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snake bite and management
- 1. Management of snake bite Presented BY: Rahul Krishna .k M pharm first year DEPARTMENT OF PHARMACY PRACTICE Reg no:244 NIPER, Hajipur
- 2. CONTENTS 1. INTRODUCTION 2. EPIDEMIOLOGY 3. CLASSIFICATION 4. TYPES 5. MECHANISM OFACTION 6. VENOM COMPOSITION 7. SIGNS AND SYMPTOMS 8. FIRST AID 9. INVESTIGATION OR LABORATORY TEST 10.MANAGEMENT 11.RECENT ADVANCEMENT 12.REFERENCE
- 3. INTRODUCTION >Snake bite is frequent and devastating medical emergency and need hospital admission . > It is an occupational disease results in the death or chronic disability. About 54 types of venomous snakes are found in India >About 15000 to 20000 deaths are reported every year in India . > Diagnosis of the species of snake responsible for the bite is important for optimal clinical management. > Antivenom is the only effective antidote for snake venom.
- 4. EPIDEMIOLOGY
- 6. Dubio’s Sea Snake Fierce Snake Eastern Brown Snake Blue Krait Black Mamba Tiger Snake Philippine Cobra Vipers Death Adder Rattle Snake MOST VENOMOUS SNAKES IN THE WORLD Taipan
- 7. MAJOR VENOMOUS SNAKES OF INDIA Cobra Common Krait Russel’s Viper Saw scaled Viper N E U R O T O X I C H A E M O T O X I C
- 8. TYPES OF VENOMS NEUROTOXINS Eg;Cobra CYTOTOXINS Eg;Puff adder CARDIOTOXINS Eg;Taipan snake HEMOTOXINS Eg;Russel viper
- 9. Neurotoxins antagonistically bind tightly and noncovalently to Nm AChRs of skeletal muscles, thereby blocking the action of ACh at the postsynaptic membrane, inhibiting ion flow and leading to paralysis Haemotoxins are toxins that destroy red blood cells (that is, cause hemolysis), disrupt blood clotting, and/or cause organ degeneration and generalized tissue damage. MECHANISM OF ACTION OF SNAKE VENOM NEUROTOXIC HAEMOTOXIC
- 11. SIGNS AND SYMPTOMS (when venom is injected) Fang mark, pain, local bleeding, bruising, burning sensation, enlargement of lymph node, swelling. LOCAL SYSTEMIC Nausea, vomiting , abdominal pain, weakness , drowsiness, shock, hypotension, cardiac arrhythmia, visual disturbances, pulmonary oedema.
- 14. 1.Identify the snake species if possible 2.Keep the person calm. Acute stress reaction increases blood flow and endangers the person 3.Immediately transport the person to hospital as soon as possible 4. Do not administer stimulants or pain medications unless specifically directed to do so by a physician. 5.Remove any items or clothing which may constrict the bitten limb if it swells 6.Keep the person as still as possible 7.Do not incise the bitten site. 8.Bitten limb should be placed below heart level 9. Do not use tight tourniquets FIRST AID
- 15. INVESTIGATION OR LABORATORY TEST ► 20-minute whole blood clotting test ► Haemoglobin concentration/haematocrit ► Platelet and WBC count ► Blood film ► Plasma/serum ► Urine examination ► Biochemical test
- 16. ANTIVENOM TREATMENT ► Antivenom is immunoglobulin purified from the serum or plasma of a horse or sheep that has been immunized with the venom of snake. ► Monovalent or monospecific antivenom neutralizes the venom of only one species of snake. ► Polyvalent or polyspecific antivenom neutralizes the venoms of several different species of snakes. ► The ASV that is available in India is a polyvalent type which is active against the commonly found snakes in India including the Favorite Four.
- 17. Indications for antivenom treatment ► Neurotoxicity ► ARF ► Bleeding /coagulopathy ► Myoglobinuria/haemoglobinuria ► Cardiac toxicity ► Local swelling involving more than half of the bitten limb ► Rapid extension of swelling ► Development of an enlarged tender lymph node
- 18. Administration of antivenom Epinephrine (adrenaline) should always be drawn up in readiness before antivenom is administered. Antivenom should be given by the intravenous route whenever possible. Two methods of administration are recommended: 1) Intravenous “push” injection 2) Intravenous infusion Patients must be closely observed for at least one hour after starting intravenous antivenom administration, so that early anaphylactic antivenom reactions can be detected and treated early with epinephrine.
- 20. Criteria for repeating the initial dose of antivenom If the blood remains incoagulable In patients who continue to bleed In case of deteriorating neurotoxicity or abnormal cardiovascular signs
- 21. DOSE OF VENOM SNAKE SPECIES AVERAGE DOSE INTIAL DOSE COMMON KRAIT --------- 100 ml RUSSELL’S VIPER -------- 100 ml SAW SCALED VIPER --------- 50ml INDIAN COBRA ---------- 100ml
- 22. Supportive/ancillary treatment Antivenom treatment can be expected to neutralize free circulating venom, prevent progression of envenoming and allow recovery. However, these processes take time and the severely envenomed patient may require life support systems such as treatment of shock, assisted ventilation and renal dialysis until the severely damaged organs and tissues have had time to recover.
- 23. Treatment of hypotension and shock Causes of hypotension and shock 1) Anaphylaxis 2) Vasodilatation 3) Cardio toxicity 4) Hypovolaemia 5) Antivenom reaction 6) Respiratory failure 7) Acute pituitary adrenal insufficiency 8) Septicemia In patients with hypotension as dopamine may be given by intravenous infusion, preferably into a central vein (starting dose 2.5-5 mg/kg/minute). Shock is mainly due to acute adrenal insufficiency due to hemorrhage and can be treated by Hydrocortisone.
- 24. Treatment of oliguria and acute kidney injury 1 Oliguric phase of renal failure Establish intravenous access. Give fluid challenge Insert a urethral catheter with full sterile precautions Diuretic treatment mainly using furesemide Biochemical monitoring Detection and management of hyperkalaemia Management of severe acidosis Dialysis
- 25. Cont.. Prevention of renal damage in patients with myoglobinuria or haemoglobinuria 1) Correct hypovolaemia and maintain saline diuresis (if possible) 2) Correct severe acidosis with bicarbonate 3) Give a single infusion of mannitol (200 ml of 20% solution over 20 minutes)
- 26. Haemostatic disturbances 1) Bleeding and clotting disturbances may occur due to the treatment of specific antivenom. 2) Dose may be repeated several time within the interval of six hours before blood coagulability is finally restored. 3) Heparin and antifibrinolytic agents are not used in the treatment of snake venom. 4) Venipuncture should be avoided in the patients with haemostatic disturbances.
- 27. Management of cobra spit ophthalmia > Urgent decontamination by copious irrigation. >Analgesia by vasoconstrictors with weak mydriatic activity (e.g. epinephrine) and limited topical administration of local anesthetics (e.g. tetracaine). > Exclusion of corneal abrasions by fluorescein staining with a slit lamp examination and application of prophylactic topical antibiotics . > Antihistamines in case of allergic keratoconjunctivitis.
- 28. RECENT ADVANCEMENT >Researches are going on to develop a herbal antidote against snake venom. >Many plant species are found to be effective against the snake venom.Some of the important examples for them includes Worm wood, grape vine , Arsitolochia indica , amla etc . >Snake venom are now found to be posess anticancer and analgesic activity. >Venoms of cobra , Russels viper, rattle snake etc is found to be have potent anticancer activity. >Venom of black mamba is found to be have potent analgesic activity .
- 29. REFERENCES 1) WHO guidelines for management of snake bite 2) Wikipedia 3) WHO. Guidelines for the Production, Control and Regulation of Snake Antivenom Immunoglobulins. Geneva: World Health Organization, 2010.
- 30. THANK YOU