Professional Documents
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POISONOUS SNAKES
POISONOUS
NON POISONOUS
Head scales : small Large and opening / pit b/w eye & nostril (pit viper) Teeth : 2 Loong fang
INDIAN COBRA
KING COBRA
Common Krait
GRADES OF ENVENOMATION
GRADE Non-envenomated FEATURES Presence of fang marks without local / systemic reactions Local swelling & pain without systemic reaction Extensive local effects with minima systemic effects
GRADES OF ENVENOMATION
GRADE Severe envenomation FEATURES Extensive local effects & maximal systemic effects
BITES BY ELAPIDS
Generally cause minimal local effects Swelling, local pain & local necrosis ( cobra ) Descending paralysis, initially of muscles innervated by cranial nerves commencing with PTOSIS, DIPLOPIA, OPHTHALMOPLEGIA Numbness around lips & mouth, progressing to pooling of secretions, bulbar paralysis & resp.failure Paradoxical resp intercostal muscle paralysis Stomach pain ( Krait ) submucosal hage in stomach Krait bites present in early morning with paralysis can be mistaken for STROKE .
BITES BY VIPERIDAE
Severe local effects as early as within 15 min of bite Extensive swelling spreading quickly to involve whole limb. Asso with blistering , necrosis & regional tender lymphadenopathy. Hemostatic persistant ooze & bleeding from venepuncture sites, fang marks & later bleeding from gums, epistaxis, petechiae, purpura & ecchymoses Abdominal tenderness gi / retroperitoneal bleed Passage of reddish / dark brown urine / diminishing / nil urine output.
HYDROPHID BITES
Stiffness, ache, tenderness in muscles Later, rhabdomyolysis, myoglobinuria resulting in acute renal failure .
TREATMENT PROTOCOL
Attend to AIRWAY , BREATHING, CIRCULATION Tetanus toxoid Routine antibiotic is not necessary Identify the snake responsible All patients should be kept under observation for a min period of 24 hrs. Determine the exact time of bite
INVESTIGATIONS
Complete Blood Count Anemia, Leucocytosis, Thrombocytopenia, HCT Evidence of Hemolysis Fragmented RBCs Prolonged Clotting Time Ampoule method Prolonged APTT Serum Electrolytes Hyperkalemia Raised Urea, Creatinine
INVESTIGATIONS
Urine for RBC Viper Bite Hematuria, Proteinuria, Hemoglobinuria, Myoglobinuria ECG Normal, Bradycardia with ST elevation or depression, T inversion, QT prolongation Chest X- ray Normal, Pulmonary Oedema, Intrapulmonary Hemorhages, Pleural Effusion
Observe every patient for minimum 24 hours Pulse, BP, Respiration Urine output Blood urea, Creatinine
Bleeding tendency
Local swelling Vomiting Diplopia, Ptosis, Muscle Weakness, Breathlessness
SUPPORTIVE THERAPY
RESPIRATORY FAILURE : ABC Intubate & Ventilate Neostigmine & Atropine HYPOTENSION : Plasma expanders Dopamine 2.5 5 micrograms/Kg/min
SUPPORTIVE THERAPY
PERSISTANT / SEVERE BLEEDING : Majority timely use of ASV will stop sys.bleed ASV + Blood Transfusion RENAL FAILURE Hemodialysis / peritoneal dialysis COMPARTMENT SYNDROME : Fasciotomy SURGICAL DEBRIDEMENT OF WOUND
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