SNAKE BITE

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SNAKE BITE

• BY
• Dr. Riaz Ahmed

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OBJECTIVES

• 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

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• IMPORTANCE
• 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.

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• CLASSIFICATION
• PHYLUM CHORDATA
• SUB PHYLUM VERTEBRATA
• CLASS REPTILIA C.R
• ORDER SQUAMATA (KEY) P
  C
• S.ORDER OPHIDIA S
  V
• FAMILIES
  O S
• MEDICALLY IMPORTANCE FAMILIES THEIR VENOM
  CHARACTERISTICS
• VIPRIDAE HAEMATO TOXIC
• ELAPIDAE NEURO TOXIC
• HYDRO PHIDAE (MYO TOXIC)

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• W.H.O STATISTICS
• WORLD WIDE OCCURRENCE 3L / ANN
• MORTALITY 30
  40,000 / ANN
• TOTAL SPECLIES UPTO (12 MIL)
• WORLD 2500 to 3000 (Species)
• PAKISTAN 330
• LAND SEA
• 300 30
• 29
• VENOMOUS
• DEATH RATE
• BURMA 15.40 L / ANN TOP
• PAK 1.90 7TH
• BRITISH GVIANA 0.80 ( LOWEST )

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• 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.

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EPIDEMIOLOGY

• WHO (PERSON) / POP. AT RISK
• / VICTIM
• FARM-WORKERS, VILLAGERS, HARVESTORS, CULTIVATORS,
  MILITARY-TROOPS, SCOUTS, FISHERMEN,
  LAND-PLOUGHERS, BATHERS, PADDLERS, LAB-WORKERS,
  ZOO-WORKERS HUNTERS etc.
• T
• WHEN (TIME)
• P P
• PEAK INCIDENCE BETWEEN JUNE AUGUST?
• WHERE (PLACE) ALREADY DISCUSSED. .
• IN FIELDS, JUNGLES, GRASSYLANDS, MARSHES,
  PERI-URBAN SLUM AREAS.
• FIRST DOCUMENTED CASE 1550 B.C.

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• IN PAK
• HOSPITAL DATA SHOWSRISK ADULT MALES
• 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.

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• 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.
• RUSSELS VIPER VIVIPAROUS SAW
  SCALED VIPER
• OVI LAYING EGGS
• VIVI GIVING YOUNG ONES.

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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.
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• CLINICAL-MANIFESTATION
• VIPRIDAE - SEVERE LOCAL PAIN, ECCHYMOSIS, AND
  PAINFUL-LYMPHADENO PATHY.
• SYSTEMIC NAUSEA, VOMITING, SWEATING HYPOTENSION.

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PASTHOGENESIS OF S.B

• 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

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• DANGER SIGNS
• NUMBNESS
• TINGLING OF FACE
• HAEMATEMESIS
• HAEMATO-CHAZIA

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• 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 PROTEIN
  (URIA), DEATH USUALLY DUE TO EXTREME PAESIS
  RES. FUNCTION. DIAGNOSIS
• HISTORY
• P
• BITES
• N.P
• VENOM EFFECTS i.e. MIN VS MAXIMUM

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MANAGEMENT

• LOCAL MEASURES
• FIELD
• FIRST AID
• TOURNIQUET
• LOCALWASHING
• INCISION DRAINAGE
• FASCIOTOMY
• RUPTURE OF BLEBS BLISTERS.
• IMMOBALIZATION OF AFFECTED EXTREMITY.
• SYSTEMIC -
• SPECIFIC SERUM THERAPY.
• SUPPORTIVE SYMPTOMATIC.

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• SPECIFIC
• POLY - VENIN
• ANTI-VENIN THERAPY
• ANTI VENIN
• ROUTE OF ADMINISTRATION
• 1 / V OR 1 / ART.
• 1 / M S / S
• DOSAGE
• CHILDREN 1 / a

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• 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
•  

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Major Venomous Snakes of PakistanFirst Aid
Treatment Do it R. I. G. H. T

• Reassure
• 70 of bites are from non-venomous snakes
• 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.

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• Get to Hospital
• Without delay
• No traditional treatments
• Tell tale signs
• Mark rate of swelling
• Note onset time of symptoms and tell the doctor.

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• PREVENTIVE-MEASURES
• WEARING OF HIGH KNEE BOOTS AS 50 BITES 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.

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• 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?
  
  

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• 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

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THANK YOU