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IN THE NAME OF
THE MOST BENEFICENT
THE MOST MERCIFUL
SNAKE BITE
Irfan Ahmed
ARTHROPODS
• At least 750,000
species
• Three times
number of all other
animal species
combined
• Scorpions, spiders,
ticks, Insects etc.
ARTHROPODS
SNAKES
 A world free of snakes
• Nearly a quarter of us would go hungry
• Are important elements in the food chain
to control the rodent population- Which
destroy all major crops
The bottom line is we need
snakes to survive
• Snakes belong to the order of animals called
reptiles
• This group also include crocodiles, lizards, and
turtles
• Snakes maintain a fairly steady body
temperature by their behavior
• Raise their temperature by lying in the sun or
lower it by crawling into the shade
SNAKES
• Snakes have a
long, legless, flexible body that is
covered with dry scales
• Snake's eyes are covered by clear
scales rather than movable
eyelids; therefore, their eyes are
always open
SNAKES
• They repeatedly flick out their
narrow, forked tongue, using it
to bring odors to a special sense
organ in the mouth
SNAKES
SNAKES – EVOLUTION
• Early snakes killed their prey using
surprise attacks and by suffocating
them to death
• Snakes evolved a venom as new
weapon about 60 million years ago
• 3000 species of
snakes in the
world
• 375 are
venomous (10
to 15 %)
SNAKES
WORLD DISTRIBUTION OF SNAKES
• Occur practically all
over the
world, apart from
places like
Greenland, Iceland,
and Antarctica
• Most snakes are
found in tropical
regions
SNAKES – HABITAT
• Long grass
• Shrubs & hedges
• Holes & burrows
• Shady places like
under pre-
fabricated
construction
• Garbage pits
SNAKES – COLD BLOODED
• Do not have the ability of generating
adequate amounts of heat in order to keep
their body temperature at a constant level
• Dependent on the heat from their
surroundings and the sun to control the
temperature of their body
• Most snake species are found in the humid and
warm climes of tropical regions
SNAKES – SIZE
• Anaconda can
grow up to 38 feet
in length
• Brahminy blind
snake is just 2
inches
long, making it
the smallest snake
SNAKES – SENSE OF HEARING
• No external ears
• Probably deaf to
most sounds
• Hear by sensing
vibrations with
their belly scales
and lower jaw
SNAKES – SENSE OF SMELL
• Snakes use their
forked tongue to
smell
• Tongue gathers
airborne particles
SNAKES – COLOUR
• Dull to brilliant with striking
patterns
• Dull for camouflage
• Brightly coloured are usually
poisonous
• Use bright colours to warn
predators
• Some non-poisonous snakes
mimic the patterns and bright
colors of poisonous snakes to fool
predators
SNAKES – METABOLISM
• Slow rate of
metabolism
• King Cobra can
go for months
without food
SNAKES – MOLTING
• We shed small
quantities of old
skin continuously
• Snakes shed their
old skins in a
continuous sheet (a
process called
ecdysis)
SNAKES – MOLTING
• Interval between
sheds depends on
age, growth
rate, environmental
factors
• Young shed more
frequently
• Adult snakes shed
less often
SNAKES – CRAWLING
• The type of
movement used
depends largely on
the terrain
 Concertina
 Serpentine
 Side – winding
 Rectilinear
SNAKES – VENOM
• Venom is the toxic
saliva produced by
the parotid salivary
glands of the
poisonous snakes
• Snake venom is highly modified
saliva, and is produced by
modified saliva glands
• Proteinaceous nature of snake
venom was established by
Napoleon Bonaparte's
brother, Lucien in 1843
SNAKES – VENOM
• Proteins constitute the major portion of venom's
dry weight–90% or more
• Snake venom is a cocktail of hundreds, sometimes
thousands, of different proteins and enzymes
• Many of these proteins are harmless but a
percentage of them are toxins
• The makeup of these toxins varies widely from
species to species
• This complexity accounts for the widely differing
effects of snakebite
SNAKES – VENOM
SNAKES – VENOM
• Composition
 Fibrinolysins
 Proteolysins
 Neurotoxins
 Cholinestarses
 Haemolysins
 Thromboplastin
 Agglutinins
 Cardiotoxins
 Hyaluronidase
POISON GLANDS AND VENOM
EXTRACTION
POISON GLANDS AND VENOM
EXTRACTION
• Venoms are rich in hydrolithic
enzymes, a complex mix of
polypeptides, nucleases, peptidases, etc
., which help digest the snake's prey
• Some of them also enhance or
contribute to the toxic effect of the
venom
SNAKES – VENOM
• Hemotoxin (blood toxin)
 Hemotoxic venom attacks the circulatory system and
muscle tissue causing excessive
scarring, gangrene, and sometimes leads to
amputation of the affected area
 This venom basically destroys tissue and blood cells
 In addition to killing the prey, part of the function of
a hemotoxic venom for some animals is to aid
digestion
 The venom breaks down protein in the region of the
bite, making prey easier to digest.ex : Vipers
SNAKES – VENOM
SNAKES – VENOM
• Vasculotoxic poison
 Enzymatic
destruction of cell
membranes and
coagulation disorders
 Result in
 Destruction of endothelial
cells of blood vessels
 Lyses of RBCs
 Failure of blood clotting
• Neurotoxin (nerve toxin)
 Neurotoxic venom attacks the
victim's central nervous system and
usually result in heart failure and/or
breathing difficulties or even total
respiratory paralysis. eg:
Cobras, Kraits, Coral Snakes
SNAKES – VENOM
SNAKES – VENOM
• Neuro Toxin
 Acts on motor nerve
 Similar manner to tubocurarine poison
 Compete with acetylcholine at nicotinic receptors
 Render acetylcholine inactive
 Leading to muscular weakness
SNAKES – VENOM• Krait- Pre-synaptic action
 Beta-bungarotoxin- Phospholipases A2
 Inhibiting the release of acetylcholine from the
presynaptic membrane
 Presynaptic nerve terminals exhibited signs of
irreversible physical damage and are devoid of synaptic
vesicles
 Antivenoms & anticholinesterases have no effect
 Paralysis lasts several weeks and frequently requires
prolonged MV. Recovery is dependent upon regeneration
of the terminal axon
SNAKES – VENOM
• Krait- Pre-synaptic action
1) Inhibiting the release of
acetylcholine from the
presynaptic membrane
2) Presynaptic nerve terminals
exhibited signs of irreversible
physical damage and are
devoid of synaptic vesicles
3) Antivenoms &
anticholinesterases have no
effect
SNAKES – VENOM
• Myotoxic poison
 Muscular pains
 Myoglobinuria
 Respiratory failure
due to muscular
weakness
CLASSIFICATION OF SNAKES
Five families
CLOBRIDAE
• Most numerous snake
family
• Two third of all snakes in
the world
• Majority are
non-poisonous
• Examples
— Corn snakes
— Rat snakes
• Largest (size) snakes in
the world
• Non-poisonous (Use
their strength to
constrict and kill prey)
• Three largest snakes
— African rock python
— Reticulated python
— Anaconda
BOIDAE
VIPERIDAE• Poisonous (Haemotoxic
- Affects blood)
• Body characteristics
— Typical triangle shaped
head
— Folding fangs
— Head covered with small
scales and nostrils are
placed vertically
• Examples
─ Copperheads, cottonmouths
and rattlesnakes
ELAPSIDAE
• Poisonous (Neurotoxic -
Affects nerves)
• Body characteristics
— Hollow fixed fangs in the jaw
below or in front of the eyes
— Do not have the triangle
shaped head
— Head covered with large scales
— Lateral Nostrils
• Examples
— Cobras, mambas, kraits and
the coral snake
• 18 feet
• Head as large as man’s hand
• Hood
• Six feet tall
HYDROPHIIDAE
• Sea snakes
• Majority are poisonous
(Neurotoxic – Affects
nerves)
• Examples
— Banded sea snake
— Yellow bellied sea
snake
COMPARISON OF POISONOUS &
NON-POISONOUS SNAKES
COMPARISON OF POISONOUS & NON-
POISONOUS SNAKES
Scale arrangement
Single row
Double row
COMPARISON OF POISONOUS & NON-
POISONOUS SNAKES
COMPARISON OF POISONOUS & NON-
POISONOUS SNAKES
WATER SNAKES
WATER SNAKES
• If just the head is
showing, it is probably a
harmless water snake
• Almost all venomous
snakes swim with their
lungs inflated, leaving
the majority of their
bodies afloat
Characteristic Poisonous Nonpoisonous
Shape of head Triangular Round
Pit (+) (-)
Pupils Elliptical Round
Bite marks Fang marks 2 rows of teeth
Caudal plates Single row Double row
Color body Red ring next to yellow Alternating color
Swim in water Most of the body afloat Often only head
showing
POISONOUS / NON POISONOUS SNAKES
POISONOUS SNAKES IN PAKISTAN
• Rat Snake (Ptyas
mucosus) Local
Name: - Dhaman
• Indian Python
(Python molurus)
Local Name: -
Azdaha
• Indian Cobra (Naja
naja) Local Name: -
Cobra
• Leaf-nosed Viper
( Eristocophis
macmahoni) Local
Name: - Cobra
RISK TO HUMANS
• Species and size of the snake
• Venom injected
• Localization of the bites
• Weight & general health of
the victim
• Sensitivity to the venom
• The availability of health
facility
SIGNS AND SYMPTOMS
• Local effects
 Fang mark at the site of injection
 Intense local pain
 Swelling
 Oozing out of haemolyzed blood
 Blisters may appear
SIGNS AND SYMPTOMS• General effects
 Haemoglobinuria
 Petechial haemorrhages
 Bleeding from gums, mucus membranes
such as rectum and body orifices
 Haemoptysis
 Cold, clammy skin
 Death due to circulatory failure
SIGNS AND SYMPTOMS
• Myotoxic
 At the site of bite no pain and swelling
 Muscle weakness
 Ptosis develops
 Generalized muscle paralysis
 Urine is brown in colour
 Respiratory muscle weakness leads to death
 Hyperkalemia may result in cardiac failure
SIGNS AND SYMPTOMS
• Neurotoxic
 Lethargy , giddiness , muscular weakness and
spreading paralysis
 Increased salivation and vomiting
 Ptosis and paralysis of extra ocular muscles
 Breathing becomes slow and laboured
 Patient remains conscious but unable to speak
 Finally respiratory paralysis consequently death
WHAT TO DO
On seeing the Snake
• Remain calm and cautious
• Get out of the way
• Call for help
• Use stick to kill the snake
by keeping a safe distance
and striking the head
If you are the Victim
• Be calm
• Try not to move the
effected part much
• Call for help
• Move away from snake
• Prevent further bite
• Nearest health facility
WHAT TO DO
If you are the helper of the
Victim
• Remain calm
• Reassure the victim
• Call for help
• Move the patient to safety
• Evacuate the patient to
the nearest health facility
• Try to kill the snake with
the help of others
WHAT TO DO
• There are two
important aspects
of snakebite
treatment, one is
the first-aid and
then the treatment
(antivenom serum)
TREATMENT – SNAKE BITE
FIRST AID
•Reassure
•Evacuate
•Splintage
•Tourniquet
TREATMENT
• Allaying anxiety and
fright
• Prevention of spread
of venom
• Shifting the victim to
medical aid center
• Use of antivenin
TREATMENT
• Allaying anxiety and Fright
 To prevent the shock due to fright it is desirable
to reassure the victim by clarifying that
 All snakes are not poisonous
 Even poisonous snakes are not fully charged
with poison all the time
 Even a snake with fully charged with poison
does not always inject it’s lethal dose
TREATMENT
• Prevention of spread of Venom
 Immobilization
 Application of tourniquet
 Cleaning the wound
 Local emetine injection
 Incision and suction at the site
TREATMENT
• Prevention of spread of Venom
 Immobilization
 Application of tourniquet
 Cleaning the wound
 Local emetine injection
 Incision and suction at the site
TREATMENT
• Wash the bitten
surface with plain
water without rubbing
• Polyvalent anti-venom
should be given
• Antibiotic & Tetanus
prophylaxis
TREATMENT
• Anti – Venom
 Types
 Specific antivenin
 Polyvalent antivenin
 Strength of polyvalent antivenin is
 1ml will neutralize 0.6mg of dried cobra
venom, 0.45mg of dried krait venom, 0.6mg of
dried russel’s viper venom and 0.45mg of dried
saw-scaled viper venom
TREATMENT
• Neutralize Toxin at Tissue Level
 Neostigmine and atropine administration
in elapid snakebite
 Heparin and fibrinogen in viper snakebite
• Contraindications
 Morphine and alcohol as these depresses
respiratory center
TREATMENT
• General measures
 Artificial respiration
 Blood Transfusion
 Steroids
 Antihistamines
 Antibiotics
 Stimulants are helpful in paralytic cases
 Aspirin short acting barbiturates
TREATMENT
• Anti – Snake Venom (ASV)
 Anti–venom is immunoglobulin (usually the
enzyme refined F(ab)2 fragment of IgG) purified
from the serum or plasma of a horse or sheep
that has been immunized with the venoms of
one or more species of snake
TREATMENT
5 vials(50ml)
5-10 vials
(50-
100ml)
10-20 vials
(100-200ml)
TREATMENT
• Repeat dose of Anti – Snake Venom (ASV)
 Continuing absorption- due to improved blood
supply following correction of
shock, hypovolaemia etc,
 After elimination of antivenom
 A redistribution of venom from the tissues into
the vascular space
TREATMENT
• At the earliest sign of a reaction
 Antivenom administration must be temporarily suspended
 Adrenaline-0.1% solution, 1 in 1,000, 1 mg/ml is the effective treatment for early
anaphylactic reactions
 IV hydrocortisone (adults 100 mg, children 2 mg/kg body weight). The
corticosteroid is unlikely to act for several hours, but may prevent recurrent
anaphylaxis
 Increasing evidence for anti H2 antihistamines-Ranitidine – adults 50
mg, children 1 mg/kg
 Start fluids, inotropes along with IV adrenaline for circulatory collapse-
5-day course of oral antihistamine/ Prednisolone.
Chlorpheniramine: 2 mg six hourly Prednisolone:
5 mg six hourly
Serum
sickness
DON'TS• Tight tourniquets (Tight
band / rope)
• Incisions at the site of
snake
• Local suction
• Application of herbal
medicines, cow
dung, seeds, saliva etc
• Unnecessary delaying
• Always remain cautious, snakes
may silently harbour anywhere
• Ankle boots be used, with
trousers tucked in the socks
• Boots should be shaken before
use
• Remove bushes, shrubs etc
lying close to the buildings
• Alter all sites that provide
cool, damp, dark habitat
• A stick and torch, be used at
night
PREVENTION OF SNAKE BITES
PREVENTION OF SNAKE BITES
• Never reach in to holes or
crevices
• Bedding & clothing should be
thoroughly shaken
• Mosquito nets
• Two feet deep and two feet
wide trench with vertical sides
• The trench or the sleeping
platform should be thoroughly
inspected
• Watch your step; very few
snakes bite unprovoked
WORLD DEADLIEST SNAKES
• Black Mamba
 Most deadly snake
 Located in Africa and is colored dark olive or a dark
brown color with black spotting along its back
 Longest fangs
 Delivers quick multiple bites and flees
 Venom is a cardio toxin and a fully grown Black
Mamba can deliver 100mg to 120mg.
 A lethal dose of a cardio toxin to a human is 10mg to
15mg
WORLD DEADLIEST SNAKES
Black Mamba
• Common Krait
 Located mostly in Southeast Asia
 Normally black with yellow bands around it
 Can go either on land or water
 Affects the nerves and produces a nerve
paralysis.
 Fangs are not very long so has to chew on it’s
pray to induce the venom into the blood
stream
WORLD DEADLIEST SNAKES
Common Krait
• Russell’s Viper
 Located in South Asia
 Light brown with three rows of black or
brown spots bordered by yellow or white
around
 Responsible for the most fatalities
 Highly irritable, coils up before strike
 Damage to the blood cells and tissue
WORLD DEADLIEST SNAKES
Russell’s Viper
• Taipan
 Located in Australia
 Pale creamy color on the head
 Light brown, dark brown, copper, or
olive
 Usually stay away from humans
 Defend itself
WORLD DEADLIEST SNAKES
Taipan
• Cobra
 Located in South Asia
 Hood that pops up behind
 Symbol on the back, looks like eyes
 Either spit venom or bite
 Spiting venom isn’t deadly
 Severe pain and damage to eyes
WORLD DEADLIEST SNAKES
Cobra
A
Q&Q u e s t i o n s
A n s w e r s

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Snakes and snake bites

  • 1. IN THE NAME OF THE MOST BENEFICENT THE MOST MERCIFUL
  • 3.
  • 5. • At least 750,000 species • Three times number of all other animal species combined • Scorpions, spiders, ticks, Insects etc. ARTHROPODS
  • 6. SNAKES  A world free of snakes • Nearly a quarter of us would go hungry • Are important elements in the food chain to control the rodent population- Which destroy all major crops The bottom line is we need snakes to survive
  • 7. • Snakes belong to the order of animals called reptiles • This group also include crocodiles, lizards, and turtles • Snakes maintain a fairly steady body temperature by their behavior • Raise their temperature by lying in the sun or lower it by crawling into the shade SNAKES
  • 8. • Snakes have a long, legless, flexible body that is covered with dry scales • Snake's eyes are covered by clear scales rather than movable eyelids; therefore, their eyes are always open SNAKES
  • 9. • They repeatedly flick out their narrow, forked tongue, using it to bring odors to a special sense organ in the mouth SNAKES
  • 10. SNAKES – EVOLUTION • Early snakes killed their prey using surprise attacks and by suffocating them to death • Snakes evolved a venom as new weapon about 60 million years ago
  • 11. • 3000 species of snakes in the world • 375 are venomous (10 to 15 %) SNAKES
  • 12. WORLD DISTRIBUTION OF SNAKES • Occur practically all over the world, apart from places like Greenland, Iceland, and Antarctica • Most snakes are found in tropical regions
  • 13. SNAKES – HABITAT • Long grass • Shrubs & hedges • Holes & burrows • Shady places like under pre- fabricated construction • Garbage pits
  • 14. SNAKES – COLD BLOODED • Do not have the ability of generating adequate amounts of heat in order to keep their body temperature at a constant level • Dependent on the heat from their surroundings and the sun to control the temperature of their body • Most snake species are found in the humid and warm climes of tropical regions
  • 15. SNAKES – SIZE • Anaconda can grow up to 38 feet in length • Brahminy blind snake is just 2 inches long, making it the smallest snake
  • 16. SNAKES – SENSE OF HEARING • No external ears • Probably deaf to most sounds • Hear by sensing vibrations with their belly scales and lower jaw
  • 17. SNAKES – SENSE OF SMELL • Snakes use their forked tongue to smell • Tongue gathers airborne particles
  • 18. SNAKES – COLOUR • Dull to brilliant with striking patterns • Dull for camouflage • Brightly coloured are usually poisonous • Use bright colours to warn predators • Some non-poisonous snakes mimic the patterns and bright colors of poisonous snakes to fool predators
  • 19. SNAKES – METABOLISM • Slow rate of metabolism • King Cobra can go for months without food
  • 20. SNAKES – MOLTING • We shed small quantities of old skin continuously • Snakes shed their old skins in a continuous sheet (a process called ecdysis)
  • 21. SNAKES – MOLTING • Interval between sheds depends on age, growth rate, environmental factors • Young shed more frequently • Adult snakes shed less often
  • 22. SNAKES – CRAWLING • The type of movement used depends largely on the terrain  Concertina  Serpentine  Side – winding  Rectilinear
  • 23. SNAKES – VENOM • Venom is the toxic saliva produced by the parotid salivary glands of the poisonous snakes
  • 24. • Snake venom is highly modified saliva, and is produced by modified saliva glands • Proteinaceous nature of snake venom was established by Napoleon Bonaparte's brother, Lucien in 1843 SNAKES – VENOM
  • 25. • Proteins constitute the major portion of venom's dry weight–90% or more • Snake venom is a cocktail of hundreds, sometimes thousands, of different proteins and enzymes • Many of these proteins are harmless but a percentage of them are toxins • The makeup of these toxins varies widely from species to species • This complexity accounts for the widely differing effects of snakebite SNAKES – VENOM
  • 26. SNAKES – VENOM • Composition  Fibrinolysins  Proteolysins  Neurotoxins  Cholinestarses  Haemolysins  Thromboplastin  Agglutinins  Cardiotoxins  Hyaluronidase
  • 27. POISON GLANDS AND VENOM EXTRACTION
  • 28. POISON GLANDS AND VENOM EXTRACTION
  • 29. • Venoms are rich in hydrolithic enzymes, a complex mix of polypeptides, nucleases, peptidases, etc ., which help digest the snake's prey • Some of them also enhance or contribute to the toxic effect of the venom SNAKES – VENOM
  • 30. • Hemotoxin (blood toxin)  Hemotoxic venom attacks the circulatory system and muscle tissue causing excessive scarring, gangrene, and sometimes leads to amputation of the affected area  This venom basically destroys tissue and blood cells  In addition to killing the prey, part of the function of a hemotoxic venom for some animals is to aid digestion  The venom breaks down protein in the region of the bite, making prey easier to digest.ex : Vipers SNAKES – VENOM
  • 31. SNAKES – VENOM • Vasculotoxic poison  Enzymatic destruction of cell membranes and coagulation disorders  Result in  Destruction of endothelial cells of blood vessels  Lyses of RBCs  Failure of blood clotting
  • 32. • Neurotoxin (nerve toxin)  Neurotoxic venom attacks the victim's central nervous system and usually result in heart failure and/or breathing difficulties or even total respiratory paralysis. eg: Cobras, Kraits, Coral Snakes SNAKES – VENOM
  • 33. SNAKES – VENOM • Neuro Toxin  Acts on motor nerve  Similar manner to tubocurarine poison  Compete with acetylcholine at nicotinic receptors  Render acetylcholine inactive  Leading to muscular weakness
  • 34. SNAKES – VENOM• Krait- Pre-synaptic action  Beta-bungarotoxin- Phospholipases A2  Inhibiting the release of acetylcholine from the presynaptic membrane  Presynaptic nerve terminals exhibited signs of irreversible physical damage and are devoid of synaptic vesicles  Antivenoms & anticholinesterases have no effect  Paralysis lasts several weeks and frequently requires prolonged MV. Recovery is dependent upon regeneration of the terminal axon
  • 35. SNAKES – VENOM • Krait- Pre-synaptic action 1) Inhibiting the release of acetylcholine from the presynaptic membrane 2) Presynaptic nerve terminals exhibited signs of irreversible physical damage and are devoid of synaptic vesicles 3) Antivenoms & anticholinesterases have no effect
  • 36. SNAKES – VENOM • Myotoxic poison  Muscular pains  Myoglobinuria  Respiratory failure due to muscular weakness
  • 38. CLOBRIDAE • Most numerous snake family • Two third of all snakes in the world • Majority are non-poisonous • Examples — Corn snakes — Rat snakes
  • 39. • Largest (size) snakes in the world • Non-poisonous (Use their strength to constrict and kill prey) • Three largest snakes — African rock python — Reticulated python — Anaconda BOIDAE
  • 40. VIPERIDAE• Poisonous (Haemotoxic - Affects blood) • Body characteristics — Typical triangle shaped head — Folding fangs — Head covered with small scales and nostrils are placed vertically • Examples ─ Copperheads, cottonmouths and rattlesnakes
  • 41. ELAPSIDAE • Poisonous (Neurotoxic - Affects nerves) • Body characteristics — Hollow fixed fangs in the jaw below or in front of the eyes — Do not have the triangle shaped head — Head covered with large scales — Lateral Nostrils • Examples — Cobras, mambas, kraits and the coral snake
  • 42. • 18 feet • Head as large as man’s hand • Hood • Six feet tall
  • 43. HYDROPHIIDAE • Sea snakes • Majority are poisonous (Neurotoxic – Affects nerves) • Examples — Banded sea snake — Yellow bellied sea snake
  • 44. COMPARISON OF POISONOUS & NON-POISONOUS SNAKES
  • 45. COMPARISON OF POISONOUS & NON- POISONOUS SNAKES
  • 46. Scale arrangement Single row Double row COMPARISON OF POISONOUS & NON- POISONOUS SNAKES
  • 47. COMPARISON OF POISONOUS & NON- POISONOUS SNAKES
  • 49. WATER SNAKES • If just the head is showing, it is probably a harmless water snake • Almost all venomous snakes swim with their lungs inflated, leaving the majority of their bodies afloat
  • 50. Characteristic Poisonous Nonpoisonous Shape of head Triangular Round Pit (+) (-) Pupils Elliptical Round Bite marks Fang marks 2 rows of teeth Caudal plates Single row Double row Color body Red ring next to yellow Alternating color Swim in water Most of the body afloat Often only head showing POISONOUS / NON POISONOUS SNAKES
  • 51. POISONOUS SNAKES IN PAKISTAN • Rat Snake (Ptyas mucosus) Local Name: - Dhaman • Indian Python (Python molurus) Local Name: - Azdaha • Indian Cobra (Naja naja) Local Name: - Cobra • Leaf-nosed Viper ( Eristocophis macmahoni) Local Name: - Cobra
  • 52. RISK TO HUMANS • Species and size of the snake • Venom injected • Localization of the bites • Weight & general health of the victim • Sensitivity to the venom • The availability of health facility
  • 53. SIGNS AND SYMPTOMS • Local effects  Fang mark at the site of injection  Intense local pain  Swelling  Oozing out of haemolyzed blood  Blisters may appear
  • 54. SIGNS AND SYMPTOMS• General effects  Haemoglobinuria  Petechial haemorrhages  Bleeding from gums, mucus membranes such as rectum and body orifices  Haemoptysis  Cold, clammy skin  Death due to circulatory failure
  • 55. SIGNS AND SYMPTOMS • Myotoxic  At the site of bite no pain and swelling  Muscle weakness  Ptosis develops  Generalized muscle paralysis  Urine is brown in colour  Respiratory muscle weakness leads to death  Hyperkalemia may result in cardiac failure
  • 56. SIGNS AND SYMPTOMS • Neurotoxic  Lethargy , giddiness , muscular weakness and spreading paralysis  Increased salivation and vomiting  Ptosis and paralysis of extra ocular muscles  Breathing becomes slow and laboured  Patient remains conscious but unable to speak  Finally respiratory paralysis consequently death
  • 57.
  • 58. WHAT TO DO On seeing the Snake • Remain calm and cautious • Get out of the way • Call for help • Use stick to kill the snake by keeping a safe distance and striking the head
  • 59. If you are the Victim • Be calm • Try not to move the effected part much • Call for help • Move away from snake • Prevent further bite • Nearest health facility WHAT TO DO
  • 60. If you are the helper of the Victim • Remain calm • Reassure the victim • Call for help • Move the patient to safety • Evacuate the patient to the nearest health facility • Try to kill the snake with the help of others WHAT TO DO
  • 61. • There are two important aspects of snakebite treatment, one is the first-aid and then the treatment (antivenom serum) TREATMENT – SNAKE BITE
  • 63. TREATMENT • Allaying anxiety and fright • Prevention of spread of venom • Shifting the victim to medical aid center • Use of antivenin
  • 64. TREATMENT • Allaying anxiety and Fright  To prevent the shock due to fright it is desirable to reassure the victim by clarifying that  All snakes are not poisonous  Even poisonous snakes are not fully charged with poison all the time  Even a snake with fully charged with poison does not always inject it’s lethal dose
  • 65. TREATMENT • Prevention of spread of Venom  Immobilization  Application of tourniquet  Cleaning the wound  Local emetine injection  Incision and suction at the site
  • 66. TREATMENT • Prevention of spread of Venom  Immobilization  Application of tourniquet  Cleaning the wound  Local emetine injection  Incision and suction at the site
  • 67. TREATMENT • Wash the bitten surface with plain water without rubbing • Polyvalent anti-venom should be given • Antibiotic & Tetanus prophylaxis
  • 68. TREATMENT • Anti – Venom  Types  Specific antivenin  Polyvalent antivenin  Strength of polyvalent antivenin is  1ml will neutralize 0.6mg of dried cobra venom, 0.45mg of dried krait venom, 0.6mg of dried russel’s viper venom and 0.45mg of dried saw-scaled viper venom
  • 69. TREATMENT • Neutralize Toxin at Tissue Level  Neostigmine and atropine administration in elapid snakebite  Heparin and fibrinogen in viper snakebite • Contraindications  Morphine and alcohol as these depresses respiratory center
  • 70. TREATMENT • General measures  Artificial respiration  Blood Transfusion  Steroids  Antihistamines  Antibiotics  Stimulants are helpful in paralytic cases  Aspirin short acting barbiturates
  • 71. TREATMENT • Anti – Snake Venom (ASV)  Anti–venom is immunoglobulin (usually the enzyme refined F(ab)2 fragment of IgG) purified from the serum or plasma of a horse or sheep that has been immunized with the venoms of one or more species of snake
  • 73. TREATMENT • Repeat dose of Anti – Snake Venom (ASV)  Continuing absorption- due to improved blood supply following correction of shock, hypovolaemia etc,  After elimination of antivenom  A redistribution of venom from the tissues into the vascular space
  • 74. TREATMENT • At the earliest sign of a reaction  Antivenom administration must be temporarily suspended  Adrenaline-0.1% solution, 1 in 1,000, 1 mg/ml is the effective treatment for early anaphylactic reactions  IV hydrocortisone (adults 100 mg, children 2 mg/kg body weight). The corticosteroid is unlikely to act for several hours, but may prevent recurrent anaphylaxis  Increasing evidence for anti H2 antihistamines-Ranitidine – adults 50 mg, children 1 mg/kg  Start fluids, inotropes along with IV adrenaline for circulatory collapse- 5-day course of oral antihistamine/ Prednisolone. Chlorpheniramine: 2 mg six hourly Prednisolone: 5 mg six hourly Serum sickness
  • 75. DON'TS• Tight tourniquets (Tight band / rope) • Incisions at the site of snake • Local suction • Application of herbal medicines, cow dung, seeds, saliva etc • Unnecessary delaying
  • 76. • Always remain cautious, snakes may silently harbour anywhere • Ankle boots be used, with trousers tucked in the socks • Boots should be shaken before use • Remove bushes, shrubs etc lying close to the buildings • Alter all sites that provide cool, damp, dark habitat • A stick and torch, be used at night PREVENTION OF SNAKE BITES
  • 77. PREVENTION OF SNAKE BITES • Never reach in to holes or crevices • Bedding & clothing should be thoroughly shaken • Mosquito nets • Two feet deep and two feet wide trench with vertical sides • The trench or the sleeping platform should be thoroughly inspected • Watch your step; very few snakes bite unprovoked
  • 79. • Black Mamba  Most deadly snake  Located in Africa and is colored dark olive or a dark brown color with black spotting along its back  Longest fangs  Delivers quick multiple bites and flees  Venom is a cardio toxin and a fully grown Black Mamba can deliver 100mg to 120mg.  A lethal dose of a cardio toxin to a human is 10mg to 15mg WORLD DEADLIEST SNAKES
  • 81. • Common Krait  Located mostly in Southeast Asia  Normally black with yellow bands around it  Can go either on land or water  Affects the nerves and produces a nerve paralysis.  Fangs are not very long so has to chew on it’s pray to induce the venom into the blood stream WORLD DEADLIEST SNAKES
  • 83. • Russell’s Viper  Located in South Asia  Light brown with three rows of black or brown spots bordered by yellow or white around  Responsible for the most fatalities  Highly irritable, coils up before strike  Damage to the blood cells and tissue WORLD DEADLIEST SNAKES
  • 85. • Taipan  Located in Australia  Pale creamy color on the head  Light brown, dark brown, copper, or olive  Usually stay away from humans  Defend itself WORLD DEADLIEST SNAKES
  • 87. • Cobra  Located in South Asia  Hood that pops up behind  Symbol on the back, looks like eyes  Either spit venom or bite  Spiting venom isn’t deadly  Severe pain and damage to eyes WORLD DEADLIEST SNAKES
  • 88. Cobra
  • 89. A Q&Q u e s t i o n s A n s w e r s