Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 10-10-14
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Oct 10, 2014
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About This Presentation
Snake Bite ,Rabies ,Scorpion bite are like urgency or Emergency type of conditions .This topics come under Toxicology or Agadtantra Subject of 2nd Year BAMS .This ppt will save the time to make notes from Huge books of Toxicology .This ppt is very useful for Ayurvedic students,Teachers,Doctors.Ready...
Slide Content
10/10/2014 Prof.Dr.R.R.Deshpande 1
Snake bite,Rabies,Scorpion Bite
•Presented By –
•Prof.Dr.R.R.Deshpande (M.D in Ayurvdic
Medicine & M.D. in Ayurvedic Physiology)
•www.ayurvedicfriend.com
•Mobile – 922 68 10 630
•[email protected]
Snake bite,Rabies,Scorpion Bite
•Presented By –
•Prof.Dr.R.R.Deshpande (M.D in Ayurvdic
Medicine & M.D. in Ayurvedic Physiology)
•www.ayurvedicfriend.com
•Mobile – 922 68 10 630
•[email protected]
Special Thanks for
Expertise suggestions
•Prof.Dr.Jayant Phadke – HOD ,Toxicology
Dept ,Ayurved college ,Nigdi ,Pune
•Dr.Sohiel Deshpande,MBBS
Expertise suggestions
•Prof.Dr.Jayant Phadke – HOD ,Toxicology
Dept ,Ayurved college ,Nigdi ,Pune
•Dr.Sohiel Deshpande,MBBS
God of Health = God Dhanvantari
10/10/2014 Prof.Dr.R.R.Deshpande 4
Snake Bite
•Toxic Snakes
•1) Neuro Toxic – Nag ( Cobra) & Manyar
(common Krait)
•2) Haemotoxic or Vasculotoxic – Ghonas (
Russels viper ) & Furse ( Saw scaled
Viper)
Snake Bite
•Toxic Snakes
•1) Neuro Toxic – Nag ( Cobra) & Manyar
(common Krait)
•2) Haemotoxic or Vasculotoxic – Ghonas (
Russels viper ) & Furse ( Saw scaled
Viper)
Cobra & common krait
10/10/2014 Prof.Dr.R.R.Deshpande 5
10/10/2014 Prof.Dr.R.R.Deshpande 5
Russels viper &
Saw scaled Viper
10/10/2014 Prof.Dr.R.R.Deshpande 6
Saw scaled Viper
10/10/2014 Prof.Dr.R.R.Deshpande 6
Difference of Poisonous
& Non Poisonous
Sr,No Poisonous Non Poisonous
1 Head Scales – Small Head Scales – Large
2 Body scales -- Large Body scales – small or moderate
3 Tail - Compressed Not so
4 Nocturnal Not so
5 Bite mark – 2 Fang marks No fang marks
10/10/2014 Prof.Dr.R.R.Deshpande 7
& Non Poisonous
Sr,No Poisonous Non Poisonous
1 Head Scales – Small Head Scales – Large
2 Body scales -- Large Body scales – small or moderate
3 Tail - Compressed Not so
4 Nocturnal Not so
5 Bite mark – 2 Fang marks No fang marks
10/10/2014 Prof.Dr.R.R.Deshpande 7
Poisonous Snakes –Special
Anatomical featurs
•1) All poisonous snakes have broad
ventral plates on the belly that extend right
across.
•2) All poisonous snakes have 2 fangs,
which really are 2 prominent teeth besides
many other small teeth.
10/10/2014 Prof.Dr.R.R.Deshpande 8
Anatomical featurs
•1) All poisonous snakes have broad
ventral plates on the belly that extend right
across.
•2) All poisonous snakes have 2 fangs,
which really are 2 prominent teeth besides
many other small teeth.
10/10/2014 Prof.Dr.R.R.Deshpande 8
Poisonous & Non Poisonous –
Head Scales
Head Scales
Poisonous & Non Poisonous -
Body Scales
Body Scales
After bite of Snake
•1) A patient bitten by a poisonous snake
will always complain of pain over the bitten
area.
•2) Two fang marks are always seen. The
shape of an inverted U (∩).
10/10/2014 Prof.Dr.R.R.Deshpande 11
•1) A patient bitten by a poisonous snake
will always complain of pain over the bitten
area.
•2) Two fang marks are always seen. The
shape of an inverted U (∩).
10/10/2014 Prof.Dr.R.R.Deshpande 11
After bite of Snake
•3) Bite by poisonous snake should not be
considered as serious poisoning every
time, because the poison glands of the
snake at the time of the bite might have
been empty.
•Also even a thin layer of clothing usually
gives great protection.
10/10/2014 Prof.Dr.R.R.Deshpande 12
•3) Bite by poisonous snake should not be
considered as serious poisoning every
time, because the poison glands of the
snake at the time of the bite might have
been empty.
•Also even a thin layer of clothing usually
gives great protection.
10/10/2014 Prof.Dr.R.R.Deshpande 12
After bite of Snake
•4) Many times fright and panic leads to
fainting.
10/10/2014 Prof.Dr.R.R.Deshpande 13
•4) Many times fright and panic leads to
fainting.
10/10/2014 Prof.Dr.R.R.Deshpande 13
10/10/2014 Prof.Dr.R.R.Deshpande 14
Watch Symptoms
•1) Elapids Neurotoxic – Cobra or Krait
•Local – Mild Burning ,Triple Response i.e
redness, swelling,inflammation
•Systemic – Vomiting, Giddiness, Ptosis
,Difficulty in speaking & swalowing, Staggering
gait ,Difficult respiration, Difficulty in motor
Activities like hand & leg movements, spreading
paralysis ( ascending from lower limbs),
convulsions ,death may results within minutes or
several hours due to respiratory failure
Watch Symptoms
•1) Elapids Neurotoxic – Cobra or Krait
•Local – Mild Burning ,Triple Response i.e
redness, swelling,inflammation
•Systemic – Vomiting, Giddiness, Ptosis
,Difficulty in speaking & swalowing, Staggering
gait ,Difficult respiration, Difficulty in motor
Activities like hand & leg movements, spreading
paralysis ( ascending from lower limbs),
convulsions ,death may results within minutes or
several hours due to respiratory failure
10/10/2014 Prof.Dr.R.R.Deshpande 15
Watch Symptoms
•2) From Russell’s & saw scaled Vipers -
Haemotoxic Symptoms – Local symptoms are
more severe like Intense
pain,swelling,Cellulitis,Ozzing of bloody serum &
formation of blisters & necrosis
•Systemic – Vomiting, Unconsciousness,
Intravascular haemolysis, Epistaxsis,
Haematuria, Haemetemesis, Bleeding under
skin like Petechiae, Bleeding from orifices
,Hypotension.Death result from cardiovascular
shock or renal failure
Watch Symptoms
•2) From Russell’s & saw scaled Vipers -
Haemotoxic Symptoms – Local symptoms are
more severe like Intense
pain,swelling,Cellulitis,Ozzing of bloody serum &
formation of blisters & necrosis
•Systemic – Vomiting, Unconsciousness,
Intravascular haemolysis, Epistaxsis,
Haematuria, Haemetemesis, Bleeding under
skin like Petechiae, Bleeding from orifices
,Hypotension.Death result from cardiovascular
shock or renal failure
2 types of Snake Poison
•3 stages can be seen in Paralytic Type
•Stage 1 – Ptosis
•Stage 2 – Difficulty in Swallowing
•Stage 3 – Difficulty in Respiration ,
Paralysis
•3 stages can be seen in Paralytic Type
•Stage 1 – Ptosis
•Stage 2 – Difficulty in Swallowing
•Stage 3 – Difficulty in Respiration ,
Paralysis
2 types of Snake Poison
•Haemolytic Type
•Local swelling around the bite appears
quickly
•Blood collected in bulb does not clot
•Haemolytic Type
•Local swelling around the bite appears
quickly
•Blood collected in bulb does not clot
Symptoms of Snake Bite
Snake Bite
Signs of Poisoning
•2 puncture marks ,3/4
th
to 1 cm apart can
be of Poisonous snake bite
•2 puncture marks ,3/4
th
to 1 cm apart can
be of Poisonous snake bite
When person can die ?
•1) After bite of Elapidae –20 min to 6 hrs
•2) After bite of Viperine – 2 to 4 days
10/10/2014 Prof.Dr.R.R.Deshpande 21
•1) After bite of Elapidae –20 min to 6 hrs
•2) After bite of Viperine – 2 to 4 days
10/10/2014 Prof.Dr.R.R.Deshpande 21
Snake Bite Management
Snake Bite Management
•1) Snake bites should be treated as
wounds. Antibiotics is given for secondary
infection and Inj. Tetanus toxoid.
•2) If the patient is completely alright 6-8
hours after the bite, he is usually out of
danger.
10/10/2014 Prof.Dr.R.R.Deshpande 23
•1) Snake bites should be treated as
wounds. Antibiotics is given for secondary
infection and Inj. Tetanus toxoid.
•2) If the patient is completely alright 6-8
hours after the bite, he is usually out of
danger.
10/10/2014 Prof.Dr.R.R.Deshpande 23
Snake Bite Management
•To Slow the absorption and spread of the
poison:
•1) Patient is prevented from walking. Bitten limb
is immobilized, preferably in a splint.
•2) Strip of cloth or handkerchief or a rubber
tourniquet should applied a few cms. above the
bitten area. Be released every 15 minutes for a
period of one minute.
•3) Tourniquet should not be too tight .It is just to
occlude venous & lymphatic return
10/10/2014 Prof.Dr.R.R.Deshpande 24
•To Slow the absorption and spread of the
poison:
•1) Patient is prevented from walking. Bitten limb
is immobilized, preferably in a splint.
•2) Strip of cloth or handkerchief or a rubber
tourniquet should applied a few cms. above the
bitten area. Be released every 15 minutes for a
period of one minute.
•3) Tourniquet should not be too tight .It is just to
occlude venous & lymphatic return
10/10/2014 Prof.Dr.R.R.Deshpande 24
Snake Bite Management
•4) Ice should be applied to and around the bitten
area.
•5) Immobilize the part .Because movements can
cause more absorption of poison
•4) Ice should be applied to and around the bitten
area.
•5) Immobilize the part .Because movements can
cause more absorption of poison
Snake Bite Management
•4) The wound and the incision can be
washed with very dilute solution of
potassium permanganate.
10/10/2014 Prof.Dr.R.R.Deshpande 26
•4) The wound and the incision can be
washed with very dilute solution of
potassium permanganate.
10/10/2014 Prof.Dr.R.R.Deshpande 26
Snake Bite Management
•When there are No signs of Poison –
•Tab Diazepam – 1 tab stat as a
Tranquilizer
•Tab Paracetamol – As Analgesic
•When there are No signs of Poison –
•Tab Diazepam – 1 tab stat as a
Tranquilizer
•Tab Paracetamol – As Analgesic
Wait & Watch for min 6 hours
•Look following signs of Poisoning
•1) Ptosis
•2) Local swelling
•3) Dysphagia
•4) Difficulty in breathing
•Look following signs of Poisoning
•1) Ptosis
•2) Local swelling
•3) Dysphagia
•4) Difficulty in breathing
Snake Bite Management
•In Paralytic Type –
•If Ptosis or Dysphagia develops ,take
immediate action
•If GP & do not have ASV – shift to
appropriate hospital
•Respiratory Paralysis is an Emergency
•In Paralytic Type –
•If Ptosis or Dysphagia develops ,take
immediate action
•If GP & do not have ASV – shift to
appropriate hospital
•Respiratory Paralysis is an Emergency
Snake Bite Management
•Neutralize the poison by --
1)Injection of anti venom. Most effective if
administered within 1 to 4 hours of the
bite.
2) Old Thought -- Sensitivity tests must be
done. If the patient is not sensitive, 5cc. of
the serum should be injected locally
around the wound. Avoid local infiltration
into a finger or a toe
10/10/2014 Prof.Dr.R.R.Deshpande 30
•Neutralize the poison by --
1)Injection of anti venom. Most effective if
administered within 1 to 4 hours of the
bite.
2) Old Thought -- Sensitivity tests must be
done. If the patient is not sensitive, 5cc. of
the serum should be injected locally
around the wound. Avoid local infiltration
into a finger or a toe
10/10/2014 Prof.Dr.R.R.Deshpande 30
Snake Bite Management
•ASV vial contains powder. Dissolve in 10 ml of sterile
water for injection.
•Give ½ cc IV as Test Dose .Watch for 2 min for Urticaria
•If no allergy ,inject Full dose
•New Thought in 2014 -- Sensitivity tests are no longer
recommended because they are unreliable and may
even lead to sensitisation of patient before the actual
therapeutic dose.
•ASV vial contains powder. Dissolve in 10 ml of sterile
water for injection.
•Give ½ cc IV as Test Dose .Watch for 2 min for Urticaria
•If no allergy ,inject Full dose
•New Thought in 2014 -- Sensitivity tests are no longer
recommended because they are unreliable and may
even lead to sensitisation of patient before the actual
therapeutic dose.
Snake Venom Antiserum
•Manufactured by Vins Bioproducts Limited
Survey no 117 Thimmapur (V)
509325,Kothur (Mandal) ,Mahaboobnagar
( Dist) ,Andhra Pradesh,India
•Manufactured by Vins Bioproducts Limited
Survey no 117 Thimmapur (V)
509325,Kothur (Mandal) ,Mahaboobnagar
( Dist) ,Andhra Pradesh,India
Snake Venom Antiserum
•Each 1 ml of has capacity of specifically
neutralising the venom of following
species of Snake
•O.60 mg of dried Indian Cobra venom
•0.45 mg of dried common Krait Venom
•0.60 mg of dried Russell’s viper venom
•0.45 mg of dried Saw scaled Viper
•Each 1 ml of has capacity of specifically
neutralising the venom of following
species of Snake
•O.60 mg of dried Indian Cobra venom
•0.45 mg of dried common Krait Venom
•0.60 mg of dried Russell’s viper venom
•0.45 mg of dried Saw scaled Viper
Snake Venom Antiserum
•Reconstituted antivenin is administered as
soon as possible ,if clear cut signs or
symptoms of envenomation are evident
•Reconstituted antivenin is administered as
soon as possible ,if clear cut signs or
symptoms of envenomation are evident
Snake Venom Antiserum
•It can be administered in 2 ways
•1) Intravenous injections – Reconstituted
antivenin is administered by slow
intravenous injection ( 1 to 2 ml per
minute)
•2) Infusion – Reconstituted antivenin is
diluted in isotonic saline or glucose
solution ( 5 to 10 ml per kg body weight)
•It can be administered in 2 ways
•1) Intravenous injections – Reconstituted
antivenin is administered by slow
intravenous injection ( 1 to 2 ml per
minute)
•2) Infusion – Reconstituted antivenin is
diluted in isotonic saline or glucose
solution ( 5 to 10 ml per kg body weight)
Snake Venom Antiserum
•At present there is no simple method to
measure the amount of circulating venom
in the body.
•So dose of Antivenin can not be accurately
recommended
•The dose also depends on the type of
snake bite & severity of envenomation
•At present there is no simple method to
measure the amount of circulating venom
in the body.
•So dose of Antivenin can not be accurately
recommended
•The dose also depends on the type of
snake bite & severity of envenomation
Snake Venom Antiserum
•Presentation – Snake venom antiserum IP
is supplied as freeze dried powder in glass
vials .Sterile water for Injection IP is
supplied in 10 ml vials
•The antivenin is also supplied as 10 ml
liquid in glass vials
•Presentation – Snake venom antiserum IP
is supplied as freeze dried powder in glass
vials .Sterile water for Injection IP is
supplied in 10 ml vials
•The antivenin is also supplied as 10 ml
liquid in glass vials
Snake Venom Antiserum
•Disposal – Left over antivenin & used
empty vials should be discarded as
biomedical waste
•Disposal – Left over antivenin & used
empty vials should be discarded as
biomedical waste
Snake Venom Antiserum
•2 vials are usually injected directly by IV
route slowly ( 1 to 2 ml per minute) &
taking care of sensitivity reaction
•2 more vials are given after half an hour to
one hour ,if the symptoms of
envenomation persists.
•Further dose can be given with IV fluids,till
envenomation symptoms subside
•2 vials are usually injected directly by IV
route slowly ( 1 to 2 ml per minute) &
taking care of sensitivity reaction
•2 more vials are given after half an hour to
one hour ,if the symptoms of
envenomation persists.
•Further dose can be given with IV fluids,till
envenomation symptoms subside
Snake Venom Antiserum
•The patient should be closely monitored
for 2 hours
•Local administration of antivenin in or
around the bite site is ineffective ,painful &
may raise intra compartmental pressure
particularly in digits .So not recommended
•The patient should be closely monitored
for 2 hours
•Local administration of antivenin in or
around the bite site is ineffective ,painful &
may raise intra compartmental pressure
particularly in digits .So not recommended
Snake Venom Antiserum
•Antivenin Reactions – Anaphylaxis is life
threatening .
•Anaphylaxis can be rapid onset & can
deteriorate into a life threatening
emergency very quickly
•Patient should be monitored closely & at
the first sign of any of the following ,anti
venin should be discontinued
•Antivenin Reactions – Anaphylaxis is life
threatening .
•Anaphylaxis can be rapid onset & can
deteriorate into a life threatening
emergency very quickly
•Patient should be monitored closely & at
the first sign of any of the following ,anti
venin should be discontinued
Snake Venom Antiserum
•Anaphylaxis –
•Indicating signs & symptoms – Urticaria,
Itching, fever, chills or rigors, vomiting,
diarrhoea, abdominal cramps,
Tachycardia, Hypotension,
Bronchospasm, angioedema.
•Anaphylaxis –
•Indicating signs & symptoms – Urticaria,
Itching, fever, chills or rigors, vomiting,
diarrhoea, abdominal cramps,
Tachycardia, Hypotension,
Bronchospasm, angioedema.
Snake Venom Antiserum
•Anaphylaxis – 0.5 mg of 1: 1000
Adrenaline IM
•Children – Adrenaline IM – 0.01 mg/kg
body weight
•Anaphylaxis – 0.5 mg of 1: 1000
Adrenaline IM
•Children – Adrenaline IM – 0.01 mg/kg
body weight
Snake Venom Antiserum
•Anaphylaxis – To provide longer term
protection against Anaphylactoid reaction
,100 mg of Hydrocortisone & 10 mg of H1
antihistamine ,IV
•Children – 0.2 mg/kg of Anti histamine IV
& 2 mg /kg of Hydrocortisone IV
•Anaphylaxis – To provide longer term
protection against Anaphylactoid reaction
,100 mg of Hydrocortisone & 10 mg of H1
antihistamine ,IV
•Children – 0.2 mg/kg of Anti histamine IV
& 2 mg /kg of Hydrocortisone IV
Snake Venom Antiserum
•Anaphylaxis – If the condition is worsening
,a second dose of 0.5 mg of Adrenaline
1:1000 IM ,may be given
•Anaphylaxis – If the condition is worsening
,a second dose of 0.5 mg of Adrenaline
1:1000 IM ,may be given
Snake Bite Management
•Inj ASV 1 to 4 vials ,slow IV
•Then 1 vial ,every 15 to 30 min ,till the
signs start reversing
•Inj Atropine 2 amp IV ,to control excess
salivation
•Inj Neostigmine 4 amp IV
•Inj ASV 1 to 4 vials ,slow IV
•Then 1 vial ,every 15 to 30 min ,till the
signs start reversing
•Inj Atropine 2 amp IV ,to control excess
salivation
•Inj Neostigmine 4 amp IV
Snake Bite Management
•Associated Treatment – Pain – Paracetamol
•Aspirin or other NSAIDS should not be given –
can excerbate bleeding
•For severe pain – mild opiates – Tramodol 50
mg
•Neostigmine is Anti cholinesterase drug –
prolongs the action of Acetylcholine – revert
respiratory failure & Neurotoxic symptoms – 0.5
mg IM ,half hourly + 0.6 mg of Atropine IV ,over
an 8 hour period by continuous infusion
•Associated Treatment – Pain – Paracetamol
•Aspirin or other NSAIDS should not be given –
can excerbate bleeding
•For severe pain – mild opiates – Tramodol 50
mg
•Neostigmine is Anti cholinesterase drug –
prolongs the action of Acetylcholine – revert
respiratory failure & Neurotoxic symptoms – 0.5
mg IM ,half hourly + 0.6 mg of Atropine IV ,over
an 8 hour period by continuous infusion
Snake Bite Management
•In Dysphagia – Continuous throat suction
•In Respiratory Paralysis – Endotracheal
Intubation, Artificial Respiration
•Total 10 to 15 vials of ASV may be
required in Respiratory Paralysis
•In Dysphagia – Continuous throat suction
•In Respiratory Paralysis – Endotracheal
Intubation, Artificial Respiration
•Total 10 to 15 vials of ASV may be
required in Respiratory Paralysis
Snake Bite Management
•Haemolytic Type –
•Inj Decadron 2 cc IV stat
•Inj Avil 1 amp IV stat
•Inj ASV 2 to 6 vials IV slowly ( Old
Thought -- AST)
•Repeat Inj ASV ,if local swelling continues
to increase
•Repeat CT ,every 4 to 6 hours
•Haemolytic Type –
•Inj Decadron 2 cc IV stat
•Inj Avil 1 amp IV stat
•Inj ASV 2 to 6 vials IV slowly ( Old
Thought -- AST)
•Repeat Inj ASV ,if local swelling continues
to increase
•Repeat CT ,every 4 to 6 hours
Snake Bite Management
•Haemolytic Type
•Inj ASV 1 vial ,if Local swelling continues to
increase
•Locally -- around the site-
• Inj ASC -1 to 2 ml
•Elevation of Leg
•Application of Thrombophob ointment
•Megasulph compresses
•Haemolytic Type
•Inj ASV 1 vial ,if Local swelling continues to
increase
•Locally -- around the site-
• Inj ASC -1 to 2 ml
•Elevation of Leg
•Application of Thrombophob ointment
•Megasulph compresses
Snake Bite Management
•Haemolytic Type
•Local –
•If Oedema is very less then,
•Apply -- Elastrocrepe bandage
•After 6 hours ,remove the bandage + watch Skin
•If necessary -- Reapply
•Haemolytic Type
•Local –
•If Oedema is very less then,
•Apply -- Elastrocrepe bandage
•After 6 hours ,remove the bandage + watch Skin
•If necessary -- Reapply
Snake Bite Management
•Haemolytic Type
•When oedema becomes severe ,Skin
becomes bluish black ,Circulation of toes
is diminished ---
•Then to save the limb ,emergency
Faciotomy incisions must be taken
•Haemolytic Type
•When oedema becomes severe ,Skin
becomes bluish black ,Circulation of toes
is diminished ---
•Then to save the limb ,emergency
Faciotomy incisions must be taken
Snake Bite Management
•Haemolytic Type
•In advanced cases ,we must look for
Haematuria, Bleeding from other sites like
nose, skin, check urine output.
•Haemolytic Type
•In advanced cases ,we must look for
Haematuria, Bleeding from other sites like
nose, skin, check urine output.
Snake Bite Management
•Haemolytic Type --
•In cases of bleeding –
•BT is given
•When possible – Platelet Transfusion is given
•Inj Fibrinogen 300 to 600 mg IV
•Inj Heparin –if DIC [ New Thought in 2014 -
Heparin is ineffective against venom induced
Thrombin and should never be used]
•Haemolytic Type --
•In cases of bleeding –
•BT is given
•When possible – Platelet Transfusion is given
•Inj Fibrinogen 300 to 600 mg IV
•Inj Heparin –if DIC [ New Thought in 2014 -
Heparin is ineffective against venom induced
Thrombin and should never be used]
Snake Bite Management
•Haemolytic Type
•When urine out put reduces –
•Inj Mannitol 300 ml IV
•Inj Lasix 2 amp IV stat & repeat sos
•Inj Decadron 2cc IV – 6 hrly
•In Renal failure ( Urea & Creatinine level
increases) – Peritoneal Dialysis is done
•Haemolytic Type
•When urine out put reduces –
•Inj Mannitol 300 ml IV
•Inj Lasix 2 amp IV stat & repeat sos
•Inj Decadron 2cc IV – 6 hrly
•In Renal failure ( Urea & Creatinine level
increases) – Peritoneal Dialysis is done
Snake Bite Management
•After giving adrenaline 1:1000 solution I.M.
½ c.c. and antihistaminic, 30 c.c. of the
serum should be added to 300 c.c. or
normal saline and given as I.V. drip in 1 to
2 hours.
•[ New Thought in 2014 - Prophylactic
Adrenaline should not be given as a
routine]
10/10/2014 Prof.Dr.R.R.Deshpande 56
•After giving adrenaline 1:1000 solution I.M.
½ c.c. and antihistaminic, 30 c.c. of the
serum should be added to 300 c.c. or
normal saline and given as I.V. drip in 1 to
2 hours.
•[ New Thought in 2014 - Prophylactic
Adrenaline should not be given as a
routine]
10/10/2014 Prof.Dr.R.R.Deshpande 56
Snake Bite Management
•Old Thought -- Patients who are, sensitive,
desensitization should be done. Under the cover
of adrenaline, antihistaminic and steroids, small
doses are injected till 40 c.c. of serum I.M. are
given.
•New Thought in 2014 -- In sensitive patients
Adrenaline , Antihistaminics and steroids can be
given prophylactically but ASV is always given
IV only
10/10/2014 Prof.Dr.R.R.Deshpande 57
•Old Thought -- Patients who are, sensitive,
desensitization should be done. Under the cover
of adrenaline, antihistaminic and steroids, small
doses are injected till 40 c.c. of serum I.M. are
given.
•New Thought in 2014 -- In sensitive patients
Adrenaline , Antihistaminics and steroids can be
given prophylactically but ASV is always given
IV only
10/10/2014 Prof.Dr.R.R.Deshpande 57
Snake Bite Management
• Symptomatic treatment:
•1) Inj. Pethidine (not morphine) 50 mg.
I.M. or Inj. Largactil 25 mgm. I.M. is given
for pain.
•2) Inj. Streptopenicillin
•3) Inj. Tetanus Toxoid
10/10/2014 Prof.Dr.R.R.Deshpande 58
• Symptomatic treatment:
•1) Inj. Pethidine (not morphine) 50 mg.
I.M. or Inj. Largactil 25 mgm. I.M. is given
for pain.
•2) Inj. Streptopenicillin
•3) Inj. Tetanus Toxoid
10/10/2014 Prof.Dr.R.R.Deshpande 58
Snake Bite Management
•4) I.V. steroid is given in massive doses
e.g. in serious patients, 300mgm. Efcorlin
I.V. to start and 200 mgm. as slow I.V. drip
later.
•5) If B.P. is falling, Inj. Lomodex or glucose
saline with two ampoules of Noradrenaline
or 100 mgm. Inj. Mephentine is added to
the bottle
10/10/2014 Prof.Dr.R.R.Deshpande 59
•4) I.V. steroid is given in massive doses
e.g. in serious patients, 300mgm. Efcorlin
I.V. to start and 200 mgm. as slow I.V. drip
later.
•5) If B.P. is falling, Inj. Lomodex or glucose
saline with two ampoules of Noradrenaline
or 100 mgm. Inj. Mephentine is added to
the bottle
10/10/2014 Prof.Dr.R.R.Deshpande 59
When Hospital Admission is
must in Snake Bite ?
• Patients who start bleeding extensively or
• Develop blackish red urine or
•Extensive paralysis
10/10/2014 Prof.Dr.R.R.Deshpande 60
must in Snake Bite ?
• Patients who start bleeding extensively or
• Develop blackish red urine or
•Extensive paralysis
10/10/2014 Prof.Dr.R.R.Deshpande 60
10/10/2014 Prof.Dr.R.R.Deshpande 61
Snake Bite Management
•Assurance – Relieve fear & Anxiety
•Clean the bite area with soap & water
•Symptomatic & General Treatment --
•Wait & watch – First just give Inj TT+ IV DNS +
Antibiotics, Anti histaminics, Analgesics,
Steroids, Blood Transfusion, Artificial respiration,
Haemodyalysis etc .If absolute No symptoms
except fear & Patient is alright ,not necessary to
give ASV
Snake Bite Management
•Assurance – Relieve fear & Anxiety
•Clean the bite area with soap & water
•Symptomatic & General Treatment --
•Wait & watch – First just give Inj TT+ IV DNS +
Antibiotics, Anti histaminics, Analgesics,
Steroids, Blood Transfusion, Artificial respiration,
Haemodyalysis etc .If absolute No symptoms
except fear & Patient is alright ,not necessary to
give ASV
Treatment of absorbed venom
•1) In Elapids – Alternate 0.6 mg Inj.
Atropine & 0.5 mg Neostigmine
•In paralytic cases – Inj.Adrenaline – s/c &
Inj Calcium chloride – I/M
10/10/2014 Prof.Dr.R.R.Deshpande 62
•1) In Elapids – Alternate 0.6 mg Inj.
Atropine & 0.5 mg Neostigmine
•In paralytic cases – Inj.Adrenaline – s/c &
Inj Calcium chloride – I/M
10/10/2014 Prof.Dr.R.R.Deshpande 62
Treatment of absorbed venom
•2) In Vipers –
•30,000 to 40,000 Units Inj Heparin
•[Heparin not to be used]
•300 to 600 gms – Inj Fibrinogen
•Also used are fresh whole blood, Platelets
or Fresh frozen plasma(FFP).
10/10/2014 Prof.Dr.R.R.Deshpande 63
•2) In Vipers –
•30,000 to 40,000 Units Inj Heparin
•[Heparin not to be used]
•300 to 600 gms – Inj Fibrinogen
•Also used are fresh whole blood, Platelets
or Fresh frozen plasma(FFP).
10/10/2014 Prof.Dr.R.R.Deshpande 63
10/10/2014 Prof.Dr.R.R.Deshpande 64
Anti Snake Venom
•1) Powder form – ASV – By Serum
Institute of India ( SII) –This is PAVS =
Polyvalent Anti snake Venom Serum
.Price – Rs 400/- for Powder to form 10 ml
solution
•Also available Powder by Haffkine Bio
Pharma ,Mumbai .10 ml .Rs 400/-
Anti Snake Venom
•1) Powder form – ASV – By Serum
Institute of India ( SII) –This is PAVS =
Polyvalent Anti snake Venom Serum
.Price – Rs 400/- for Powder to form 10 ml
solution
•Also available Powder by Haffkine Bio
Pharma ,Mumbai .10 ml .Rs 400/-
10/10/2014 Prof.Dr.R.R.Deshpande 65
Anti Snake Venom
•2) Liquid Form – By Bharat
Company,Thane ,Mumbai.For IV – 10 ml
vial .Rs.400/-
Anti Snake Venom
•2) Liquid Form – By Bharat
Company,Thane ,Mumbai.For IV – 10 ml
vial .Rs.400/-
10/10/2014 Prof.Dr.R.R.Deshpande 66
How to Administer ASV ?
•1) Old Thought -- Test Dose – 0.01 ml by
Insulin Syringe s/c --- New Thought --
Not Recommended as unreliable.
•If No Allergic reactions –
•10 ml Liquid ASV in 500 ml DNS .Speed
30 drops per min
•Constant watch in the Improvement of
Symptoms or Toxic or Side effects of ASV
How to Administer ASV ?
•1) Old Thought -- Test Dose – 0.01 ml by
Insulin Syringe s/c --- New Thought --
Not Recommended as unreliable.
•If No Allergic reactions –
•10 ml Liquid ASV in 500 ml DNS .Speed
30 drops per min
•Constant watch in the Improvement of
Symptoms or Toxic or Side effects of ASV
10/10/2014 Prof.Dr.R.R.Deshpande 67
ASV & Blood Test
•1) PT,BT,CT – For Viperidae ( Ghonas &
Phurse ) Haemotoxic
ASV & Blood Test
•1) PT,BT,CT – For Viperidae ( Ghonas &
Phurse ) Haemotoxic
Blood Tests
•20 WBCT : 2ml fresh venous blood collected in Glass
bulb.Keep undisturbed for 20 minutes.Slightly tilt the bulb
and check for clotting.
Normally the blood should have clotted by the end of 20
minutes. Repeat test after 6 hours.
•BT/CT
•Platelet count : May be decreased in viper bite.
•PT : Normal is 12-14 seconds.
•TLC/DLC : May show neutrophil predominant
leucocytosis.
10/10/2014 Prof.Dr.R.R.Deshpande 68
•20 WBCT : 2ml fresh venous blood collected in Glass
bulb.Keep undisturbed for 20 minutes.Slightly tilt the bulb
and check for clotting.
Normally the blood should have clotted by the end of 20
minutes. Repeat test after 6 hours.
•BT/CT
•Platelet count : May be decreased in viper bite.
•PT : Normal is 12-14 seconds.
•TLC/DLC : May show neutrophil predominant
leucocytosis.
10/10/2014 Prof.Dr.R.R.Deshpande 68
Snake Bite
•Tab Pinak – Herbal Tablet
•http://www.shreebharadiayurpharma.com/t
abpinak.html
•http://www.shreebharadiayurpharma.com/
studypinaksasun.html ( Study in Sassoon
Hosp,Pune)
10/10/2014 Prof.Dr.R.R.Deshpande 69
•Tab Pinak – Herbal Tablet
•http://www.shreebharadiayurpharma.com/t
abpinak.html
•http://www.shreebharadiayurpharma.com/
studypinaksasun.html ( Study in Sassoon
Hosp,Pune)
10/10/2014 Prof.Dr.R.R.Deshpande 69
Rabies or Hydrophobia
•Infectious disease – due to Neurotropic
filtrable virus ,transmitted by the bite or lick
of an infected dog
•Incubation period – 10 days to several
months
10/10/2014 Prof.Dr.R.R.Deshpande 70
•Infectious disease – due to Neurotropic
filtrable virus ,transmitted by the bite or lick
of an infected dog
•Incubation period – 10 days to several
months
10/10/2014 Prof.Dr.R.R.Deshpande 70
10/10/2014 Prof.Dr.R.R.Deshpande 71
Rabies – Symptoms
•1) Premonitory – Stage lasts for 2 days
.Pain & discomfort at the site of
bite.Irritable even to slight noise – cause
spasm of different muscles like muscles of
swallowing
•2) Stage of Irritability – Spasm of
different muscles ,particularly deglutition
•Can not speak or drink
Rabies – Symptoms
•1) Premonitory – Stage lasts for 2 days
.Pain & discomfort at the site of
bite.Irritable even to slight noise – cause
spasm of different muscles like muscles of
swallowing
•2) Stage of Irritability – Spasm of
different muscles ,particularly deglutition
•Can not speak or drink
Rabies – Symptoms
•2) Contd –
•Even sight of water may initiate spasm
•Muscles of Larynx etc undergo spasmodic
contraction.
•Respiration becomes difficult .RR – Increased
•Cyanosis, Hoarseness of voice, Jerks become
brisk
•Stage lasts for 3 days .Then Heart Failure
10/10/2014 Prof.Dr.R.R.Deshpande 72
•2) Contd –
•Even sight of water may initiate spasm
•Muscles of Larynx etc undergo spasmodic
contraction.
•Respiration becomes difficult .RR – Increased
•Cyanosis, Hoarseness of voice, Jerks become
brisk
•Stage lasts for 3 days .Then Heart Failure
10/10/2014 Prof.Dr.R.R.Deshpande 72
Rabies – Symptoms
•3) Stage of Paralysis –
•Paralysis of different muscle groups like
respiration,Heart.
•Stage lasts for few hours & then Death
•Death is inevitable
•So take immediate injection after dog bite
10/10/2014 Prof.Dr.R.R.Deshpande 73
•3) Stage of Paralysis –
•Paralysis of different muscle groups like
respiration,Heart.
•Stage lasts for few hours & then Death
•Death is inevitable
•So take immediate injection after dog bite
10/10/2014 Prof.Dr.R.R.Deshpande 73
Do not kill the Dog
•The dog in question should never be killed
•Rather it should be kept under observation for
10 days
•If Dog is normal & live after 5 days – Chances of
Rabies are almost zero & so no worry
•If dog behaves abnormal or dies in this period ,&
then if Negri bodies are found in the Brain in
postmartem –Then Diagnosis is confirmed of
Rabies
10/10/2014 Prof.Dr.R.R.Deshpande 74
•The dog in question should never be killed
•Rather it should be kept under observation for
10 days
•If Dog is normal & live after 5 days – Chances of
Rabies are almost zero & so no worry
•If dog behaves abnormal or dies in this period ,&
then if Negri bodies are found in the Brain in
postmartem –Then Diagnosis is confirmed of
Rabies
10/10/2014 Prof.Dr.R.R.Deshpande 74
When full Immunization is must ?
•Rabies is a Fatal disease
•So dog is unknown or street dog or difficult
to keep watch or people killed the dog –
Then Full Immunization for Rabies is must
•Do not avoid Treatment of Rabies
,because it is Fatal disease ( Death of
Rabies patient is 100%)
•In Pune (MS)India ,these patients are
isolated in Naidu Hospital
•Rabies is a Fatal disease
•So dog is unknown or street dog or difficult
to keep watch or people killed the dog –
Then Full Immunization for Rabies is must
•Do not avoid Treatment of Rabies
,because it is Fatal disease ( Death of
Rabies patient is 100%)
•In Pune (MS)India ,these patients are
isolated in Naidu Hospital
Catch Rabied Dog
10/10/2014 Prof.Dr.R.R.Deshpande 76
10/10/2014 Prof.Dr.R.R.Deshpande 76
Rabid Dog – Post mortem
Rabid Dog Bite prevention
Bite By Rabid Dog
Rabies Symptoms
Rabies Virus
10/10/2014 Prof.Dr.R.R.Deshpande 82
Rabies – Local care
•Wash the wound repeatedly with soap & flowing
water for atleast 15 mins.
•Clean the wound with 70% alcohol or Iodine (
under LA)
•If CLW is small – Do not suture
•If CLW is large – Suture loosely with drain after
24 hours
•Bite wound should not be sutured during primary
treatment for the fear of introducing the virus into
deeper tissue.
Rabies – Local care
•Wash the wound repeatedly with soap & flowing
water for atleast 15 mins.
•Clean the wound with 70% alcohol or Iodine (
under LA)
•If CLW is small – Do not suture
•If CLW is large – Suture loosely with drain after
24 hours
•Bite wound should not be sutured during primary
treatment for the fear of introducing the virus into
deeper tissue.
Thanks for Rabies Vaccine
10/10/2014 Prof.Dr.R.R.Deshpande 84
Rabies Management
•1) Inj Rabipur = PCEC = Purified Chick
Embryo Cell Vaccine = Total 6 Injections
•1 dose Vial of Powder = 1 ml = Rs.400/-
•Inj on Deltoid
•Days = 0 – 3 – 7 – 14 – 1 month & 3
months
Rabies Management
•1) Inj Rabipur = PCEC = Purified Chick
Embryo Cell Vaccine = Total 6 Injections
•1 dose Vial of Powder = 1 ml = Rs.400/-
•Inj on Deltoid
•Days = 0 – 3 – 7 – 14 – 1 month & 3
months
Rabies – Passive Immunization
•If dog bites are multiple & deep
•If dog bites on face & neck
•Then ,
•Inj Berirab P ( Immunoglobulins) – 300 IU
in 1 ml amp --- 3 to 4 ml IM – Injected
away from the site of Inj Rabipur
•Sr.TIG 1 ml is applied locally to the wound
or infiltrated around it
•If dog bites are multiple & deep
•If dog bites on face & neck
•Then ,
•Inj Berirab P ( Immunoglobulins) – 300 IU
in 1 ml amp --- 3 to 4 ml IM – Injected
away from the site of Inj Rabipur
•Sr.TIG 1 ml is applied locally to the wound
or infiltrated around it
Vaccine Site
Inj Rabipur
•Can be given Intradermal ,in low dose
•So more Economical
•Suggested by Dr.Anant Phadke ,Mumbai
10/10/2014 Prof.Dr.R.R.Deshpande 87
•Can be given Intradermal ,in low dose
•So more Economical
•Suggested by Dr.Anant Phadke ,Mumbai
10/10/2014 Prof.Dr.R.R.Deshpande 87
Intradermal schedule.
•8 site intradermal schedule.
•Sites : Deltoids, lateral thigh,
suprascapular area and lower quadrant of
abdomen.
•Dose : 0.1ml ID
10/10/2014 Prof.Dr.R.R.Deshpande 88
•8 site intradermal schedule.
•Sites : Deltoids, lateral thigh,
suprascapular area and lower quadrant of
abdomen.
•Dose : 0.1ml ID
10/10/2014 Prof.Dr.R.R.Deshpande 88
8 site intradermal schedule
•Schedule :
Day 0 : 0.1ml ID on 8 sites
Day 7 : 0.1ml ID on 4 sites (Deltoid & thighs)
Day 28 : 0.1ml on 1 site (Deltoid)
Day 90 : 0.1ml on 1 site (Deltoid)
10/10/2014 Prof.Dr.R.R.Deshpande 89
•Schedule :
Day 0 : 0.1ml ID on 8 sites
Day 7 : 0.1ml ID on 4 sites (Deltoid & thighs)
Day 28 : 0.1ml on 1 site (Deltoid)
Day 90 : 0.1ml on 1 site (Deltoid)
10/10/2014 Prof.Dr.R.R.Deshpande 89
Rabies Management
•2) Human Rabies Immuno Globulins
•20 IU /KG body weight
•60 kg person = 1200 IU
•Half Dose s/c ,around wound & half dose
IM
•Price --- 3500/- for 1vial contains 150
IU/ml. (By Bharat serum/ Ranbaxy)Total
cost may go around 16 thousand Rs
10/10/2014 Prof.Dr.R.R.Deshpande 90
•2) Human Rabies Immuno Globulins
•20 IU /KG body weight
•60 kg person = 1200 IU
•Half Dose s/c ,around wound & half dose
IM
•Price --- 3500/- for 1vial contains 150
IU/ml. (By Bharat serum/ Ranbaxy)Total
cost may go around 16 thousand Rs
10/10/2014 Prof.Dr.R.R.Deshpande 90
Prevention is better than cure
•Persons exposed to Rabid animals –
Veterinary Doctors ,Workers in forestry or
in slaughter houses ,research workers
doing animal experiments ,rural postmen
•Prophylactic vaccine
•Inj Rabipur 1 ml on days as – 0,7,21,1
year ,then every 3 years
•Persons exposed to Rabid animals –
Veterinary Doctors ,Workers in forestry or
in slaughter houses ,research workers
doing animal experiments ,rural postmen
•Prophylactic vaccine
•Inj Rabipur 1 ml on days as – 0,7,21,1
year ,then every 3 years
10/10/2014 Prof.Dr.R.R.Deshpande 92
Rabies seen after bite of
Carnivorous Animals
•Dog,Cat ,Wolf ,Jackel
Rabies seen after bite of
Carnivorous Animals
•Dog,Cat ,Wolf ,Jackel
10/10/2014 Prof.Dr.R.R.Deshpande 93
Scropion Bite
•2 Types of Scorpion
•1) Black – 99% -- Pain is severe ,but not
fatal .To releive pain – Inj.Xylocaine 2 % -
around wound
•Another way – Keep KMno4 crystals on
the wound & sqeeze lemon on it
Scropion Bite
•2 Types of Scorpion
•1) Black – 99% -- Pain is severe ,but not
fatal .To releive pain – Inj.Xylocaine 2 % -
around wound
•Another way – Keep KMno4 crystals on
the wound & sqeeze lemon on it
Red & Black Scorpion
10/10/2014 Prof.Dr.R.R.Deshpande 94
10/10/2014 Prof.Dr.R.R.Deshpande 94
10/10/2014 Prof.Dr.R.R.Deshpande 95
Scorpion Bite
•2 Types of Scorpion
•2) Red Scorpion – found in Guhagar,Chiplun ,Kokan
area of Maharashtra state of India,Pondechari
•This bite can be Fatal
•Tab Prazosin ( Minipress) – Drug invented by
Dr.Bavaskar ( Actually this drug was previously used
only as Anti Hypertensive )
•Dose of Prazosin –1mg stat followed by 0.25 to 0.5mg
every 4 to 6 hours
Scorpion Bite
•2 Types of Scorpion
•2) Red Scorpion – found in Guhagar,Chiplun ,Kokan
area of Maharashtra state of India,Pondechari
•This bite can be Fatal
•Tab Prazosin ( Minipress) – Drug invented by
Dr.Bavaskar ( Actually this drug was previously used
only as Anti Hypertensive )
•Dose of Prazosin –1mg stat followed by 0.25 to 0.5mg
every 4 to 6 hours
Scorpion Bite
•Scorpion Venom – Neurotoxic &
Haematotoxic
•Since only a small quantity of the venom is
injected – mortality is very less
10/10/2014 Prof.Dr.R.R.Deshpande 96
•Scorpion Venom – Neurotoxic &
Haematotoxic
•Since only a small quantity of the venom is
injected – mortality is very less
10/10/2014 Prof.Dr.R.R.Deshpande 96
Symptoms of scorpion bite
•Local – more severe than snake bite –
pain,oedema & reddening
•Systemic –
Nausea,vomiting,restlessness,fever,convul
sions,coma,cyanosis
•The site of the bite is adentified as –
Pinpoint puncture spot ,local sweating &
oedema
10/10/2014 Prof.Dr.R.R.Deshpande 97
•Local – more severe than snake bite –
pain,oedema & reddening
•Systemic –
Nausea,vomiting,restlessness,fever,convul
sions,coma,cyanosis
•The site of the bite is adentified as –
Pinpoint puncture spot ,local sweating &
oedema
10/10/2014 Prof.Dr.R.R.Deshpande 97
Treatment of Scorpion bite
•1) A tight ligature should be placed
proximal to the bite.
•2) Ice should be applied around
•3) Severe pain often responds to local
injection of emetine hydrochloride 30
mgm. given through the puncture made by
the sting, if this is visible.
10/10/2014 Prof.Dr.R.R.Deshpande 98
•1) A tight ligature should be placed
proximal to the bite.
•2) Ice should be applied around
•3) Severe pain often responds to local
injection of emetine hydrochloride 30
mgm. given through the puncture made by
the sting, if this is visible.
10/10/2014 Prof.Dr.R.R.Deshpande 98
Treatment for Scorpion bite
•If severe pain & sweating –
•Inj Fortwin or Inj Pethidine 10 mg IM or IV
stat
•Inj Local Xylocaine 2 % -- Infiltrate around
the site of bite
•Tab Prazopress 1 mg stat or Tab Ciplar 40
mg stat ( Inchildren Tab Prazopress 1 mg
one forth to one half tab)
•If severe pain & sweating –
•Inj Fortwin or Inj Pethidine 10 mg IM or IV
stat
•Inj Local Xylocaine 2 % -- Infiltrate around
the site of bite
•Tab Prazopress 1 mg stat or Tab Ciplar 40
mg stat ( Inchildren Tab Prazopress 1 mg
one forth to one half tab)
Treatment for Scorpion bite
•Systemic Involvement –
•Profuse sweating
•Ice cold extrmities
•Priapism
•Hypersalivation
•Vomiting
•Hypertension
•Tachycardia
•Pulmonary oedema
•Systemic Involvement –
•Profuse sweating
•Ice cold extrmities
•Priapism
•Hypersalivation
•Vomiting
•Hypertension
•Tachycardia
•Pulmonary oedema
Treatment for Scorpion bite
•Note – BP ,RR –every 10 min
•Tab Prazopress 1 mg stat .Then ½ tab
after 4 hrs .Then ½ tab ,every 6 hours – till
systemic symptoms & signs disappear
•If pain is severe -- Inj Fortwin 1cc IM or IV
•If profuse sweating & dehydration – Inj
Ringer lactate IV
•Note – BP ,RR –every 10 min
•Tab Prazopress 1 mg stat .Then ½ tab
after 4 hrs .Then ½ tab ,every 6 hours – till
systemic symptoms & signs disappear
•If pain is severe -- Inj Fortwin 1cc IM or IV
•If profuse sweating & dehydration – Inj
Ringer lactate IV
Treatment for Scorpion bite
•If BP > 150 / 100 – Cap Depin 5 mg
sublingual .Can be repeated sos ,after ½
to 1 hour
•In Tachycardia .PR >110 /min
•Inj.Calmpose 2 cc IM or slow IV
•If BP > 150 / 100 – Cap Depin 5 mg
sublingual .Can be repeated sos ,after ½
to 1 hour
•In Tachycardia .PR >110 /min
•Inj.Calmpose 2 cc IM or slow IV
Treatment for Scorpion bite
•In Pulmonary oedema (
Breathlessness,Fine Basal Crepitions )
•Propped up position
•Oxygen
•Inj Lasix 2 to 4 amp IV stat
•Inj Efcorlin 100 mg IV stat
•Inj Aminophylline 10 ml + 25 % glucose 10
ml slow IV
•In Pulmonary oedema (
Breathlessness,Fine Basal Crepitions )
•Propped up position
•Oxygen
•Inj Lasix 2 to 4 amp IV stat
•Inj Efcorlin 100 mg IV stat
•Inj Aminophylline 10 ml + 25 % glucose 10
ml slow IV
Treatment for Scorpion bite
•Life Threatening condition – severe
Dyspnoea ,frothing through mouth
•Sodium Nitroprusside drip – till pulmonary
oedema is controlled
•Inj Pruside 50 mg in 5 ml – added to 500
ml 5 % dextrose – 15 drops/min – can be
increased upto 40 drops / min
•Life Threatening condition – severe
Dyspnoea ,frothing through mouth
•Sodium Nitroprusside drip – till pulmonary
oedema is controlled
•Inj Pruside 50 mg in 5 ml – added to 500
ml 5 % dextrose – 15 drops/min – can be
increased upto 40 drops / min
Treatment of Scorpion bite
•4) Alternatively, local injection of
Novocaine and adrenaline around the
puncture can be tried.
•5) Application of tamarind juice locally may
also relieve the pain.
10/10/2014 Prof.Dr.R.R.Deshpande 105
•4) Alternatively, local injection of
Novocaine and adrenaline around the
puncture can be tried.
•5) Application of tamarind juice locally may
also relieve the pain.
10/10/2014 Prof.Dr.R.R.Deshpande 105
Scorpion Bite
•There is no specific Antidote for scorpion
poison
•Invention – by Dr.Bavaskar
,Mahad,Raigad,MS
•Prazocin – Total protection against cardiac
toxicity of Scorpion bite
•There is no specific Antidote for scorpion
poison
•Invention – by Dr.Bavaskar
,Mahad,Raigad,MS
•Prazocin – Total protection against cardiac
toxicity of Scorpion bite
Treatment of Scorpion bite
•Wash wound with KMno4 water
•Immobilization
•Local infiltration of Anaesthetic
•Inj. Calcium Gluconate IV – to control
swelling
•Inj Atropine to avoid pulmonary oedema
•Inj Glucose, Saline & hydrocortisone
10/10/2014 Prof.Dr.R.R.Deshpande 107
•Wash wound with KMno4 water
•Immobilization
•Local infiltration of Anaesthetic
•Inj. Calcium Gluconate IV – to control
swelling
•Inj Atropine to avoid pulmonary oedema
•Inj Glucose, Saline & hydrocortisone
10/10/2014 Prof.Dr.R.R.Deshpande 107
10/10/2014 Prof.Dr.R.R.Deshpande 108
Scropion Bite
•Scropion Venom Antiserum – Haffkine Bio
pharmaceuticals cop Ltd,Mumbai .Dose is 1 vial
reconstituted in 10 ml of Inj for water .If symptoms
persist administer another vial after 1 hour
•Dose ---
•5–25 mL of antivenom diluted in two to three volumes of
isotonic saline to be given intravenously over an hour. If
there is no significant improvement, further doses of
antivenom can be given (total dose of antivenom
required is 30–100 mL in severe envenomation).
Scropion Bite
•Scropion Venom Antiserum – Haffkine Bio
pharmaceuticals cop Ltd,Mumbai .Dose is 1 vial
reconstituted in 10 ml of Inj for water .If symptoms
persist administer another vial after 1 hour
•Dose ---
•5–25 mL of antivenom diluted in two to three volumes of
isotonic saline to be given intravenously over an hour. If
there is no significant improvement, further doses of
antivenom can be given (total dose of antivenom
required is 30–100 mL in severe envenomation).
10/10/2014 Prof.Dr.R.R.Deshpande 109
Rat Bite
•Inj TT
•If Rat bite fever – Inj Penicilline G
•Dose --
•3-5 million units IV 6 hourly.
•Even in Rat bite ,better give Inj Rabipur (
Anti Rabies Injection also)
Rat Bite
•Inj TT
•If Rat bite fever – Inj Penicilline G
•Dose --
•3-5 million units IV 6 hourly.
•Even in Rat bite ,better give Inj Rabipur (
Anti Rabies Injection also)
Rat Bite
10/10/2014 Prof.Dr.R.R.Deshpande 111
Rat Bite
Rat Bite
10/10/2014 Prof.Dr.R.R.Deshpande 112
Rat Bite
Rat Bite
10/10/2014 Prof.Dr.R.R.Deshpande 113
Rat Bite Fever
•Infection caused by Spirillum Minus
•Charaterised by Relapsing Fever ,arthritis
& Skin eruptions
•More common in infants
•Incubation period – 1 to 6 weeks
Rat Bite Fever
•Infection caused by Spirillum Minus
•Charaterised by Relapsing Fever ,arthritis
& Skin eruptions
•More common in infants
•Incubation period – 1 to 6 weeks
10/10/2014 Prof.Dr.R.R.Deshpande 114
Rat Bite Fever
•Clinical Features –
•Local – Site becomes swollen ,purplish in
colour,Lymphadenitis,draining the part
•General – Fever with chill & rigor ,remains
for 2 to 4 days
•Then afebrile for 2 to 4 days .This cycle
goes on
•Headache,photophobia,nausea
Rat Bite Fever
•Clinical Features –
•Local – Site becomes swollen ,purplish in
colour,Lymphadenitis,draining the part
•General – Fever with chill & rigor ,remains
for 2 to 4 days
•Then afebrile for 2 to 4 days .This cycle
goes on
•Headache,photophobia,nausea
10/10/2014 Prof.Dr.R.R.Deshpande 115
Rat Bite Fever
•Clinical Features –
•General –-
•Arthritis of 1 or more joints
•Skin rashes of reddish or purplish patches
often confluent & found in extremities
,asymmetrically
•Course for – 4 to 8 weeks
Rat Bite Fever
•Clinical Features –
•General –-
•Arthritis of 1 or more joints
•Skin rashes of reddish or purplish patches
often confluent & found in extremities
,asymmetrically
•Course for – 4 to 8 weeks
10/10/2014 Prof.Dr.R.R.Deshpande 116
Ayurved for General Practioner
•Very very popular
Book in Medical
Practioners
•100 common
symptoms of General
Practice with
causes,Investigations
& Ayurvedic
Treatments
Ayurved for General Practioner
•Very very popular
Book in Medical
Practioners
•100 common
symptoms of General
Practice with
causes,Investigations
& Ayurvedic
Treatments
10/10/2014 Prof.Dr.R.R.Deshpande 117
Clinical Examination
•Systemic Examination
of 8 systems
•Ayurvedic Srotas
Examination
•Clinical significance of
Lab Tests &
Radiology,USG,2D
Echo
Clinical Examination
•Systemic Examination
of 8 systems
•Ayurvedic Srotas
Examination
•Clinical significance of
Lab Tests &
Radiology,USG,2D
Echo
10/10/2014 Prof.Dr.R.R.Deshpande 118
Notes on Medicine Part 1
•Very very useful Book
for all Medical
Practioners
•Guidelines with
causes,symptoms,Ay
urvedic & Modern
Treatments to treat
Fever,Pain in
Abdomen & Arthritis
Notes on Medicine Part 1
•Very very useful Book
for all Medical
Practioners
•Guidelines with
causes,symptoms,Ay
urvedic & Modern
Treatments to treat
Fever,Pain in
Abdomen & Arthritis
10/10/2014 Prof.Dr.R.R.Deshpande 119
Best Book for
Medical Students & Practioners
Best Book for
Medical Students & Practioners
Preventive Cardiology
& Ayurvedic Management
•Best Book for GP
•All cardiac problems
like
Hypertention,CCF,
Angina,Myocardial
Infarct are discussed
with Ayurvedic
Management
Contact -922 68 10 630
10/10/2014 Prof.Dr.R.R.Deshpande 120
& Ayurvedic Management
•Best Book for GP
•All cardiac problems
like
Hypertention,CCF,
Angina,Myocardial
Infarct are discussed
with Ayurvedic
Management
Contact -922 68 10 630
10/10/2014 Prof.Dr.R.R.Deshpande 120
Digestive Problems
& Ayurvedic Management
•Best Book for GP
•All Digestive
problems like
Acidity,Pain in
abdomen,
•Constipation ,colitis
are discussed with
Ayurvedic
Management
Contact -922 68 10 630
10/10/2014 Prof.Dr.R.R.Deshpande 121
& Ayurvedic Management
•Best Book for GP
•All Digestive
problems like
Acidity,Pain in
abdomen,
•Constipation ,colitis
are discussed with
Ayurvedic
Management
Contact -922 68 10 630
10/10/2014 Prof.Dr.R.R.Deshpande 121
Gynaecological Problems &
Ayurvedic Management
•Best Book for GP
•All Gynaecological
problems like Heavy
bleeding,White
discharge,Infertility,ca
ncer are discussed
with Ayurvedic
Management
Contact -922 68 10 630
10/10/2014 Prof.Dr.R.R.Deshpande 122
Ayurvedic Management
•Best Book for GP
•All Gynaecological
problems like Heavy
bleeding,White
discharge,Infertility,ca
ncer are discussed
with Ayurvedic
Management
Contact -922 68 10 630
10/10/2014 Prof.Dr.R.R.Deshpande 122
Arthritis,Backache &
Ayurvedic Management
•Best Book for GP
•All Joint problems
like Rheumatoid
Arthritis,Osteoarthritis
,Backache are
discussed with
Ayurvedic
Management
Contact -922 68 10 630
10/10/2014 Prof.Dr.R.R.Deshpande 123
Ayurvedic Management
•Best Book for GP
•All Joint problems
like Rheumatoid
Arthritis,Osteoarthritis
,Backache are
discussed with
Ayurvedic
Management
Contact -922 68 10 630
10/10/2014 Prof.Dr.R.R.Deshpande 123
Neurological Problems & Ayurvedic
Management
•Best Book for GP
•All Neurological
problems like
Headache,Epilepsy,Al
zeimer’s Disease are
discussed with
Ayurvedic
Management
Contact -922 68 10 630
10/10/2014 Prof.Dr.R.R.Deshpande 124
Management
•Best Book for GP
•All Neurological
problems like
Headache,Epilepsy,Al
zeimer’s Disease are
discussed with
Ayurvedic
Management
Contact -922 68 10 630
10/10/2014 Prof.Dr.R.R.Deshpande 124
Ayurvedic Concept of Diet
& Nutrition
•Best Book for GP
•Dietary Advice
according to Prakruti
,Dietary prescriptions
for many diseases are
given
•Contact -922 68 10
630
10/10/2014 Prof.Dr.R.R.Deshpande 125
& Nutrition
•Best Book for GP
•Dietary Advice
according to Prakruti
,Dietary prescriptions
for many diseases are
given
•Contact -922 68 10
630
10/10/2014 Prof.Dr.R.R.Deshpande 125
Prof.Dr.Deshpande’s
Popular Links on Internet
•Just Start Internet on Desk top or Lap top
or on your mobile . Copy Following Link &
Paste as Web address –URL
•http://www.youtube.com/user/deshpande1
959
•http://www.slideshare.net/rajendra9a/
•http://www.mixcloud.com/jamdadey/
10/10/2014 Prof.Dr.R.R.Deshpande 126
Popular Links on Internet
•Just Start Internet on Desk top or Lap top
or on your mobile . Copy Following Link &
Paste as Web address –URL
•http://www.youtube.com/user/deshpande1
959
•http://www.slideshare.net/rajendra9a/
•http://www.mixcloud.com/jamdadey/
10/10/2014 Prof.Dr.R.R.Deshpande 126
Prof.Dr.Deshpande’s
Popular Links on Internet
•Just Start Internet on Desk top or Lap top
or on your mobile . Copy Following Link &
Paste as Web address –URL
•http://professordeshpande.blogspot.in
•http://professordrdeshpande.blogspot.in/
•http://www.mixcloud.com/rajendra-
deshpande
•https://soundcloud.com/professor-
deshpande
10/10/2014 Prof.Dr.R.R.Deshpande 127
Popular Links on Internet
•Just Start Internet on Desk top or Lap top
or on your mobile . Copy Following Link &
Paste as Web address –URL
•http://professordeshpande.blogspot.in
•http://professordrdeshpande.blogspot.in/
•http://www.mixcloud.com/rajendra-
deshpande
•https://soundcloud.com/professor-
deshpande
10/10/2014 Prof.Dr.R.R.Deshpande 127
10/10/2014 Prof.Dr.R.R.Deshpande 128
10/10/2014 Prof.Dr.R.R.Deshpande 129
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