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Dr Dilip Kumar Raiguru,Former CDMO,Jharsuguda

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Are All Snakes Poisonous?

In India..

INDIAN SNAKES

Indian Snakes

Land Snakes80% N.P.20% Poison.Sea Snakes20% N.P.80% Poison.

Indian Snakes

Land Snakes80% N.P.20% Poison.Sea Snakes20% N.P.80% Poison.

Elapidae(Neurotoxic)

Viperidae(Vasculotoxic)

Hydrophidae(Myotoxic)

Indian Snakes

Land Snakes80% N.P.20% Poison.Sea Snakes20% N.P.80% Poison.

Elapidae(Neurotoxic)

Viperidae(Vasculotoxic)

Hydrophidae(Myotoxic)Cobra Family

Krait Family

Pit Viper

Pit less Viper

Found in allParts of worldExcept Europe

Found in all parts Of world except USAResponsible forMost of the deaths

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King Cobra

Common Cobra

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Common Krait: Most Poisonous among all. Its venom is 10 times poisonous than Cobra.

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Banded Krait

Russell's Viper

Russell's Viper

Echis Carinatae (Saw Scaled Viper)

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Saw Scaled Viper

Pit Viper

Himalayan Pit viper

Bamboo Pit Viper

Sea Snakes

Function of Snake Venom

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Toxic Principles in Snake Venom

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Fatal Dose

Fatal Period

How much venom is injected in one biteDried Venom yield per biteIn mg.per biteFatal dose in mg.Cobra200-350mg15mgViper150-250mg40mgKrait22mg6mgEchis Carinatae25mg8mg

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1ml of polyvalent anti snake venom serum(ASV) neutralizes:Snake VenomNeutralizingDose of 1ml of ASVFatal Dose VenomInjected per biteCobra0.6mg 15mg200-350mgRusselsViper0.6mg40mg150-250mgCommon Krait0.45mg6mg22mgEchis Carinate0.45mg8mg25mg

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Factors Affecting the Severity of Snake Bite:Age: In Children more severe than adultSite: Bite in extremities or adipose tissue is less dangerous than bite on the face or trunkSuperficial bite or bite through clothing afford more protectionIf venom glands are recently discharged it is less harmfulExertion immediately after poisoning speeds up poisoningPresence of bacteria in the mouth of snake or on the skin of the victim may cause serious infection in the necrotic tissues at the local site.

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Factors Affecting the Severity of Snake Bite:

Clinical Features: Sea Snake Bites: MYOTOXIC

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Clinical Features: Viper Bites VASCULOTOXIC

Clinical Features: Cobra Bites-NEUROTOXIC

Clinical Features of Krait Bites--NEUROTOXICThe symptoms are similar to cobra bite.In addition there may be severe transient abdominal colicky pain with cramp

Diagnosis of Snake Bite:HistoryFang MarksLocal reactions

Pain , Swelling , Bleeding-oozing of blood from bite site.Note:- In Viper bitesLocal reaction is usually severe & evident within few minutesIn Cobra bites it may be minimal & delayed up to 24 hours.

Fang Marks

Envenomations in Viper Bite

MildSevere12 hr after viper bite

Diagnosis of Snake Bite:Systemic Reactions

Bleeding TendenciesNeuromuscular Paralysis Common with Cobra & Krait Bite: Ocular- Ptosis , Blurred vision , Diplopia,Pharyngeal-Dysphagia , Drooling of saliva, Respiratory muscle weakness , Limb weakness etcRenal FailureCardiac Insufficiency & ArrhythmiasShock

Management ofSnake Bite(Pre Hospital Management)

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First Aid (DOs)1. Reassure the patient: 2. Immobilize the limb-as fracture 3. Get to Hospital Fast 4. Tell the Doctor about symptoms Do it R.I.G.H.T.80% Bites :Non PoisonousOnly in 50% of Poisonous snake bite inject venom Dont waste time on traditional Rx. Ptosis, Bleeding, Dysphasia-on the way to hospital

Use Bandage or Cloth To hold the splints& not to obstruct blood supplyDont pressurize.

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First Aid(Donts)1. Do not cut or incise the wound2. Do not apply electric shock or ice3. Do not seek for traditional cure 4. Do not take alcohol or aspirin 5. Do not apply tight tourniquet6. Do not suck the wound

Management: (General Measures)Wide Tourniquet:

If within 1st 2 hr of bite till Pt. shifted to hospitalNot used if bite is on face, trunk or neck.10 cm above the site of biteLoose enough to allow one finger to just pass throughTo distend vein without impending the arterial flow

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Management: (General Measures)PIM(Pressure Immobilisation Method):A newer technique-developed in Australia in late-1970s.Crepe bandage starting from distal to bitten site with a pressure enough that can easily introduce the finger between skin & bandage.(Entire bitten limb is wrapped)Tying the elasticated/crepe bandage around the limb including an integral splint, in the same way as a sprain can also be done.It was thought that it will inhibit venom flow into the system.

In summary, the pressure immobilization method of first aid is:

Apply a firm broad bandage or similar (even clothing strips or pantyhose will do in an emergency) over the bite site, at the same pressure as for a sprain. Do not occlude the circulation. Apply further bandage over as much of the rest of the bitten limb as practical. Ensure fingers or toes are covered to immobilize them. Ensure the bitten limb is kept motionless by applying a splint and instructing the patient to cease all use of the limb and any general activity.

The pressure immobilisation method of first aid

Management: (General Measures)Use of Aspirin for pain relief is contraindicated.Just clean the wound with plain water or normal saline.Establish a patent airway : if respiratory distress is present

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Key Questions to ask a victim are:

Polyvalent Anti Snake Venom Serum(ASV)

By hyper immunization of horses against venom of 4 common poisonous snakes:CobraRussell Viper Common Krait Echis Carinate

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Some TIPS

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Prevention of Snake Bite:Fire wood, Cow dung, cattle shed,& rubble should be kept away from residential house.Old Storage rubble particularly in old house should be handled in full sun light.Bare foot walking in dark ness ,in Grown up grasses should be avoidedOne should go out with a torchProper care of rats,mice,lizards-they can be killed by rat poisonDont try to catch snake or kill it.Killed snake should not be handled ,even sheared head may inject venomSee before wearing Shoes, Going to Toilets.Avoid sleeping in ground to prevent krait biteThick electrician gloves with rubber shoes should be worn at time of handling Paddy or Sugar Cane Husk.

Snakebites: First aid(Summary)

To reduce your risk of a snakebite, avoid picking up or playing with any snake. Most snakes usually avoid people if possible and bite only when threatened or surprised. If you've experienced a snakebite: Remain calm ,still and dont move around.Don't try to capture the snake Immobilize the bitten arm or leg and try to stay as quiet as possible Remove jewelry, because swelling tends to progress rapidly

Snakebites: First aid(Summary)

Apply a loose splint to reduce movement of the affected area, but make sure it is loose enough that it won't restrict blood flow Don't cut the wound or attempt to remove the venom Do not give alcohol to the patient.Do not give food and only non-alcoholic clear fluids may be used for drinks.Always seek medical help at the earliest opportunity.If the snake has been killed, bring it with the patient, but do not waste time, risk further bites and delay application of pressure bandage and splint by trying to kill the snake.

No body except mad people or animal do harm to others without provocations

If a Rabid animal (Dog,Jackel,fox,monkeyetc) bites or licks on the wound on the body,it can cause death from Rabies or Tetanus

Disease Risk

Rabies is 100% FATAL!

Rabies virus is present in the saliva of the rabid animal & it affects the brain through nerves.

CLINICAL FEATURES:-H/O dog bite without any provocation

Presence of tooth mark with laceration

Bleeding or oozing of blood from site of bite.

First AidWash the wound immediately & repeatedly with running water.Wash again with soap & water or diluted dettol waterCover with a sterile dressing & dont apply any bandageSend the victim to hospital immediately for T.T. & ARV.Watch/Observe the dog for 10 days.

Scorpion StingDuring Construction works , farms etc may be affected by black scorpion stings

Some varieties of scorpion liberate toxins which pass through blood vessels & affect heart.

Death due to scorpion sting also have been encountered though rare.

Symptoms & SignsSevere pain & burning at the site of sting.Redness & Swelling around the site.Palpitation/RestlessnessProfuse sweatingSalivation from mouthNausea and vomitingMuscular pain/twitching of muscleBody temp. may be raised slightly.

First Aid ManagementApply a constrictive bandage above site of sting

Wash the affected area with running water

Send the victim to hospital quickly.

Doctor may give local anaesthetic injection to relieve the pain

Spiders/Ticks/Ants/Bees/WaspsHornets etcAccidental Bite

Alarmingly painful

May cause serious consequence in children

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Symptoms & SignsSevere pain & Burning sensation at the site of bite/sting.Sometimes the bees or wasp leave its sting in the skinSwelling & redness in the affected areaNausea & VomitingIf the victim is allergic to the venom then there may be swelling around face,eyes,mouth,throat & all over body.

First AidPull out the sting gently with a pair of fine forceps if it is present in the skin.Apply cold compress or ice cubes at the siteApply vinegar/lemon juice in case of wasp biteApply soda bicarb / Methylene blue in case of bee biteIf the sting is inside the mouth give the victim a few ice cubes to suck & rinse mouth with ice cold water repeatedly.

First Aid(Insect bites & Stings)Move to a safe area to avoid more stings. Scrap or brush off the stinger with a straight-edged object, such as a credit card or the back of a knife. Wash the affected area with soap and water. Apply a cold pack or cloth filled with ice to reduce pain and swelling. Apply hydrocortisone cream (0.5 percent or 1 percent), calamine lotion or a baking soda paste with a ratio of 3 teaspoons baking soda to 1 teaspoon water to the bite or sting several times a day until your symptoms subside. Take an antihistamine containing diphenhydramine (Benadryl, Tylenol Severe Allergy) or chlorpheniramine maleate (Chlor-Trimeton, Actifed).

Human bites:

Human bites can be as dangerous as or even more dangerous than animal bites because of the types of bacteria and viruses contained in the human mouth.

If someone cuts his or her knuckles on another person's teeth, as might happen in a fight, this is also considered a human bite.

If you sustain a human bite that breaks the skin: Then..

Human bites: First aidStop the bleeding by applying pressure.

Wash the wound thoroughly with soap and water.

Apply an antibiotic cream to prevent infection.

Apply a clean bandage. If the bite is bleeding, apply pressure directly on the wound using a sterile bandage or clean cloth until the bleeding stops.

Seek emergency medical care.

Thank You

AmritavaniSukham Samagam Vijnane Vimale cha PratishthitamAll happiness is rooted in the Good Science. - Charaka Samhita

Thank You One and All

dkraiguru@gmail.com