREATMENT
AUSTRAILIAN PRESSURE TECHNIQUE

20. GIVING POLYVALENT ANTIVENIN THERAPY:
 Antivenom is prepared by hyperimmunisation of horses
with venom of four common snakes COBRA, COMMON
KRAIT, RUSSELS’S AND SAW SCALED VIPER.
 Check sensitivity by giving a test dose(0.1ml) either I/D or
intraconjunctival.
 If S/S appear of sensitivity give Epinephrine.
 Proceed with either of the two ways:
 20-50ml antivenin diluted in 5 times normal saline
given as an I/V drip @15 drops/min over a period of
45 minutes
 1/3rd of total dosage s/c at bite site, 1/3rd I/M, 1/3rd
given as I/V.
 It is better to give more antivenin then less and in large
doses rather than a series of doses
 Amount needed inversely propotional to the body size

21. Adrenaline as needed esp in paralytic cases
Respiratory support
Blood transfusion
Antibiotics
Tetanus prophylaxis
Analgesics and sedatives: Codeine and meperidine
ideal. Morphine avoided
Heparin in case of D.I.C
Steroids (Hydrocortisone) for allergic manifestations
of antivenom
Antiemetics
Antiseizure medications
Antihistamines
Hydration therapy

23.  Wearing knee high boots.
 Torches should be used in snake infested areas while
working in fields.
 Residential areas surveyed for holes and kept clean.
 During camping military personnel are to examine their
boots, sleeping bags and beddings.
 Stay out of tall grass.
 Be alert while climbing rocks covered with vegitation.
 Leave snakes alone.
 Mass public eductaion regarding first aid measures and
health education.
 Antivenin with appropriate apparatus be provided in
secondary health centres in areas where snake bite is
prevalent.

25. 1. True about cobra poison
*Neurotoxic
*Myotoxic
*Cardiotoxic
*Vasculotoxic

26. 2.Cholinesterase is present in
*Elapid
*Viper
*Sea snakes
*All

27. 3.Muscle paralysis is caused by
*Sea snakes
*Mamba
*Krait
*python

28. 4. Most characteristic feature of elapidae snake
envenomation
*Bleeding manifestation
*Neuro-paralytic symptoms
*Rhabdomyolysis
*Cardiotoxicity

29. 1.http://www.who.int/neglected_diseases/integ
rated_media_snakebite/en/
2. Ilyaas Textbook-Public health and community
medicine
THANK YOU