SNAKE BITE
BY
Dr. Riaz Ahmed
OBJECTIVES
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INTRODUCTION / CLASSIFICATION
WHO – STATISTICS.
S.B- A- P.H. PROBLEM WHY?
EPIDEMIOLOGY
ETIOLOGY / CAUSES OF INCIDENCE OF S.B.
GRAVITY OF S.B SNAKES
VICTIM
SOME DANGER SIGNS
MANAGEMENT
MAJOR VENOMOUS SNAKES OF PAKISTAN
PREVENTION
IMPORTANCE:
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SNAKES ARE REPTILES:
NO (LEGS, EXT-EARS & EYE – LIDS).
NIOCTURNAL IN NATURE / HABIT.
AVOID CITIES & HEAVILY POPULATED AREAS.
MORE NUMEROUS IN VILLAGES, FIELDS,
AGRICULTURE-LANDS, VEGETATION,
MARSHES & JUNGLES.
 CLASSIFICATION:
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PHYLUM
CHORDATA
SUB PHYLUM
VERTEBRATA
CLASS
REPTILIA
C.R
ORDER
SQUAMATA (KEY) P
S.ORDER
OPHIDIA
S
FAMILIES
O
C
V
S
 MEDICALLY IMPORTANCE FAMILIES &
THEIR VENOM CHARACTERISTICS:
 VIPRIDAE
HAEMATO TOXIC
 ELAPIDAE
NEURO –TOXIC
 HYDRO – PHIDAE
(MYO – TOXIC)
 W.H.O STATISTICS:
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WORLD WIDE OCCURRENCE: 3L / ANN
MORTALITY: 30 – 40,000 / ANN
TOTAL SPECLIES: UPTO – (1—2 MIL)
WORLD 2500 to 3000 (Species)
PAKISTAN 330
LAND SEA
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300
 29
 VENOMOUS
 DEATH – RATE
30
 BURMA – 15.40 L / ANN
 PAK – 1.90
7TH
 BRITISH GVIANA
TOP
0.80 ( LOWEST )
 SNAKE – BITE A PUB. HEALTH PROBLEM
 WHY?
 68 % POP IN RURAL AREAS DUE TO
URBANIZATION.
 MAJORITY FARM WORKERS.
 WATER LANDS BARE – FOOTED.
 LACK OF EDUCATION, MEDICAL &
MECHANIZED FARMING FACILITIES.
EPIDEMIOLOGY
 WHO (PERSON) / POP. AT RISK:
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/ VICTIM:
 FARM-WORKERS, VILLAGERS, HARVESTORS, CULTIVATORS,
MILITARY-TROOPS, SCOUTS, FISHERMEN, LANDPLOUGHERS, BATHERS, PADDLERS, LAB-WORKERS, ZOOWORKERS & HUNTERS etc.
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 WHEN (TIME):
P
P
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 PEAK INCIDENCE BETWEEN JUNE – AUGUST?
 WHERE: (PLACE) ALREADY DISCUSSED. +.
 IN FIELDS, JUNGLES, GRASSYLANDS, MARSHES, PERI-
URBAN & SLUM AREAS.
 FIRST DOCUMENTED CASE
1550 B.C.
 IN PAK:
 HOSPITAL DATA SHOWS:
RISK
ADULT MALES
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CHILDREN B / W 9 ---15 YEAR
AT RISK ACTIVITIES ( IN WILD ) :
FIRE WORK COLLECTION
DISLODGING OF LOGS / STONES.
PROBING OF CREVICES / NICHE ‘ S.
CLIMBING ROCKS / TREES COVERED WITH
VEGETATION.
IN SIND (THAR) – 5TH COMMONEST CAUSE OF
HOSPITAL ADMISSION.
 CAUSES OF HIGH INCIDENCE OF S.B IN
JUNE TO AUGUST:
 COLD BLOODED
MORE ACTIVE IN
HOTTER MONTHS ( POKLIO-THERMIC)
 VENOM YIELD IS MORE
 SLEEPING HABITS OF PEOPLE IN RURAL
AREAS
BARE FOOTED & IN OPEN
SITE.
 RAINS & FLOOD SEASON.
 COBRA & KRAIT
OVIPAROUS
IN SUMMER.
 RUSSEL’S VIPER
VIVIPAROUS & SAW
SCALED VIPER
 OVI – LAYING EGGS
 VIVI – GIVING YOUNG ONES.
Gravity of snake-bite
FACTORS IN SNAKE
FACTORS IN VENOM
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
Psychological impact, type of 1st aid.
 CLINICAL-MANIFESTATION:
 VIPRIDAE: - SEVERE LOCAL PAIN,
ECCHYMOSIS, AND PAINFUL-LYMPHADENO
PATHY.
 SYSTEMIC: NAUSEA, VOMITING, SWEATING
HYPOTENSION.
PASTHOGENESIS OF S.B
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INOCULATION / INJECTION BY SNAKES
ENTERS SURROUNDING TISSUE
AUTOPHARMACOLOGICAL MANIFESTATAION
CAPILLARY ABSORPTION
ACTS ON BLOOD VESSELS&
LYMPHATICS,TARGET ORGANS
SHOW SYSTEMIC EFFECT
 Recovery
OR
Death
 DIRECT VENOM ACTION
 DANGER SIGNS:
 NUMBNESS
 TINGLING OF FACE
 HAEMATEMESIS
 HAEMATO-CHAZIA
 ELAPIDAE (IIND FAMILY)
 (MEDICALLY IMPORTANT)
 VENOM NEURO-TOXIC
 RELATED S / S APPEAR.
 HYDRO-PHIDAE:(III ONE).
 AS VENOM IS MYO-TOXIC SO S / S LIKE
 TRISMUS, EXT. OPTHALMOPLEGIA, MYOGLOBIN
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+ PROTEIN (URIA), DEATH USUALLY DUE TO
EXTREME PAESIS
RES. FUNCTION.
DIAGNOSIS:
HISTORY
P
BITES
N.P
VENOM EFFECTS i.e. MIN VS MAXIMUM
MANAGEMENT
LOCAL MEASURES
 FIELD
&
 FIRST AID
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TOURNIQUET
LOCALWASHING
INCISION & DRAINAGE
FASCIOTOMY
RUPTURE OF BLEBS & BLISTERS.
IMMOBALIZATION OF AFFECTED – EXTREMITY.
 SYSTEMIC:  SPECIFIC SERUM THERAPY.
 SUPPORTIVE & SYMPTOMATIC.
 SPECIFIC:
 POLY - VENIN
 ANTI-VENIN THERAPY
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ANTI – VENIN
 ROUTE OF ADMINISTRATION
 1 / V OR 1 / ART.
 1/M
S/S
 DOSAGE
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CHILDREN 1 / α
 SUPPORTIVE:
 BED-REST
 ANALGESICS & SEDATIVES
 WARMTH
 VENTILATION – SUPPORT
 SEQULAE:
 NO EFFECT
 PSYCOLOGICAL
 ACCORDING TO EN-VENOMATION
 OTHERS:
 OF
 TOURNIQUET
 INCISION
 WOUND SEPSIS
 HAZARDS OF ANTI-VEN
Major Venomous Snakes of
Pakistan
 Reassure
First Aid Treatment : Do it R. I.
• 70% of bites are from non-venomous snakes
G. H. T
• Only 50% of bites from venomous snakes
envenomate, the rest are dry bites.
Immobilize
• As if for a broken limb with a cloth and/or splint
• No tight bandages
• No washing, cutting or sucking bite site.
 Get
to Hospital
• Without delay
• No traditional treatments
Tell tale signs
• Mark rate of swelling
• Note onset time of symptoms and tell the doctor.
 PREVENTIVE-MEASURES:
 WEARING OF HIGH KNEE BOOTS AS 50 % BITES
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BELOW KNEE (ESP FOR P.P AT RISK). E.g. SCOUTS,
MIL. TROOPS ETC.
USE OF TORCH WHILE WATERING THE FIELDS OR
OTHERWISE AT NIGHT
HEALTH EDUCATION FOR CHILDREN AS WELL AS
FOR TROOPS
ANTI-VENOM USE
1ST-AID MEASURES / ANTI-S.B-KIT.
VACCINATION.
Snake bite
 OSPE:
(04)
A farmer has been brought in hospital with H/O snake bite
showing following
Symptoms:
i) Bleeding gums
ii)Hematuria
ii) Hematemesis
(a) What is the likely family of snake?
(01)
(b) Which system of farmer will be affected by the venom
of this snake? (01)
(c) How will you manage the case?
key:
(a) Family Viperidae
(b) Cardiovacular system
(c) i) Application of tourniquet proximal to
bleeding area
ii) Analgesics
iii) Anti-pyretics
iv) ATS
v) Anti-venin therapy