emergency Snakebite_Management_Presentation.pptx

snake bite

1. Snakebite Management – A Clinical Perspective A Comprehensive Guide for Postgraduate Medical Training

2. Introduction • Snakebite: A life-threatening, time-sensitive medical emergency • Prevalence in tropical and subtropical regions • WHO classifies it as a Neglected Tropical Disease (NTD) (2009)

3. Epidemiology • Global Burden: Over 5 million snakebites annually • India: 50,000 annual deaths (Mohapatra et al., 2011) • Highest mortality: UP, Andhra Pradesh, Bihar • More common in males, aged 15-29 years • Under-reporting due to traditional healers

4. Classification of Snakes in India • Venomous Families: 1. Elapidae (Neurotoxic) – Cobra, Krait 2. Viperidae ( Vasculotoxic ) – Russell’s Viper, Saw-scaled Viper 3. Hydrophidae (Myotoxic) – Sea Snakes • Non-Venomous Species – Many but still cause dry bites

5. When to Suspect a Snakebite? • History: Walking barefoot, sleeping on the floor (Krait risk) • Clinical Signs: - Fang marks, pain, swelling, ecchymosis - Systemic signs: Neuroparalysis, coagulopathy, shock, renal injury

6. Clinical Syndromes of Envenomation 1. Neurotoxic: Ptosis, diplopia, dysarthria, respiratory failure 2. Vasculotoxic : Bleeding diathesis, shock, renal failure 3. Myotoxic: Muscle breakdown, myoglobinuria, hyperkalemia 4. Local Cytotoxic: Necrosis, blistering, compartment syndrome

7. Pre-Hospital First Aid – DO’s • Immobilization (like a fractured limb) • Reassure the patient • Transport to the nearest hospital immediately • Remove tight clothing, rings, watches

8. Pre-Hospital First Aid – DON’Ts • ❌ Cutting or sucking the wound • ❌ Applying tourniquet • ❌ Icing or electroshock • ❌ Use of traditional remedies (herbs, black stones, etc.)

9. Emergency Hospital Management • Admit all suspected cases for 24h observation • Vital Monitoring: BP, HR, RR, SpO₂ • Evaluate envenomation severity • Establish IV access, oxygen support if needed

10. Laboratory Investigations • Bedside: 20WBCT, urine dipstick (hematuria/myoglobinuria) • Primary Center: CBC, RFT, LFT, coagulation profile • Tertiary Care: ABG, ECG, serum fibrinogen, FDPs, D-dimer

11. Antivenom Therapy (ASV) – Indications • Signs of Systemic Envenomation: - Progressive swelling, coagulopathy, neuroparalysis, AKI • ASV should NOT be given in: - Dry bites - Local swelling without systemic signs

12. ASV – Dosage and Administration • Neurotoxic Bites (Cobra, Krait): - 10 vials IV over 30 minutes - Repeat 10 vials after 1 hour if no improvement • Vasculotoxic Bites (Vipers): - 10 vials IV stat, then 2 vials every 6h till clotting time normalizes

13. ASV Precautions • Given IV ONLY (never IM or local injection) • Epinephrine should always be kept ready • Monitor closely for anaphylaxis

14. ASV Adverse Reactions • Early (within 10–180 mins): Urticaria, hypotension, bronchospasm • Pyrogenic (1–2 hrs): Fever, chills, rigors • Late (1–12 days): Serum sickness

15. Management of Neurotoxic Envenomation • Airway protection, assisted ventilation if needed • ASV administration: 10 vials IV, repeat if necessary • Supportive care: Neostigmine-atropine test for muscle recovery

16. Management of Vasculotoxic Envenomation • Key symptoms: Bleeding, hypotension, shock, AKI • ASV administration: 10 vials IV stat, repeated based on 20WBCT • Supportive care: Blood transfusions, dialysis if AKI develops

17. Local Envenomation and Wound Management • Signs: Swelling, necrosis, compartment syndrome • Treatment: - Pain control (avoid NSAIDs) - Antibiotics if infection present - Fasciotomy only if confirmed compartment syndrome

18. Pediatric Considerations in Snakebite • Same ASV dosage as adults • Monitor for fluid overload and respiratory failure • Early airway intervention in neurotoxic bites

19. Snakebite Management in Pregnancy • ASV is safe during pregnancy • Monitor for fetal distress, preterm labor risks • Referral for obstetric evaluation if needed

20. Referral Criteria • When to transfer: - Severe neurotoxic symptoms - Uncontrolled bleeding/DIC - Refractory shock or renal failure - Need for mechanical ventilation

21. ICU Care for Severe Snakebite Cases • Ventilation and oxygen therapy • Hemodynamic support • Dialysis for AKI • Plasma exchange in refractory coagulopathy

22. Recovery and Follow-up Care • Monitor for late complications (PTSD, muscle atrophy, renal impairment) • Rehabilitation (physiotherapy for muscle weakness) • Endocrine follow-up (hypopituitarism in Russell’s viper bites)

23. Public Health and Prevention Strategies • Community awareness programs • Protective footwear campaigns • ASV stock management at primary centers

24. Case Studies • Case 1: Krait bite – early morning neuroparalysis • Case 2: Russell’s viper bite – AKI and DIC • Case 3: Sea snake bite – Myotoxic paralysis

25. Recent Advances in Snakebite Treatment • New ASV formulations • Regional antivenoms under research • Artificial intelligence in snakebite identification

26. Quiz / Interactive Discussion • MCQs and clinical scenario-based questions • Discussion on controversial management topics

27. Summary of Key Takeaways • Early recognition & rapid ASV administration save lives • Avoid harmful first-aid practices • Timely referral is crucial

28. References & Acknowledgments • National Snakebite Protocols, WHO Guidelines, Research Papers