By the end of this lecture students will be able to understand Importance, epidemiology, pathogenesis of snake bite Clinical manifestations

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3 By the end of this lecture students will be able to understand Importance, epidemiology, pathogenesis of snake bite Clinical manifestations Management Prevention of snake bite

4 Non poisonous snakes may also bite, but the term snakebite generally refers to the bite of poisonous snake.

5 PHYLUM chordata SUBPHYLUM vertebrata CLASS reptelia ORDER Squamata SUBORDER ophedia FAMILY colubridae &viperidae (poisonous) Important subfamilies are Elapidae neurotoxic e.g cobra,krait Hydrophaidae myotoxic Viperinae hemolytic toxin e.g viper

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9 Cold blooded nocturnal in nature / habit. avoid cities & heavily populated areas. more numerous in villages, fields, agriculture-lands, vegetation, marshes & jungles species most of them are non venomous

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11 Snake-bite is a neglected tropical disease Early in 2009, snake-bite was finally included in the WHO s list of neglected Tropical diseases i. It is clear that in many parts of the South East Asian region, snake-bite is an important medical emergency and cause of hospital admission ii. Snake-bite is an occupational disease of farmers, plantation workers,herdsmen, fishermen, snake restaurant workers and other food producers

12 Geographical distribution Incidence WHO incidence is /yr 1 to 5 million people bitten / yr mortality is /yr fatal snakebites in South East Asia Death rate is 1.90 per pop in Pakistan Peak incidence from June to August Worldwide incidence has 3 main causes

13 Agricultural areas Mountains of Pakistan Sindh (acute public health problem) among 5 commonest causes of hospital admission Due to cultural, socioeconomic factors not all cases reffered to doctors

14 Varies from specie to specie Current research estimates that as many as one in 5 snake bites are dry(no venom) Specialized glands derived from salivary glands evolved as defensive machanism Contains proteins many of which have enzymatic action(25 different enzymes) Two type of toxins HEMOLYTIC TOXIN NEUROTOXINS

15 Type of toxin Microbial contamination Gravity of snake bite

16 FACTORS IN SNAKE FACTORS IN VICTIM Age, size, health of snake Also age and general health Agitation Absorption rate Weather Site of distal end / fatty area Hibernation Personality Prior attack Sensitivity of attack to venom Preventive measures/type of venom & amount of venom/depth of envenomation Psychological impact, type of 1 st aid. 16

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18 Firewood collection Dislodging of stones Probing Climbing trees / rocks Sleeping on ground Children from 9-15 years

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21 Acc to type of snake Viper Local pain, edema, swelling discolouration Lymphadenopathy, ecchymosis, serum filled blebs Shock Danger signs hematuria bleeding gums, hematemesis, melena Cause of death may be massive cerebral /intestinal hemorrhage

22 Elapid pain Local sypmtoms much less General symptoms neurotoxins involve bulbar centers causing ptosis, strabismus, slurred speech, dysphagia, drooling of saliva paralysis Respiratory arrest can occur

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27 AIMS OF MANAGEMENT Retarding absorption of venom & removing as much as possible neutralization of venom relief of symptoms & prevention of symptoms

28 IMMEDIATE MEASURES(reassurance app. of constriction band Clean the bite with soap and water or antiseptic wipe before administering any other,snake bite first aid) EXAMINATION OF THE BITE SITE WHEN SNAKE IS AVAILABLE FOR EXAMINATION 1 st AID

29 Aims of first-aid attempt to retard systemic absorption of venom. preserve life and prevent complications before the patient can receive medical care control distressing or dangerous early symptoms of envenoming. arrange the transport of the patient to a place where they can receive medical care. ABOVE ALL, AIM TO DO NO HARM

30 Cut and suck Cold Pack method Electroshock treatment Australian Pressure Technique

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34 Envenomation (if escaped) Diffrentiation b/w poisonous and non poisonous snakes Pain, swelling, discolouration & discharge from the wound------poisonous snake Systemic signs & symptoms also confirm

35 Tails not markedly compressed Usually belly covered with transverse plates which do not extend completely No long & grooved fangs

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37 Serum Therapy(antivenin Therapy) Sensitivity Route of Administration Dosage Supportive and Symptomatic Measures

38 Polyvalent antivenin against cobra, common krait, Russell s viper and echis.the commonest poisonous snakes of Indo Pak Antivenin against cobra and Russells viper also available Epinephrine (adrenaline) should always be drawn up in readiness before antivenin is administered. Antivenin should be given by the intravenous route whenever possible. It is recommended that antivenin should be used only in patients in whom the benefits of treatment are considered to exceed the Skin/conjuctival hypersensitivity testing does not reliably predicteary or late antivenin reactions and is not recommended

39 Bed rest Warmth Analgesics and sedatives Shock Ventilation support Antibiotics Tetanus -----gas gangrene prophylaxis Steroids Heparin Symptomatic treatment of vomiting, excessive salivation & convulsions

40 Cut bite area and try to siphon out with mouth. Apply ice. Administer medications. Use Alcohol.

41 o No effect o Pschogenic effect o Effescts due to envenomation acc. To type of snake Local effect Haemotoxic Neurotoxic Myotoxic o Sequlae of wrong indigenous proceedure o Other complications

42 When you see a snake, just leave it alone! Most bites occur because people try to handle snakes they find High boots Use torches in the fields at night Not to put hands in hollow logs or animal burrows Resedential areas must be kept clean and searched for holes Special measures for scouts and soldiers In snake areas, adequate suply of anti venin in convenient centres When hiking through thick brush, use your trekking pole or a stick to flush the bushes ahead of you as you walk. This will either entice a snake to slither away or cause it to rattle. Either way, you re not getting bite. Don t reach under rocks, crevasses, logs, branches, etc where they could be hiding. Always check and shake out your boots, sleeping bag, and clothes before putting them on. Keep your tent zipped Mass public education in first aid management

43 Leave snakes alone Avoid tall grass, wear long boots Keep hands and feet out of areas where you cant see Be cautious and alert when climbing rocks

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