Snakes identification features

snake bite management

INVESTIGATIONS
Treatment in hospital

1.Rapid clinical assessment and resuscitation (ABC)

2.Detailed clinical assessment (Local, Neurological, Haematological)

3.Identification of species (Brought snake live, dead or description, photograph 20 min WBCT
Syndromic approach)

Treatment:

a.Antibiotic

b.Tetanus prophylaxis

c.Antivenom

d.NBM

Polyvalent Antivenom: In our country now only Polyvalent antivenom from Vins (lindia) is
available in lyophilized powder form. Each vial contain 10 mg of antivenom, which is effective
against systemic envenoming by Cobra, Krait, Russell's Viper and Saw scaled viper. So this type
of antivenom should not be used in bites by Green snake, Sea snakes and identified non-
venomous snake.
Antivenom treatment Indication /criteria for using antivenom: (Not indicated in Green snake and
sea snake)

1.Neurotoxic signs.

2.Rapid extension of swelling (more than half of the bitten limb). N.B- not due to green snake
bite or tight tourniquet.

3.AKI (not due to see snake).

4.Crdiovascular abnormalities

5.Bleeding abnormalities.

6.Haemoglobinuria/myoglobinuria not due to sea snake.

Anti snake venom therapy

• Dose: Each dose consists of 10 vial of polyvalent antivenom irrespective of age and sex of the
victim.

• Time and administration: Each vial is diluted with 10-ml. of distilled water. 10 such vials (100
ml) is further diluled or mixed with 100 ml of fluid (Dextrose water or saline). Then it is
administered with intravenous infusion within 40-60 min (60-70 drops/min).

• Observation and monitoring: Continuous observation and frequent monitoring of vital signs
should be ensured during antivenom therapy and few hours after its completion. Careful clinical
assessment for appearance of signs and symptoms of antivenom (A/V) reaction should be
performed.

Polyvalent anti-snake venom Active against

1.Indian cobra 2.Common Krait 3.Russsel’s viper 4.Saw scaled viper

Additional treatment:

Inj.Atropine (15µg/kg ) IV (1.5 amp for adult) 4 hourly & Inj.Neostigmine (50-100 µgm/kg) S/C
(2.5 amp for adult) in each thigh 4 hourly until neurotoxic features improve

Respiratory support- Incase of respiratory failure

Blood transfusion: For patients with coagulopathy.

Criteria for repeating the initial dose of antivenom:

Persisting or deteriorating signs of systemic antivenom.eg. 1.If no improvement or deterioration

of neurotoxic features (cobra or krait) 1-2 hours completion of antivenom.
2.Persistence or recurrence of blood incoagulopathy after 6 hours of antivenom teatment.