2. Snakes Bites in Sri Lanka
•
•
•
•
65000 snake bites annually
800 deaths
Fatality- 5 in 100000 population
Dramatic increase in Hospital
admissions
• Acceptance of Western Medical
therapy
• Case fatality rate has been
reduced
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3. 96 species of snakes in Sri Lanka.
Only 5 of the land snakes are considered
potentially deadly.
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7. A 10 years old boy is presented with a swelling
in the R/S ankle complaining of a snake bite
12.15 pm
•While the boy was playing in an abandoned
paddy field, he felt a sharp pain in the R/S ankle.
•When he checked there was bleeding from the
site of pain and there were bite marks.
•Boy didn’t see the snake.
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8. • He was taken home immediately by his brother
lifting on arms.
• They didn’t do anything with the woundwashing, tying tourniquet,etc.
• By the time he reached home, the boy was,
drowsy
vomited (food particles and few drops of fresh blood)
burning type of abdominal pain.
• Taken to ayurvedic prationer nearby.
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9. • After 1 ½ hours after the incident,he was
brought to hospital in three wheeler.
On admission,
• Bite site - Swelling ,Color change,Painful
• No Bleeding nor Bruising.
• No blister formation.
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19. Dos
•Reassure.
•Remove all rings, Bracelets from
bitten parts of the body.
•Wash the bitten area with soap and
water.
•Keep the stricken limb below the
heart.
•Immobilize the bitten limb with splint
or slings.
•Get medical help as quick as possible.
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21. Do Nots
•Don’t panic
•Don’t make any cut, scratch or
incision
•Don’t suck at the wound
•Don’t apply ice packs to the
bitten area.
•Don’t use tight bands or
tourniquet.
•Don’t drink alcohol, take herbal
medicine or Aspirin.
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22. Transport to hospital
• Quickly, but safely and Comfortably
• Minimal Movements avoid systemic absorption
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23. In the ETU
• Rapid Clinical Assessment & Resuscitation.
(ABC)
• Bite site was cleaned with soap and water.
• IV canulae was inserted.
• Blood was taken for 20WBCT
(20 minute whole blood clotting test)
• O.Paracetamol 500mg
• IV Ranitidine 25mg
• Patient was sent to the ward.
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24. Detailed Clinical Assessment
History
• 3 Preliminary Qs
– In which part of the body?
– How long ago?
– Brought the snake? Can describe it?
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28. Common/Indian Krait
නන නන
න නන
න
න
• Oily,shiny,Bluish black appearance
• Paired white bands on the dorsal surface
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29. Sri Lankan Krait
දද දදද
දද දද
• Blackish brown snake with white bands on the
body
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30. Russell’s Viper
දද ද
දද දද
දදද
• Highly poisonous 40% of deaths is due to this snake in
Sri Lanka
• Largest & most widely distributed viper in Sri Lanka.
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31. • “V” shaped white
marking in the head.
• Has 3 rows of black
elliptical markings
running alone the
length.
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33. Saw Scaled Viper
දද දදද
දද දද
ද
• Sandy brown in
colour
• birds foot mark
over the head
• When disturbed, it
rubs the coils
against each other
producing a hissing
noise
(characteristic)
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43. 20 mins Whole Blood Clotting Test
Incoagulable blood is diagnostic of a viper bite
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and rules out an elapid bite
44. Snake Venom Antiserum
• Only specific antidote to snake venom
• most important decision in the management
• IV Immunoglobulin (IgG)
• “polyvalent anti-snake venom serum”
• Covers Cobra, Krait, Russell’s viper, Sawscaled viper.
• Not against Hump nosed viper.
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45. Indications for Antivenom
• Signs of systemic envenomation (ARF,Dark
color urine,Generalized Rhabdomyolysis)
• Haemostatic abnormalities (20WBCT)
• Spontaneus Bleeding
• Neurotoxic signs
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46. Administration of antivenom Serum
• 3 IV lines
• Keep adrenaline ready in a
syringe 0.5mg (1:1000)
• 10 ampoules of AVS
• Each dissolved in 10ml of
water
• 100ml AVS into 200ml of
Normal Saline
• Slow IV infusion for 1 hour
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47. • Watch for any reaction such as,
– Fever ,Chills
– Itching,Urticaria
– Bronchospasms
• If a Early Anaphylactoid reaction occurs ???
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48. •
•
•
•
Stop AVS infusion
Give adrenaline 0.5mg (1:1000) IM
IV Chlorpheniramine 5mg
IV Hydrocortisone 200mg
• Restart AVS after the reaction settled
• In Shock ----> Sub lingual Adrenaline
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49. More Antivenom??
• Persistant or Recurrent Incoagulability by
20WBCT after 6 hours
• Further Deterioration
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51. Treatment of the bitten part
• The bitten limb is nursed in the most
• comfortable position, slightly elevated
• Bullae aspirated only if likely to rupture
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