Dr Dilip Kumar Raiguru,

Former CDMO,Jharsuguda

Are All Snakes Poisonous?

In World 3500 species of snakes: only <350 species are poisonous.

In India.

In India..

INDIAN SNAKES

Land Snakes
80% N.P.
20% Poison.

Indian
Snakes
Sea Snakes
20% N.P.
80% Poison.

Elapidae
(Neurotoxic)

Land Snakes
80% N.P.
20% Poison.

Indian
Snake
s
Sea Snakes
20% N.P.
80% Poison.

Viperidae
(Vasculotoxic)

Hydrophidae
(Myotoxic)

Cobra Family
Elapidae
(Neurotoxic)

Krait Family

Land Snakes
80% N.P.
20% Poison.

Indian
Snake
s

Pit Viper

Sea Snakes
20% N.P.
80% Poison.

Viperidae
(Vasculotoxic)
Pit less Viper

Hydrophidae
(Myotoxic)

Found in all
Parts of world
Except Europe

Found in all parts

Of world except USA
Responsible for
Most of the deaths

King Cobra

Common Cobra

Common Krait: Most Poisonous

among all. Its venom is 10 times
poisonous than Cobra.

Banded Krait

Russell's Viper

Russell's Viper

Echis Carinatae (Saw Scaled Viper)

Saw Scaled Viper

Pit Viper

Himalayan Pit viper

Bamboo Pit Viper

Sea Snakes

To immobilize the prey

Function of Snake Venom

Toxic Principles in Snake Venom

15 mg of dried Cobra Venom

Fatal Dose

Cobra/Krait Bite: 20 minutes to 30 hours

Fatal Period

How much venom is injected in

one bite
Dried Venom In mg.per
Fatal dose in
yield per bite bite
mg.
Cobra

200-350mg

15mg

Viper

150-250mg

40mg

Krait

22mg

6mg

Echis
Carinatae

25mg

8mg

1ml of polyvalent anti snake

venom serum(ASV) neutralizes:
Snake Venom Neutralizing
Dose of 1ml
of ASV

Fatal Dose

Venom
Injected per
bite

Cobra

0.6mg

15mg

200-350mg

RusselsViper 0.6mg

40mg

150-250mg

Common
Krait

0.45mg

6mg

22mg

Echis
Carinate

0.45mg

8mg

25mg

 Age:
Site:

In Children more severe than adult

Bite in extremities or adipose tissue is less
dangerous than bite on the face or trunk
Superficial bite or bite through clothing afford
more protection
If venom glands are recently discharged it is less
harmful
Exertion immediately after poisoning speeds up
poisoning
Presence of bacteria in the mouth of snake or on
the skin of the victim may cause serious infection
in the necrotic tissues at the local site.

Factors Affecting the Severity of

Snake Bite:

Potency of venom is reduced in a cold climate.

Factors Affecting the Severity of

Snake Bite:

Clinical Features: Sea Snake

Bites: MYOTOXIC

Clinical Features:
Viper Bites
VASCULOTOXIC

Clinical Features:
Cobra BitesNEUROTOXIC

Clinical Features of Krait

Bites--NEUROTOXIC
The

symptoms are similar to cobra

bite.
In addition there may be severe transient
abdominal colicky pain with cramp

History
Fang Marks
Local reactions

Pain , Swelling , Bleeding-oozing of blood from bite

site.
Note:In Viper bites
Local reaction is usually severe & evident within few
minutes
In Cobra bites
it may be minimal & delayed up to 24 hours.

Diagnosis of Snake Bite:

Fang Marks

Mild

Severe

Envenomations in Viper Bite

12 hr after viper bite

Systemic Reactions
Bleeding Tendencies
Neuromuscular Paralysis

Common with Cobra & Krait

Bite:
OcularPtosis , Blurred vision , Diplopia,
PharyngealDysphagia , Drooling of saliva, Respiratory muscle
weakness , Limb weakness etc
Renal Failure
Cardiac Insufficiency & Arrhythmias
Shock

Diagnosis of Snake Bite:

Management of
Snake Bite
Pre Hospital Management)

First Aid (DOs)

80% Bites :Non Poisonous
Only in 50% of Poisonous snake bite inject venom
Use Bandage or
Cloth To hold the
splints& not to obs
truct blood supply
Dont pressurize.

1.
1. Reassure
Reassurethe
thepatient:
patient:
2.
2. Immobilize
Immobilizethe
thelimb-as
limb-asfracture
fracture
3.
3. Get
Getto
toHospital
HospitalFast
Fast

Dont waste time

on traditional Rx.

4.
4. Tell
Tellthe
theDoctor
Doctorabout
aboutsymptoms
symptoms

Ptosis, Bleeding,
Dysphasia-on the
way to hospital

Do it R.I.G.H.T.

First Aid(Donts)
1.
1. Do
Donot
notcut
cutor
orincise
incisethe
thewound
wound
2.
2. Do
Donot
notapply
applyelectric
electricshock
shockor
orice
ice
3.
3. Do
Donot
notseek
seekfor
fortraditional
traditionalcure
cure
4.
4. Do
Donot
nottake
takealcohol
alcoholor
oraspirin
aspirin
55.. Do
Donot
not apply
applytight
tighttourniquet
tourniquet
66.. Do
Donot
notsuck
suckthe
thewound
wound

Management: (General Measures)

Wide Tourniquet:
If

within 1st 2 hr of bite till Pt. shifted to

hospital
Not used if bite is on face, trunk or neck.
10 cm above the site of bite
Loose enough to allow one finger to just
pass through
To distend vein without impending the
arterial flow

Management: (General Measures)

PIM(Pressure Immobilisation
Method):
A

newer technique-developed in Australia in

late-1970s.
Crepe bandage starting from distal to bitten
site with a pressure enough that can easily
introduce the finger between skin & bandage.
(Entire bitten limb is wrapped)
Tying the elasticated/crepe bandage around the
limb including an integral splint, in the same
way as a sprain can also be done.
It was thought that it will inhibit venom flow
into the system.

In summary, the pressure immobilization method of first aid

is:

Apply a firm broad bandage or similar (even

clothing strips or pantyhose will do in an

emergency) over the bite site, at the same
pressure as for a sprain. Do not occlude the
circulation.
Apply further bandage over as much of the rest
of the bitten limb as practical. Ensure fingers or
toes are covered to immobilize them.
Ensure the bitten limb is kept motionless by
applying a splint and instructing the patient to
cease all use of the limb and any general activity.

The pressure immobilisation

method of first aid

Management: (General Measures)

Use

of Aspirin for pain relief is

contraindicated.
Just clean the wound with plain water
or normal saline.
Establish a patent airway : if
respiratory distress is present

Where on the body you are bitten?

Key Questions to ask a victim are:

Polyvalent Anti Snake Venom

Serum(ASV)
By hyper immunization of
horses against venom of
4 common poisonous snakes:

Cobra

Common
Krait

Russell
Viper

Echis
Carinate

Some
TIPS
A patient bitten
by an elapidae snake if not dead in 2 hours will probabl

Prevention of Snake Bite:

Fire

wood, Cow dung, cattle shed,& rubble should be

kept away from residential house.
Old Storage rubble particularly in old house should
be handled in full sun light.
Bare foot walking in dark ness ,in Grown up grasses
should be avoided
One should go out with a torch
Proper care of rats,mice,lizards-they can be killed by
rat poison
Dont try to catch snake or kill it.
Killed snake should not be handled ,even sheared
head may inject venom
See before wearing Shoes, Going to Toilets.
Avoid sleeping in ground to prevent krait bite
Thick electrician gloves with rubber shoes should be
worn at time of handling Paddy or Sugar Cane Husk.

Snakebites: First aid(Summary)

To

reduce your risk of a snakebite, avoid

picking up or playing with any snake. Most
snakes usually avoid people if possible and bite
only when threatened or surprised.
If you've experienced a snakebite:
Remain calm ,still and dont move around.
Don't try to capture the snake
Immobilize the bitten arm or leg and try to stay
as quiet as possible
Remove jewelry, because swelling tends to
progress rapidly

Snakebites: First aid(Summary)

Apply

a loose splint to reduce movement of the

affected area, but make sure it is loose enough that
it won't restrict blood flow
Don't cut the wound or attempt to remove the
venom
Do not give alcohol to the patient.
Do not give food and only non-alcoholic clear fluids
may be used for drinks.
Always seek medical help at the earliest opportunity.
If the snake has been killed, bring it with the patient,
but do not waste time, risk further bites and delay
application of pressure bandage and splint by trying
to kill the snake.

Dog Bite

 No

body except mad people or animal do harm to

others without provocations

If

a Rabid animal (Dog,Jackel,fox,monkeyetc)

bites or licks on the wound on the body,it can
cause death from Rabies or Tetanus

Disease Risk

Rabies

is 100% FATAL!

Rabies virus is present in the saliva of the rabid

animal & it affects the brain through nerves.

CLINICAL FEATURES: H/O

dog bite without any provocation

Presence

of tooth mark with laceration

Bleeding

or oozing of blood from site of bite.

First Aid
Wash

the wound immediately & repeatedly

with running water.
Wash again with soap & water or diluted dettol
water
Cover with a sterile dressing & dont apply any
bandage
Send the victim to hospital immediately for T.T. &
ARV.
Watch/Observe the dog for 10 days.

Scorpion Bite

Scorpion Sting
During

Construction works , farms etc may

be affected by black scorpion stings

Some

varieties of scorpion liberate toxins

which pass through blood vessels & affect
heart.

Death

due to scorpion sting also have been

encountered though rare.

Symptoms & Signs

Severe

pain & burning at the site of

sting.
Redness & Swelling around the site.
Palpitation/Restlessness
Profuse sweating
Salivation from mouth
Nausea and vomiting
Muscular pain/twitching of muscle
Body temp. may be raised slightly.

First Aid Management

Apply

a constrictive bandage above site of

Wash

the affected area with running water

Send

the victim to hospital quickly.

sting

Doctor

may give local anaesthetic injection

to relieve the pain

Insect Bites & Stings

Spiders/Ticks/Ants/Bees/Wasps
Hornets etc

Accidental

Bite

Alarmingly

painful

May

cause serious consequence in children

Symptoms & Signs

Severe

pain & Burning sensation at the site

of bite/sting.
Sometimes the bees or wasp leave its sting
in the skin
Swelling & redness in the affected area
Nausea & Vomiting
If the victim is allergic to the venom then
there may be swelling around
face,eyes,mouth,throat & all over body.

First Aid
Pull

out the sting gently with a pair of fine

forceps if it is present in the skin.
Apply cold compress or ice cubes at the site
Apply vinegar/lemon juice in case of wasp bite
Apply soda bicarb / Methylene blue in case of
bee bite
If the sting is inside the mouth give the victim a
few ice cubes to suck & rinse mouth with ice
cold water repeatedly.

First Aid(Insect bites & Stings)

Move

to a safe area to avoid more stings.

Scrap or brush off the stinger with a straight-edged
object, such as a credit card or the back of a knife.
Wash the affected area with soap and water.
Apply a cold pack or cloth filled with ice to reduce pain
and swelling.
Apply hydrocortisone cream (0.5 percent or 1 percent),
calamine lotion or a baking soda paste with a ratio of 3
teaspoons baking soda to 1 teaspoon water to the bite
or sting several times a day until your symptoms subside.
Take an antihistamine containing diphenhydramine
(Benadryl, Tylenol Severe Allergy) or chlorpheniramine
maleate (Chlor-Trimeton, Actifed).

an Bite

Human bites:
Human

bites can be as dangerous as or even

more dangerous than animal bites because of the
types of bacteria and viruses contained in the
human mouth.

If

someone cuts his or her knuckles on another

person's teeth, as might happen in a fight, this is
also considered a human bite.

If

you sustain a human bite that breaks the skin:

Then..

Human bites: First aid

Stop

the bleeding by applying pressure.

Wash

the wound thoroughly with soap and water.

Apply

an antibiotic cream to prevent infection.

Apply

a clean bandage. If the bite is bleeding,

apply pressure directly on the wound using a sterile
bandage or clean cloth until the bleeding stops.

Seek

emergency medical care.

Thank You

Sukham Samagam
Vijnane Vimale cha
Pratishthitam
All happiness is rooted in the
Good Science.
Amritavani

Samhita

- Charaka

Thank You One and All

dkraiguru@gmail.com