SNAKES

DR.VISHNU I V
ASSISTANT PROFESSOR
DEPARTMENT OF FORENSIC MEDICINE
TMC, KOLLAM
 TAXONOMY OF SNAKES

1. VIPERIDAE

• RUSSEL'S VIPER

• SAW SCALED VIPER

• PIT VIPER – HEAT SENSITIVE PIT IS SEEN IN BETWEEN EYE AND NOSTRILS
2. CROTALIDAE
RATTLE SNAKES
3. ELAPIDAE – ALL THE DEADLIEST SNAKES
• COBRA

• KING COBRA (OPHIOPHAGUS HANNA)

• COMMON KRAIT

• BANDED KRAIT

• MAMBAS

• TAIPEN

• TIGER SNAKES
4. HYDROPHIDAE – SEA SNAKES- MYOTOXIC VENOM

5. COLUBRIDE – LARGEST FAMILY – MOSTLY NON POISONOUS SNAKES

E.G. RAT SNAKES, TREE SNAKES

6. ATRACTASPIDAE - NON VENOMOUS SNAKES

E.G. BURROWING ASPS

7. BOIDAE – BOAS AND PYTHONS

 HOW TO DIFFERENTIATE BETWEEN POISONOUS
AND NON-POISONOUS SNAKES

• There are a few steps to determine a snake is whether poisonous or

non-poisonous
• First step is the examination of body scales
• Others include: Examination of the pupil, fangs, bite mark, tail,
habitat etc.
 DIFFERENTIATE BETWEEN POISONOUS AND NON-
POISONOUS SNAKES

• If The Belly Scales are small – NON POISONOUS

• If The Belly scales are large but not covering the entire width – NON POISONOUS

• If The Belly Scales are Large and entirely covering the width – EITHER NP OR P, then

LOOK FOR HEAD SCALES

NON POISONOUS

Either poisonous or
non poisonous
• If the head scales are small – VIPER {exception – pit viper}
• If the head scales are large – POISONOUS OR NON POISONOUS SNAKES

Then, look for special arrangement of head scales

head scales are small- viper
Large head scales and if there is an opening or pit between
the eye and nostril- pit viper

heat sensitive pit is seen in between eye and nostrils

 special arrangement of head scales
Large head scales and if the 3rd supra labial scale touches the eye and nasal shield - cobra

cobra

3rd supra labial scale

3rd supra labial scale doesn’t touches the eye and nasal s
Hence not cobra- its rat snake
• Large head scales – no pit, 3rd supra labial does not touch the eye and nasal
shield, then look for scales of under-surface of mouth.

Undersurface of the mouth having four infra-labial scales and the

fourth being the largest one - krait
 ADDITIONAL FEATURE OF KRAIT

• Dorsal row in the back are large and hexagonal

 DIFFERENCE BETWEEN P AND NP SNAKES
poisonous Non-poisonous

Belly scales - Cover entire breadth of belly Small scales

May or may not cover the entire breadth of belly

Head scales

Vipers-small

Pit vipers have a pit between eye and nostril

Cobra, third supra labial touches eye and nasal Large head scales
shields

Krait large shields

 OTHER TRAITS
poisonous Non-poisonous

Fangs - Are like hypodermic needles or grooved Short and solid

Tail - Compressed Not compressed

Habitat - Nocturnal Not so

Bite marks - Two fang marks 4 - 5 cm apart Multiple teeth marks

with or without marks of other teeth

Tail plate
Not divided divided
Exception - cobra
TAIL PLATE
divided- non-poisonous Not divided- poisonous- rattle snake
 SNAKES II
IMPORTANT SNAKE
SPECIES
 COBRA ( NAJA NAJA)

• IDENTIFICATION
o HOOD
o SPECTACLE MARK
o 3RD SUPRA LABIAL SCALE TOUCHES EYE AND NASAL SHIELD.
o ROUND PUPIL
o DIVIDED TAIL PLATE

• VENOM – NEUROTOXIC

• FANGS – TRUE FANGS, GROOVED SHORT AND FINE

 COBRA

Single Spectacle mark

grooved short and fine

Double Spectacle mark
 SIGNS AND SYMPTOMS OF
OPHITOXAEMIA

OPHITOXAEMIA IS POISONING BY SNAKE VENOM

• LOCAL SYMPTOMS- MINIMAL
• REDDISH WHEAL
• TENDERNESS, RADIATING BURNING PAIN
• OOZING OF BLOOD STAINED FLUID
• SWELLING MINIMAL OR ABSENT
• SYSTEMIC SYMPTOMS
• STARTS WITHIN 30 MTS
• PTOSIS AND WEAKNESS OF LIMBS ARE THE EARLIEST NEURO-
PARALYTIC MANIFESTATIONS
• PROGRESS TO PARALYSIS OF LIMBS AND STRABISMUS
• PARALYSIS PROGRESS TO TRUNK AND FACIAL MUSCLES
• RESPIRATORY ARREST OCCURS EITHER DUE TO OBSTRUCTION
OF PARALYZED TONGUE OR ASPIRATION OF VOMITUS OR DUE
TO PARALYSIS OF DIAPHRAGM AND INTERCOSTAL MUSCLES
 COMMON KRAIT (BUNGARUS CAERULUS)
• IDENTIFICATION FEATURES

• STEEL BLUE BODY

• HEAD IS COVERED BY LARGE SCALES
• UNDERSURFACE OF THE MOUTH HAVING FOUR INFRA-
LABIAL SCALES AND THE FOURTH BEING THE LARGEST ONE
• SCALES IN CENTRAL ROW ON THE BACK ARE LARGE AND
HEXAGONAL
• SINGLE OR DOUBLE WHITE BANDS ACROSS THE BACK AND
IS ABSENT IN THE NECK.
 double white bands

Hexagonal back rows

Hexagonal back rows
ONE IS POISONOUS AND THE OTHER IS NOT?
• VENOM – NEURO TOXIN
• CLINICAL FEATURES SIMILAR TO COBRA VENOM Local symptoms- minimal
Ptosis
 BANDED KRAIT(BUNGARUS FASCIATUS)

• IDENTIFICATION FEATURES
• BLACK AND YELLOW ALTERNATING CROSS-BANDS
• A BLACK MARK ON THE NECK WHICH SPREAD TO EYES
• HEXAGONAL SCALES
• UNDERSURFACE OF THE MOUTH HAVING FOUR INFRA-LABIAL SCALES AND THE
FOURTH BEING THE LARGEST ONE.

• VENOM - NEURO TOXIC

• SYMPTOMS SIMILAR
 RUSSELL’S VIPER( VIPERA RUSSELLI)
• IDENTIFYING FEATURES
• TRIANGULAR HEAD
• BODY IS ROUND AND TAIL IS SHORT
• BROAD BELLY SCALES
• SMALL HEAD SCALES
• V SHAPED MARK ON THE HEAD WITH ITS APEX POINTING FORWARDS
• BODY HAS THREE ROWS OF DIAMOND SHAPED BLACK OR BROWN SPOTS
• OUTER TWO ROWS OF SPOTS ARE LINED WITH WHITE LINE

• VENOM – HEMOLYTIC
three rows of diamond shaped black spots

V shaped mark on the head with its apex pointing

forwards
 OPHITOXAEMIA

• LOCAL SYMPTOMS
• AREA AROUND BITE IS RED AND EXTREMELY PAINFUL

• SWELLING OF THE BITTEN AREA WITHIN 15 MIN

• OOZING OF BLOOD STAINED FLUID

• PERSISTENT BLEEDING FROM BITE SITE

• BLISTERS APPEARS IN 12 HOURS IN AND AROUND BITE SITE.

• SPREAD TO CELLULITIS OF WHOLE LEG OR TO THE TRUNK

• NECROSIS OF SKIN, SUB-CUTANEOUS TISSUES AND MUSCLES

• SUPPURATION, SLOUGHING AND MALIGNANT EDEMA

Marked Local symptoms
• SYSTEMIC SYMPTOMS
• CYTOLYSIS OF VASCULAR ENDOTHELIAL CELLS
• LYSIS OF RBC AND OTHER TISSUE CELLS
• RESULT IN COAGULATION DISORDERS AND VERY LOW LEVEL OF
FIBRINOGEN
• BLEEDING AND CLOTTING TIME PROLONGED
• PETECHIAL HEMORRHAGES
• INTRA CRANIAL HEMORRHAGES
• SUB-CONJUNCTIVAL HEMORRHAGES
• EPISTAXIS
• HEMOPTYSIS
• GUM BLEEDING
• INTRA-VASCULAR HEMOLYSIS
Gum bleeding
• HEMOGLOBINURIA
• RENAL FAILURE
• HEMATURIA
• HEMORRHAGE INTO GIT
• PARALYSIS AND NEUROLOGICAL SYMPTOMS RARE
• DEATH IS DUE TO SHOCK AND HEMORRHAGE
 SAW-SCALED VIPER( ECHIS CARINATA)

• IDENTIFYING FEATURES
• BROWN SCALES
• TRIANGULAR HEAD AND SMALL HEAD SCALES
• UPPER SURFACE OF HEAD HAVING A WHITE MARK
RESEMBLE BIRDS FOOT
• BODY IS COVERED WITH A WHITE WAVY LINE ON EACH
FLANK
• DIAMOND SHAPED AREAS BETWEEN THESE LINES
white mark resemble birds foot white wavy line
 DIFFERENCE BETWEEN COBRA BITE AND VIPER BITE

Trait Cobra bite Viper bite

Wound area Tender with slight burning pain Pain and oozing of blood stained
Minimal fluid

Swelling Minimal Extent to whole limb

Venom Neurotoxic Hemotoxic

Speech & deglutition Difficult Not affected

Paralysis Present Absent

 COBRA BITE AND VIPER BITE
Ptosis Present Absent

Pupils Normal Dilated & not reacting to light

Blood pressure Normal Hypotension

BT & CT Normal Prolonged

Hemorrhage Not present Prominent feature

Cause of death Respiratory failure Shock and hemorrhage

 SEA SNAKES( HYDROPHIDAE)
• PADDLE SHAPED FLAT TAILS
• PROMINENT NOSTRILS ON THE TOP OF THE
HEAD
• VENOM – MYOTOXIC
• PARALYSIS OF SKELETAL MUSCLES
• DEATH – PARALYSIS OF RESPIRATORY MUSCLES
OR CARDIAC ARREST
Paddle shaped flat tail
 SNAKE VENOM

❖SNAKE VENOM IS THE SALIVA OF THE SNAKE

❖IT IS A MIXTURE OF TOXALBUMIN AND ENZYMES IN VARYING

PROPORTION

❖VENOM OF DIFFERENT SPECIES VARY IN COMPOSITION,

TOXICITY, AND ANTIGENIC STRUCTURE

❖IT CONTAINS ENZYMATIC AND NON-ENZYMATIC

COMPONENTS
 COMPONENTS OF SNAKE VENOM

ENZYMATIC COMPONENTS – CAUSES THE LOCAL AND SYSTEMIC EFFECTS

1. PROTEOLYTIC ENZYMES – IT DIGEST TISSUE PROTEINS CAUSES TISSUE

DAMAGES

2. PROTEINASES – DIGEST PROTEINS

3. HEMOLYSINS - IT ACT LOCALLY AT THE BITE SITE CAUSING HEMORRHAGIC

EDEMA. IT CAUSE SYSTEMIC BLEEDING

4. CYTOLYSINS – LYSIS OF CELL MEMBRANE OF BLOOD CELLS AND TISSUE

5. PHOSPHOTIDASE – HEMOLYSIS

6. AGGLUTININS – AGGLUTINATION OF RED BLOOD CELLS

7. LECITHINASE – DESTRUCT LIPID LAYERS OF THE ENDOTHELIAL CELLS

8. NEUROTOXINS – A MAJOR CONSTITUENT IN ELAPID VENOM

9. CHOLINE ESTERASE – HYDROLYSES ACETYLCHOLINE TO CHOLINE AND

ACETIC ACID – NMJ IMPAIRMENT

10. CARDIOTOXIN – TOXIC TO HEART

11. PHOSPHOLIPASE – DESTRUCT PHOSPHOLIPIDS IN NERVOUS TISSUE AND ALTERS
NM CONDUCTION

12. HYLARONIDASE – HELPS IN RAPID SPREAD OF VENOM. SEEN IN ALL TYPE OF

VENOM

13. RIBONUCLEASE AND DEOXYRIBONUCLEASE – RAPID SPREAD OF VENOM

14 . OPHIOXIDASE – HELPS IN AUTOLYSIS

NON ENZYMATIC COMPOUNDS

❖PEPTIDES AND POLYPEPTIDES – LETHALITY TO THE POISON
 FATAL DOSE OF SNAKE VENOM
(DOSE IN TERMS OF DRY WEIGHT OF VENOM)
❖KRAIT VENOM - 6 MG
❖COBRA VENOM – 12MG
❖RUSSEL’S VIPER – 15 MG
APPROXIMATE AMOUNT OF VENOM INJECTED IN A SINGLE
BITE
❖COBRA- 170 TO 325MG
❖RUSSEL’S VIPER – 130 TO 250 MG
❖SAW SCALED VIPER- 20 TO 35 MG
❖KRAIT – 20 MG
 MANAGEMENT OF SNAKE BITE

❖1. FIRST AID

❖2. HOSPITAL MEASURES

▪ DIAGNOSIS
▪ SPECIFIC ANI DOTE
▪ CARE OF THE BITE SITE
 1. FIRST AID
❖ASSURE THE PATIENT- VERY IMPORTANT
❖TOURNIQUET THE LIMB
❖PRESSURE IMMOBILIZATION
▪ IT DELAY THE SPREAD AND ABSORPTION OF POISON
▪ TIE A BROAD FIRM BANDAGE JUST AROUND THE BITE SITE
▪ IT SHOULD BE TIGHT ENOUGH TO OCCLUDE THE SUPERFICIAL VEINS
BUT NOT TO THE ARTERIAL OR DEEP VEINS
❖Tourniquet the limb ❖Pressure immobilization
❖PRESSURE IMMOBILIZATION IS NOT RECOMMENDED IN VIPER
VENOM

❖CLEAN THE WOUND WITH SOAP AND WATER

❖IMMOBILIZE THE LIMB TO DELAY THE SPREAD OF VENOM

❖TRANSFER THE PATIENT TO THE HOSPITAL

 2. HOSPITAL MEASURES

❖DIAGNOSIS
▪ HISTORY
▪ BITE MARK
▪ CLINICAL FEATURES
▪ INVESTIGATIONS
❖MANAGEMENT
❖INVESTIGATIONS
▪ BT,CT TEST – MAY BE PROLONGED
▪ WOUND SWABS – CONTAIN SNAKE VENOM ANTIGEN
▪ HEMOGRAM, RFT, SERUM AMYLASE AND CPK, URE TO CHECK SYSTEMIC
ENVENOMATION
▪ ECG, EEG
▪ EIA,ELISA, RIA – IMMUNOLOGICAL DETECTION OF SNAKE VENOM ANTIGEN.
RADIOIMMUNOASSAY IS MOST SENSITIVE AND SPECIFIC TEST. IT CAN DETECT
VENOM LEVELS OF 0.4 MICRO/L
 MANAGEMENT

❖SPECIFIC ANTIDOTE- ANTI SNAKE VENOM

▪ IT IS OF TWO TYPES – POLYVALENT ANTI-SNAKE VENOM ( PAV)
OR MONOVALENT SPECIFIC ANTIVENOM

❖SUPPORTIVE MEASURES
 ANTI SNAKE VENOM

❖POLYVALENT ANTI-SNAKE VENOM ( PAV) OR MONOVALENT SPECIFIC

ANTIVENOM
❖MONOVALENT SPECIFIC ANTIVENOM- IT CONTAINS SPECIFIC ANTIBODY
THAT WILL NEUTRALIZE THAT PARTICULAR VENOM.
❖IN INDIA ONLY POLYVALENT ANTI SNAKE VENOM IS IN USE, BECAUSE:
▪ IT IS MORE COST EFFECTIVE COMPARED TO MONOVALENT

▪ AVAILABILITY

▪ DIFFICULTY IN IDENTIFYING THE SNAKE

 PREPARATION

ANTIVENOM IS AN IMMUNOGLOBULIN PURIFIED FROM THE SERUM/PLASMA OF A HORSE OR

SHEEP THAT HAS BEEN IMMUNIZED WITH THE VENOMS OF ONE OR MORE SPECIES OF SNAKES
 POLYVALENT ANTI-SNAKE VENOM
AGAINST FOUR COMMON POISONOUS SNAKES – BIG FOUR SNAKES OF INDIA
EACH MILLILITER OF POLYVALENT ANTI-SNAKE VENOM ( PAV) CAN NEUTRALIZE THE VENOMS OF THE FOLLOWING SPECIES OF
SNAKES

1. COBRA ( 0.6MG OF DRIED COBRA VENOM)

2. COMMON KRAIT ( 0.45 MG OF DRIED COMMON KRAIT VENOM)

3. RUSSEL VIPER ( 0.6 MG OF DRIED RUSSEL'S VIPER VENOM)

4. SAW SCALED VIPER(0.45 MG OF DRIED SAW-SCALED VENOM)

 INDICATION OF ASV

➢ ASV SHOULD NOT BE USED INDISCRIMINATELY BECAUSE IT CARRIES A RISK OF

SEVERE ADVERSE REACTIONS, AND IS COSTLY AND MAY BE IN LIMITED SUPPLY.
➢INDICATIONS
✓SNAKE IDENTIFIED IS A VERY POISONOUS ONE
✓RAPID EARLY EXTENSION OF SPREAD OF SWELLING FROM THE BITE SITE
✓EARLY SYSTEMIC SYMPTOMS
✓EARLY SPONTANEOUS SYSTEMIC BLEEDING
✓PASSAGE OF DARK BROWN URINE
❖CONTRAINDICATIONS: THERE IS NO ABSOLUTE CONTRAINDICATION
TO ASV TREATMENT.

❖SNAKES INJECT THE SAME DOSE OF VENOM INTO CHILDREN AND

ADULTS. CHILDREN MUST THEREFORE BE GIVEN EXACTLY THE SAME
DOSE OF ASV AS ADULTS.
 DOSAGE OF ASV
DEPENDS UPON THE SEVERITY OF ENVENOMATION
1. MILD ENVENOMATION – MINIMAL LOCAL REACTIONS, NO SYSTEMIC
EFFECTS – 5 VIALS OF ASV
2. MODERATE ENVENOMATION – SWELLING PROGRESSING BEYOND
THE SITE OF BITE MARK WITH SYSTEMIC REACTIONS – 5 TO 10 VIALS
3. SEVERE ENVENOMATION – SEVERE LOCAL AND SYSTEMIC
SYMPTOMS – 10 TO 20 VIALS
 ASV ADMINISTRATION
❖EACH VIAL IS RECONSTITUTED WITH 10ML OF SALINE OR DEXTROSE
OR STERILE WATER AND ADMINISTER AS SLOW IV
➢ONE VIAL EVERY 10 MIN OR
➢SLOW IV INFUSION AS DILUTED IN 500ML OF NS 0R D5 OVER A
PERIOD OF ONE HOUR.
 20 MINUTES BLOOD CLOTTING TEST
❖IT IS A QUICK BED SIDE TEST, DONE TO DETECT THE EFFECTIVENESS OF ANTI-VENOM
THERAPY.

❖A FEW ML OF FRESHLY SAMPLED VENOUS BLOOD IS PLACED IN A CLEAN TEST TUBE

AND LEFT UNDISTURBED FOR 20 MINUTES

❖AFTER 20 MINUTES, IF THE BLOOD STILL FLOATS WHICH MEANS BLOOD IS IN-
COAGULABLE AND REQUIRE MORE ANTI-VENOM.

❖RE ADMINISTER ASV - REPEAT THE TEST AFTER 6 HOURS.

 INDICATIONS OF CESSATION OF ASV
ADMINISTRATION

1. NORMALIZATION OF CLOTTING TIME

2. NORMALIZATION OF BLOOD PRESSURE

3. STOPPAGE OF BLEEDING

4. IMPROVEMENT OF NEURO-PARALYTIC MANIFESTATIONS

 ASV REACTIONS

➢20 % PATIENTS
1. EARLY ANAPHYLACTIC REACTIONS – ITCHING, URTICARIA,
BRONCHOSPASM, SHOCK
2. PYOGENIC REACTIONS – FEVER WITH CHILLS
3. LATE REACTIONS – AFTER FEW DAYS- FEVER, NAUSEA,
VOMITING, DIARRHEA, URTICARIA, ARTHRALGIA, MYALGIA,
LYMPHADENOPATHY ETC.
 SUPPORTIVE MEASURES
❖ANALGESICS & SEDATIVES
❖TT AND BROAD SPECTRUM ANTIBIOTICS
❖BLOOD TRANSFUSION
❖VOLUME EXPANDERS
❖VENTILATORY SUPPORT
❖DIALYSIS IF RENAL FAILURE SETS IN
❖SURGICAL CARE OF THE BITE SITE
 POST MORTEM APPEARANCE
❖BITE MARKS
▪ POISONOUS SNAKES LEAVE TWO FANG MARKS (OCCASIONALLY ONE) SLIGHTLY
SEPARATED FROM EACH OTHER AND ALSO SMALL MARKS OF OTHER TEETH
▪ THE BITE MARKS ARE 1–1.5 CM DEEP IN COLUBRINE AND 2.5 CM DEEP IN VIPERINE BITES.

❖IN VIPER BITE- SWELLING, CELLULITIS ABOUT THE MARK, AND HEMORRHAGES
OCCUR FROM THE PUNCTURE SITE. INTERNAL ORGANS MAY SHOW
HEMORRHAGE
❖IN ELAPID BITE – LOCAL FINDINGS ARE LESS. INTERNAL ORGANS MAY SHOW
SIGNS OF ASPHYXIA
 M.L.I

1. POISONING IS USUALLY ACCIDENTAL.

2. OCCASIONALLY A MURDER IS COMMITTED BY THROWING A

POISONOUS SNAKE ON THE BED OF SLEEPING PERSON.

3. IT IS VERY RARELY USED FOR SUICIDE.