Epidemiology 200000 snake bites and 1520000 deaths per year Males Females 21 Majority of bites occur on the lower extremities 50 of bites by venomous snakes are dry bites negligible ID: 1036819
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1. SNAKE BITES: A PRACTICAL APPROACH
2. Epidemiology2,00,000 snake bites and 15-20,000 deaths per yearMales : Females :: 2:1Majority of bites occur on the lower extremities50% of bites by venomous snakes are dry bites –negligible envenomation
3. CLASSIFICATIONPOISONOUS / NON POISONOUSLAND / WATER (FRESH / SALT WATER)
4. Poisonous SnakesIn India > 200 species of snakes only 52 are poisonousElapidaeCobra ; kraitsNeuro toxc, cardiotoxicViperidae (Vipers)Russell’s viper, Saw scaled vipers, Pit vipersHemotoxicHydrophidaeSea snakesMyotoxicKrait and Russells’ viper more toxic than cobra
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8. Severity of SnakebiteThe location of the bite (fatty tissue absorbs the venom more slowly than muscle tissue)Whether disease-causing organisms are in the venomThe size and weight of the victimThe general health and condition of the victimHow much physical activity the victim engaged in immediately following the bite (physical activity helps spread venom)
9. Diagnosis of poisonous snake biteFANG MARKS : classically , two puncture marks separated by a distance varying from 8mm to 4cm, depending upon the species involved.However a side swipe may produce only a single puncture, while multiple bites could result in numerous fang marks
10. Signs and Symptoms of SnakebiteTwo distinct fang marks about half an inch apart at the bite site, which may or may not bleed (in some cases there may be only one fang mark)Immediate and severe burning pain and swelling around the fang marks, usually within 5 minutes but sometimes taking as long as 4 hours to develop (swelling may affect the entire arm or leg)Purplish discolouration and blood-filled blisters around the bite, usually within 2 to 10 hours Numbness around the bite
11. Effects of envemomation Local effectsSystemic effects: - Neurotoxic - Haemotoxic - Cardiotoxic
12. Clinical featuresVenomous snake bitesElapid Bites ( Krait ; Cobra)Local features -indistinct fang marks -burning pain -swelling and discoloration -serosanguinous dischargePre paralytic stage : emesis-headache
13. Elapid Bites ( Krait ; Cobra)Paralytic stage:-Ptosis-Opthalmoplegia-Drowsiness-Dysarthria-Dysphagia-Convulsions-Bulbar paralysis-Respiratory failure
14. COBRA ENVENOMATION CardiotoxicityCardiac depressionCardiogenic / vasogenic shockSystolic cardiac arrest
15. VIPERID BITE (VIPER)Local features: Rapid swellingDiscolourationBlister formationBleeding from bite siteSevere pain
16. Systemic features (hemotoxic)bleeding from noseHemoptysisBleeding gumsHematuriapurpuric spotsRenal failure
17. HYDROPHID BITE (sea snake)MyotoxicLocal features : minimal swelling and painSystemic features : Muscle pain and stiffnessMyoglobinuria , renal tubular necrosis
18. Snake-bite managementSnakes don’t bite out of whimUsually forced to biteVenom has evolved as a mechanism to subdue prey and snakes need to conserve their venom for that purpose
19. FIRST AIDThings you should do:Make sure the victim and others are a safe distance away from the snake and try to memorize its appearanceSTAY CALM and in control. Take charge of the situation and reassure the victimRemove Watches, rings, bangles and anything else that will become constrictive if the limb was to swell up.Try to immobilise the victim. Never let him/ her run and only allow them to walk if unavoidable.
20. In case of neurotoxic bites (All elapids and hydrophiids: Cobras, King cobras, kraits, coral snakes and sea snakes), pressure immobilization (Sutherland method) with long crepe or other elastic bandage(5=10cm wide, several rolls) and splint to be applied immediately to the bitten limb, starting at the digits and working up to the groin or arm pit.Don’t waste time with trying to get any elaborate first aid done.Get to hospital as soon as is safely possible.Note the time of the bite and the progression of any visible symptoms.Give the doctor a brief and detailed description of the bite and symptoms.Antisnake venom serum is the only proven cure for venomous snakebite
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22. First AidThings'Not'to'Do:Never try to suck out the venomNever make an incisionNever go to traditional healers or try home remediesTie tourniquets or use iceNever clean out or tamper with the site of the biteNever try and catch the snake or kill itAll the above actions do not work and often cause more damage than good.
23. ASVS (ANTI SNAKE VENOM SERUM)Made from equine serumPolyvalent against cobra, viper (russell and saw scaled), krait1ml neutralises :0.6mg Cobra ; 0.45mg Krait0.6mg Russells; 0.45mg Saw scaledLethal dose :Cobra -0.12gm, Krait 0.06gm, Russels 0.15gm
24. Snakebite PreventionAs always, prevention is better than cure.Take care when clearing vegetation, raking dry leaves in your garden.Supervise kids in the outdoors, especially in a green neighborhood.Use torch/flashlight at night and keep wearing shoes. Check shoes before wearing them.Watch your step and see before you sit!Keep your backyard free of junk and make sure your solid waste is managed properly.If you see a snake, do nothing. Let it go. Do not try to pick it up or kill it. If a snake has entered Your premises, call professional snake rescuers.