SNAKE BITE

BYDr. Riaz Ahmed

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

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.

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)

W.H.O STATISTICS: 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

300 30 29 VENOMOUS DEATH – RATE

BURMA – 15.40 L / ANN TOP PAK – 1.90 7TH BRITISH GVIANA 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: / 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.

IN PAK: HOSPITAL DATA SHOWS:

RISK 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.

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 SNAKEFACTORS IN SNAKE FACTORS IN VENOMFACTORS IN VENOM

Age, size, health of snakeAge, size, health of snake Also age and general healthAlso age and general health

AgitationAgitation Absorption rateAbsorption rate

WeatherWeather Site of distal end / fatty areaSite of distal end / fatty area

HibernationHibernation PersonalityPersonality

Prior attackPrior attack Sensitivity of attack to venomSensitivity of attack to venom

Preventive measuresPreventive measures Psychological impact, type of 1Psychological impact, type of 1stst aid.aid.

CLINICAL-MANIFESTATION: VIPRIDAE: - SEVERE LOCAL PAIN,

ECCHYMOSIS, AND PAINFUL-LYMPHADENO PATHY.

SYSTEMIC: NAUSEA, VOMITING, SWEATING HYPOTENSION.

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

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

+ 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

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 ANTI – VENIN

ROUTE OF ADMINISTRATION 1 / V OR 1 / ART. 1 / M S / S

DOSAGE 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 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.

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 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