snake bite
TRANSCRIPT
- 1.Snake Bite
2. Incidence
In India, the annual mortality from snake bite is said to be
between 25,000-30,000. More than 2000 deaths per year are reported
from the state of Maharashtra alone.
There are about 216 species of snakes in India, of which 52 are
known to be venomous. The major families of venomous snakes in
India comprise elapids (cobra, king cobra and kraits) viperids
(Russells viper, saw scaled viper or carpet viper, and pit vipers),
and hydropids (sea snakes).
3. Poisonous Snakes in India
Cobra -there are four species of Cobra found in India all of which
belong to the family Naja.
They are
Najanaja - common Indian cobra or spectacled cobra is seen
throughout the country
Najakaouthiain the east and the north east regions
Najaoxianain the extreme north-west region
Najasagittiferain the Andaman islands.
4. Krait - The common krait or Indian krait (Bungaruscaeruleus) is
said to be the most venomous of all the species of snakes seen in
India.They are mostly nocturnal. During the daytime they may rest
in termite mounds, piles of brick,and sometimes within the house
underneath beddings or pillows. Kraits are known to enter human
dwellings quite commonly in search of prey, shelter and
warmth.
5. Russells viper- (Daboiarusselii: previouslyViperarusselii) is
commonly seen in many parts of India. It is generally 90-150 cm
long, with a stout and rough-scaled body.
The head is triangular and much broader than the neck. Nostrils are
relatively large, and the eyes have vertical pupils.
The colour of this snake is generally brown or yellowish brown.
There are three rows of large brown or black, oval or round spots
along the entire back. The head usually has a narrow, inverted V
shaped mark.
6. Saw Scaled Viper It (Echiscarinatus) is a small snake, growing
up to 30-90 cm in length. The head appears more rounded than
triangular, while the rest of the body is cylindrical, short, and
stout. It has large eyes with vertical pupils. The entire body is
covered with rough, serrated scales. This snake is usually pale
brown in colour, with dark brown, brick red, or gray zigzag
patterns on the back. An arrowhead-like or bird foot-like mark is
present on the head.
7. Snake Venom
Snake venom consists of
a) Enzymes Phospholipase A2 , Collagenase,
L-amino oxidase, hyaluronidase, acetylcholinesterase,
endopeptidases
b) Non enzymatic polypeptides Polysynaptic neurotoxin, presynaptic
neurotoxin, cardiotoxin
c) Peptides Pyroglutamylpeptide
d) Nucleosides Adenosine, Guanosine
e) Lipids Phospholipids, cholesterol
f) Amines Histamine, serotonin
g) Metals Copper, Zinc, Sodium , Magnesium
8. Clinical Features
The most common symptoms of all snakebites are overwhelming fear,
panic, and emotional instability, which may cause symptoms such
asnauseaand vomiting,diarrhoea,vertigo,fainting,tachycardia, and
cold, clammy skin.
Dry snakebites can still cause severe injury to the victim. There
are several reasons for this: a snakebite which is not treated
properly may become infected (as is often reported by the victims
of viper bites whose fangs are capable of inflicting deep puncture
wounds), the bite may causeanaphylaxisin certain people, and the
snake's saliva and fangs may harbor many dangerous microbial
contaminants, including Clostridium tetani. If neglected, an
infection may spread and potentially kill the victim.
Most snakebites, whether by a venomous snake or not, will have some
type of local effect. There is minor pain andrednessin over 90% of
cases, although this varies depending on the site.
9. 10. The venom of the cobra is neurotoxin and acts primarily by
binding to the acetylcholine receptors preventing the action of
acetylcholine preventing the opening of the sodium channels.
This causes neuromuscular blockade leading to paralysis.
The venom of the krait contains Bungarotoxin, a neurotoxin which
inhibits the presynaptic release of acetylcholine.
Presynaptic nerve terminals exhibit signs of irreversible physical
damage and are devoid ofsynaptic vesicles.
11. Haemotoxins on the other hand act as anticoagulating
factors.
Common initial symptoms of viperbites include lethargy, bleeding,
weakness, nausea, and vomiting.Symptoms may become more
life-threatening over time, developing intohypotension,tachypnoea,
severe tachycardia, severe internal bleeding,
alteredsensorium,kidney failureandrespiratory failure.
Most viper envenomations will causecoagulopathy, sometimes so
severe that a person may bleed spontaneously from the mouth, nose,
and even old, seemingly-healed wounds. Internal organs may bleed,
including the brain and intestines and will
causeecchymosis(bruising) of the victim's skin.
Symptoms of neurotoxicity start early and many patients dont have
enough time to reach the hospital while haemotoxicity takes time
and patients present at the hospital.
12. Local Examination
During the initial evaluation, the bite site should be examined for
signs of local envenomationi.eedema, petechiae, bullae, oozing from
the wound and for regional lymphadenopathy.
Early wet Gangrene is a sign of Cobra or krait bite
while slower dry gangrene is that of a viper bite.
Neurological Examination
Ptosis is the earliest sign followed by External
ophthamoplegia
Weakness of muscles of deglutition
Cranial nerves are involved causing drowsiness, respiratory
paralysis and coma
Muscles flexing the neck may be paralysed causing Broken neck
sign
13. Bleeding manifestations-
Bleeding at the site
Prolonged clotting time
Ecchymosis, Purpura. Epistaxis, bleeding from the gums
Cardiovascular changes
Arrhythmias
Hypotension, shock
Others
Parotid swelling, conjunctivaloedema,
subconjunctivalhaemorrhages
14. 15. Snake Bite Piercings
- Snake bite piercingsare a set of two lower lip piercings one on either side. Snakebite piercings are usually done at the same time and they are pierced in the same way as a single lip piercing. Initial jewellery for snake bites piercings can be either ball closure rings or labret studs, both of which have their advantages. Whichever initial jewellery you choose for your snake bites, made sure that there is room to accommodate swelling.
16. Once your snakebites are healed you can choose between BCRs, labret studs, smooth segment rings and even body spirals. These piercings are usually quick to heal and are relatively easy to care for.