Integrated Disease Surveillance Programme
(IDSP)
Snake
Bite
Snake Bite
• H/O Snake Bite, Fang Puncture
Marks/Bleeding/Swelling
• Immobilize The Limb, Patient Kept In Recovery
Position (Prone On Left Side)
• Nil By Month
• Do Not Wash The Wound:-
(i) May Introduce Infection
(ii) Increase Absorption of Venom
• Secure IV Line And Use Normal Saline
• Inj. TT
• Inj. Antibiotic
Signs &
Symptoms
• Cobra And Krait (Elopid)
(A)Neuroparalytic
(i) Ptosis
(ii)Diplopia, Disarthria (Speech
Difficulty)
(iii)Dysphonia(Pitch of Voice is Less),
Dysproca, Dysphagia
(iv)Paralysis
(v)Bilateral Dilated Non Reacting Pupil
is Not The Sign of Brain Death In
Elopid Envenomation
(B) Vasculotoxic
(i) Viper Species
(ii) Local Swelling, Bleeding, Blistering, Necrosis
(iii) Local Pain & Severe Swelling
(iv) Tender Enlargement of Lymph Nodes
Symptoms
(i) Bleeding-
Gingival/Epistaxis/Ecchymoses/Vomiting/Hemate
mesis/Bleeding P/R
(ii) Acute Abdominal Tenderness
(iii) Consumption Coagulopathy Dictable By 20 WBCT
(IV) Locked in Syndrome (Quadriplegia) And
Anarthria With Preserved Consciousness.
(V) Systemic Capillary Leak Syndrome-
Haemoconcentration, WBC
(C) Painful Progressive Swelling (Russell
Viper Cobra)
(i) Local Necrosis
(ii) Skin Tact And Shrink
(iii)Painful Swelling (Progressive)
(iv)Compartment Syndrome
(v) Regional Tender Lymphadenopathy
(D) Aryotoer (Sea Snakes)
(vi)Muscle Aches/Swelling Involuntary
Contraction
(vii)Dark Brown Urine
Occult Snake Bite
• Krait Bite Often Presents With Early Morning
Paralysis,
No Bite Mark
(i) Gets Up in The Morning With Severe
Epigastric
/Umbilical Pain & Vomiting For 3-4 Hrs.
Followed By
Neuro Paralytic Symptoms.
(ii) Unexplained Respiratory Distress In Children
&
Ptosis/AFP
* Each ASV Vial Neutralises 5-147 mg of Venom
Injected
* Give Prophylactic Epinephrine 0.25 mg. of 0.1%
Solution (Except In Known Hypertensive)
* In Children Epinephrine 0.005 Mg./Kg
* Same ASV Dose In Pregnancy And
Children
Anti Snake Venom (ASV)
* Reconstitute Dry Powder By Diluting In 10ml Distilled Water/NS
Dose:-
(A) Neuroparalytic
(i) ASV 10 Vials Infusion Over 30 min.
(ii) 2nd Dose 10 Vials After 1 Hr. If No Improvement
(iii) O2 Inhalation
(iv) Inj. Atropine 0.6 mg followed By Inj. Neostigmine 1.5 mg stat
(v) Atropine 0.2 mg with 0.5 mg Neostigmine Every 30 Min for 5
Doses
* If No Response (Ptosis) After 3rd Dose. Stop AN (Indicates Krait Bite
* No AN In Confirmed Krait Bite
Dose:-
(B) Vasculotoxic
(i) 10 Vials Stat Over 30 Min.
(ii) Followed By 2 Vials Every 6 Hr. As Infusion In 100 ml NS
Till Clotting Time Normal
1. Bed Rest
2. Test For Haematuria
3. Blood Transfusion If Necessary
Forced Alkaline Diuresis (FAD)
(A) If Urine Output Does Not Improve
(i) Inj. Furosemide 40 mg.IV Stat
(ii) Inj. NS 500 ml. + 20 ml. NaHCO3
(iii) RL 500 ml.+ 20 ml. NaHCO3
(iv) 5% Dextrose 500 ml. + 20 ml. KCL-90 ml
(v) Inj. Mannitol 150 ml. Over 20 ml
* T/C Hyperkalemia:-
(vi) 10 ml. of 10% Cal Gluconate IV Over 2 min. Repeated Upto 3 Times
(ECG)
(vii) 50 ml. Dextrose + 10 Unit Insulin
(viii) Sod. Bicarb 40 ml. of 8.4% IV Slow
• If Acidosis:- 2-3 Ampule of Sod. Bicarb In 5% Dextrose
• If No Neck Lift :- Mechanical Ventilation
THANK
YOU
