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Snake Bites

Important families of venomous snakes


Elapidae

Arabian cobra, which has neurotoxic effects leading to bulbar and respiratory paralysis saw scaled vipers (the most common snakes in Saudi Arabia), which cause severe homeostatic disturbance

Viperidae

Venom : it is a special category of toxic substance that secreted by secretory glands of animals.
Snake venom is a highly modified saliva which is

produced by a modifies salivary glands.


It is composed of a mixture of proteins, including enzymes and non enzymatic substances. Enzymatic lead to destruction of skin, connective tissues, muscles local effect Non enzymatic has remote effect cardiotoxic, neurotoxic, haemorragic and hemolytic

Degree of Toxicity depends up on:


Potency of the venom The location of the bite The snake species and size Amount of venom injected The victim's age and size Whether one or two fangs penetrated the skin. 7. Whether there were repeated strikes
1. 2. 3. 4. 5. 6.

Hematologic toxicity
Many snake venom produce anticoagulant effect by interfering with activation of clotting factors Local features: Puncture marks rapid swelling discolouration blister formation bleeding from bite site severe pain Generalised bleeding manifestations epistaxis hemoptysis bleeding gums hemauria Hemolysis lead to Renal failure

Neurologic Toxicity

Local features : burning pain, swelling,discolouration serous discharge

Systemic features: curare like & cranial nerve affection preparalytic stage : emesis, headache

paralytic stage

ptosis, ophthalmoplegia drowsiness dysarthria dysphagia convulsions bulbar paralysis resp failure.

Cardiovascular Toxicity
Hypotension and or cardiovascular shock These effects may be due to release of mediators, increased capillary permeability and reduced cardiac output

Renal Toxicity
Acute renal failure may develop due to either direct venom action or as a complications of anticoagulant effect, cardiovascular shock or hemolysis.

Diagnosis of Snake Bite


FANG MARKS: classically, two puncture wounds separated 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.

First aid

Management of snake bite


treatment resuscitation

Transport to hospital Rapid clinical assessment and

Investigations/laboratory tests
Antivenom treatment Supportive treatment Treatment of Treatment of

the bitten part chronic complications

FIRST AID
Assurance of the bitten person. Immobilize the bitten area & keep it

lower than heart level.

Useless or Dangerous Methods


Applying a bandage Making

local incisions the wound

Attempts to suck the venom out of Electric shock Topical application of

chemicals, herbs or ice packs.

CLINICAL ASSESMENT
VITAL SIGNSPULSE

--B P --RESPIRATION OBSERVE BITE MARK --LOCAL REACTION SYSTEMIC MAINFESTATIONS

# Lab. Investigations
Haematologicalleucocytosis(>20,000severe envenomation) thrombocytopenia evidence of hemolysis prolonged CT,PT,PTT

ECG: bradycardia

Urine

hematuria, proteinuria, Hburia Renal : urea, creatinine. Chest XR : pulm.edema intrapulm.Hgs pleural effusion Immunodiagnosis: by immunoassay techniques

Antivenom Treatment
Antivenom is an immunoglobulin purified from the

serum or plasma of a horse or sheep that has been immunised with the venoms of one or more species of snake.
Monovalent

or monospecific antivenom neutralises the venom of only one species of snake. the venoms of several different species of snakes

Polyvalent or polyspecific antivenom neutralises

Antivenin has been started Choice of it , its route, amount (depend on species, site and size of person) e.g.

polyvalent antivenin for vipers.


Sensitivity test should be done

It should be given within 24 hrs of bite.

Two kinds of allergic reactions to antiserum:


ANAPHYLAXIS

a type 1 hypersensitivity reaction

SERUM SICKNESS

a type 4 hypersensitivity reaction

ANAPHYLAXIS
A very serious fatal reaction

Foreign antigen (horse protein) reacts with

IgE in basophils and mast sells.


Release histamine and other mediators. Cause

smooth

muscle

contraction:

wheezing and GI symptoms.

Vasodilation: cardiovascular collapse.


Escape of

plasma into tissues: urticaria,

angioedema.
Escape

of

fluid

into alveoli: pulmonary

oedema.
Arrhythmias and cardiogenic shock.

TREATMENT:
Stop ANTIVENOM. ADRENALINE SLOWLY IV. Give intravenous fluids as fast as necessary

to restore blood pressure.


In severe bronchospasm: Aminophylline

Oxygen mask. Intubation or tracheostomy if necessary. If cardiac arrest occurs CPR and electrical

cardio version.
Observe in hospital for 24 hours after

recovery.

SERUM SICKNESS:
7 to 14 days after antivenom.
Skin rashes, angioedema, glandular swelling and joint

pains.
Develops because of antibodies formed against horse

serum.
TREATMENT: Antihistamine and steroids

SUPPORTIVE CARE
ANTIBIOTICS AND ANTI-TETANUS

CORTICOSTEROID FRESH BLOOD PREVENTION, TREATMENT OF HYPOTENSION PRVENTION OF SHOCK

Scorpion Sting ENVENOMATION

Mechanism of toxicity
The venom contains numerous digestive enzymes and several neurotoxins. These neurotoxins can cause alterations in sodium channel flow, resulting in excessive stimulation at neuromuscular junctions and the autonomic nervous system (autonomic storm).

Clinical presentation
Most stings result only in local manifestations: burning pain local tissue inflammation numbness and local paresthesis.
In some victims, especially children under age 10 years, Severe pain may be followed by sweating, restlessness Diplopia, nystagmus Vomiting, muscle fasciculation, fever Hypertension, tachycardia Convulsion, paralysis and respiratory arrest.

Diagnosis
The diagnosis is essentially clinical. Due to the quick and intense local pain, the scorpion is often noticed laboratory often shows leukocytosis

Treatment
Healthy adults may not need further treatment. First Aid:
Wash the wound with soap and water.
Apply cold compresses to the affected area to decrease

the pain and slow the venom's spread. This is most effective in the first two hours after a sting occurs.
Try to stay calm so that the poison spreads more slowly.

If available, apply a cortisone cream or antibiotic ointment.


Avoid using narcotic pain medications, which can suppress

breathing.

Specific drugs and antidotes


An antivenom best to give within 4 hrs extended to 24 hrs.
Scorpion's toxin is poor antigen so the antibodies produced against it, unlike in snakes, usually is so specific so that each species requires a different antivenom.

Emergency and supportive measures


1. Local severe pain by xylocaine as local anesthesia, oral NSAID and diazepam to relief pain. 2.Maintain an open airway and assist ventilation if necessary. 3.Treat hypertension, tachycardia, and convulsions 4. Do not over treat with excessive sedation. 5. Clean the wound and provide tetanus prophylaxis. 6. Do not perform local incision or suction.

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