SNAKES
Snakes
o 2500 - 3000 SPECIES WORLDWIDE
o 500 VENOMOUS SPECIES
o 69 POISONOUS SPECIES IN INDIA(29
SEA,40 LAND)
o DEATH IN TRANSIT, ? TRUE
INCIDENCE
EPIDEMIOLOGY
• India estimates: 200,000 Snake bites and 15-
20,000 deaths per year
• Males:Female::2:1.
• Majority of the bites being on the lower
extremities.
• 50% of bites by venomous snakes are dry
bites. that result in negligible envenomation.
INTRODUCTION
• Cold blooded animals
• No efficient thermoregulatory mechanism(no
sweat glands)
• Venom has digestive enzymes which starts
working even before the prey is swallowed
• They Do not chew but swallow their prey
completely.
LIST OF VENOMOUS SNAKES
Classification Variety of snakes Venomous/
nonvenomous
Viperidae (true viper) •Russell’s viper Haemotoxic
•Echis carinatus
Crotaline (pit viper) Crotalus and Haemotoxic
bothrops
Elapidae Cobra, Krait, Neurotoxic
Mambas
Hydrophinae (sea Beaked sea snakes Myotoxic
snakes)
VENOMOUS SNAKE
Cobra Krait
(NON-VENOMOUS)
(SEMI VENOMOUS)
(VENOMOUS)
Spectacle cobra
Monocle cobra
King cobra
Common krait
Banded krait
Russell viper
Venomous
Monocled cobra
(naja kauthia)
KING COBRA
(ophiofagas hana)
BANDED KRAIT
(Bungarus faciatus)
RUSSELLES VIPER
Venomous
OTHER SNAKES
There are other
venomous snakes in India
Pit Vipers
Coral snakes
sawscale viper
THE INDIAN COBRA
Encountered all over India
during day and night
Often found around or in
human habitation
The Common KRAIT
THE COMMON KRAIT
Paired white lines
Found all over India
Most venomous land
snake
Effective dose
DOSE
TIME
• Spectacled cobra 15 mg 7 – 8 hrs
• Monocled cobra 15 mg 7 - 8 hrs
• King cobra 12 mg 5 -6
hrs
• Banded krait 10 mg 4 hrs
• Common krait 1-3 mg 2 ½ hrs
• Russells viper 42 mg 3 days
Venomous snake
Russell viper Saw scaled viper
Anatomy- Male
SNAKE VENOM
• Combination of Enzymes & Non-Enzymatic
polypeptides.
• -Acidic
• -Sp Gravity: 1.030-1.070
• -On drying- Fine needle like crystals.
• -Water Soluble
• -Lethal Dose:
• Cobra-15mg, Krait- 10mg, Russell’s V-42mg
Equipments for handling snake
Snake hook Snake tongs
Handling of snake
Transparent tubes with
Stackable snake cage
holes
Diagnosis of snake bite
• FANG MARKS: classically, two puncture
wounds seperated by a distance varying
from 8mm to 4cm, depending on the
species involved.
• However a side swipe may produce only a
single puncture,while multiple bites
could result in numerous fang marks.
EFFECTS OF ENVENOMATION
• Local effects
• Systemic effects:
• - Neurotoxic.
• - Haemotoxic.
• - Cardiotoxic.
• - Myotoxic
Clinical features: ELAPID BITE
(Krait,Cobra)
• Local features :
• indistinct fang marks ,
• burning pain,
• swelling and discolouration,
• serosanguinous discharge
ELAPID BITE (Krait,Cobra): Neurotoxicity
• pre-paralytic stage : emesis,
• headache,
• LOC.
• paralytic stage :
• ptosis,
• ophthalmoplegia
• drowsiness,
• dysarthria,
• dysphagia,
• convulsions,
• bulbar paralysis,
• respiratory failure .
COBRA envenomation
Cardiotoxicity
• Cardiac Depression
• Cardiogenic/Vasogenic Shock
• Systolic cardiac arrest
VIPER BIITE
• Local features:
• Rapid swelling,
• discolouration,
• blister formation,
• bleeding from bite site,
• severe pain
• Systemic features(Haemotoxic)-
• Generalised bleeding manifestations.
• epistaxis,
• hemoptysis,
• bleeding gums
• hematuria
• purpuric spots
• Renal failure
HYDROPHID BITE (sea snake)
Myotoxic
• Local features: minimal swelling and
• Pain
• Systemic features:
• Myalgia,
• Muscle stiffness,
• Myoglobinuria , renal tubular necrosis.
MANAGEMENT OF SNAKE BITE
• First aid treatment
• Transport to hospital
• Rapid clinical assessment and resuscitation
• Detailed clinical assessment
• species diagnosis
• Investigations/laboratory tests
• Antivenom treatment
• Observing the response to antivenom
• Deciding whether further dose(s) of antivenom
are needed
• Supportive/ancillary treatment
• Treatment of chronic complications
FIRST AID
In Cobra and Krait bites, the
victim may stop breathing.
They are not dead, start
Artificial Respiration
This can be Life Saving
FIRST AID
Do not give incision or
attempt to suck out venom as
it is ineffective at removing
venom; and in Viper bites will
cause serious bleeding.
FIRST AID
• Reassure the victim who may be very
anxious
• Immobilize
• Pressure pad
• Avoid any interference with the bite
wound (incisions, rubbing, vigorous
cleaning, massage, application of herbs or
chemicals
RAPID CLINICAL ASSESSMENT AND
RESUSCITATION
• Airway
• Breathing (respiratory movements)
• Circulation (arterial pulse)
• Disability of the nervous system (level of
consciousness)
• Exposure and environmental control
(protect from cold, risk of drowning etc.)
DETAILED CLINICAL ASSESSMENT AND
SPECIES DIAGNOSIS
• History taking
• Snake identified as a very dangerous one.
Investigations/laboratory tests
• 20-minute whole blood clotting test
(20WBCT)
• CBC
▫ Haemoglobin concentration/haematocrit
▫ Platelet count
▫ WBC count
• Biochemical
▫ Potassium
▫ Creatinine
▫ urea or blood urea nitrogen levels are
raised in the renal failure
• Arterial blood gases and pH- acidaemia
(respiratory or metabolic acidosis).
• Urine examination
TREATMENT
• Antisnakevenom treatment(ASV)-
Intravenously
• Common Krait- initial dose 100ml
• Saw scaled viper- initial dose -50ml
• Indian cobras- initial dose 100 ml
• Western Russell’s viper – initial dose
100ml
Criteria for giving more antivenom
• Persistence or recurrence of blood
incoagulability after 6 hours or of
bleeding after 1-2 hours.
• Deteriorating neurotoxic or
cardiovascular signs after 1-2 hours.
• THANK YOU
