management of snake bite n.
Download
Skip this Video
Download Presentation
Management of snake bite

Loading in 2 Seconds...

play fullscreen
1 / 38

Management of snake bite - PowerPoint PPT Presentation


  • 185 Views
  • Uploaded on

Management of snake bite. Dr Arya Jith. Best way to a manage Is to prevent a snake bite…..!. How to prevent snake bites. A WORLD WITHOUT SNAKES NEARLY A QUARTER OF US WOULD GO HUNGRY THEY ARE IMPORTANT ELEMENTS IN FOOD CHAIN THAT CONTROL RODENT POPULATION. INDIAN SCENARIO.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Management of snake bite' - garrett-rhodes


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide2

Best way to a manage

Is to prevent a snake bite…..!

how to prevent snake bites
How to prevent snake bites
  • A WORLD WITHOUT SNAKES
  • NEARLY A QUARTER OF US WOULD GO HUNGRY
  • THEY ARE IMPORTANT ELEMENTS IN FOOD CHAIN THAT CONTROL RODENT POPULATION
indian scenario
INDIAN SCENARIO
  • 5 DANGEROUSLY POISONOUS SNAKES

KING COBRA

COMMON COBRA

COMMON KRAIT

RUSSELL’S VIPER

SAWSCALED VIPER

MOST COMMON POISONOUS SNAKE IS COMMON KRAIT

For more presentations www.medicalppt.blogspot.com

first step
FIRST STEP
  • TO IDENTIFY WHETHER IT WAS A POISONOUS SNAKE.
  • 216 SPECIES- 52 VENOMOUS
  • IF THE PAIN NUMBNESS AND OEDEMA IS SPREADING THEN IT IS A VENOMOUS SNAKE.
  • SUSPECTED SNAKE BITE

OBSERVATION 24 HOURS

symptomatology of non venomous snakes
SYMPTOMATOLOGY OF NON VENOMOUS SNAKES
  • Universal fear - a state of shock
  • Bite site -multiple teeth impressions
  • significant local pain or swelling -ABSENT
  • Adequate reassurance and symptomatic treatment .

For more presentations www.medicalppt.blogspot.com

examination
eXAMINATION
  • To rule out ptosis

Evidence of early external ophthalmoplegia .

  • size and reaction of the pupils.
  • Early paralysis of pterygoid muscles.
  • “broken neck sign
local examination
Local examination

Oedema petechiae bullae oozing from the wound should be noted

Extent of swelling

circumference of the bitten limb should be noted every 15 minutes- spreading

evidence of systemic envenomation
Evidence of systemic envenomation
  • CT> 10 MINUTES
  • Bleeding manifestations
  • Oliguria /haematuria
  • Hypotension
  • Ptosis
  • Circumoral paraesthesia
  • Aphonia/Dysarthria
classification
classification
  • GRADE0 – NO ENVENOMATION
  • GRADE 1- MINIMAL ENVENOMATION

(local pain and swelling)

  • GRADE2-MODERATE ENVENOMATION

(Pain ,swelling,ecchymosis spreading

+mild systemic/ lab manifestations)

GRADE 3-SEVERE ENVENOMATION

(Marked local response+severe systemic findings+significant lab findings)

investigations
INVESTIGATIONS
  • Blood grouping
  • Hb, elevated PCV
  • TC-leucocytosis
  • Platelet count- thrombocytopenia
  • Peripheral smear – Haemolysis
  • BT,CT(20 min)
  • prolonged PT ,aPTT
  • Urea Serum Electrolytes- hyperkalemia
  • Urine Routine-haematuria
  • Metabolic /resp acidosis
monitoring
monitoring
  • Level of consiousness
  • Pulse, BP, Resp rate,Capillary refill time
  • Clotting time 1/2hr -1hourly
  • Urine output
  • Muscle weakness
treatment
TREATMENT
  • GRADE 0-NO ENVENOMATION

Local wound care

Injn TT

Observation -24 hrs

grade 1
GRADE 1
  • MINIMAL ENVENOMATION

Injn TT

Antibiotics (inj CP/Ampicillin)

Observe for 24 hours

grade 2 and 3
Grade 2 and 3
  • Moderate and Severe Envenomation

Injn TT

Antibiotics(Ampicillin /CP/

3 rd genertn cephalosporins+

metronidazole)

local anti oedema measures

slide17

NEVER APPLY A TOURNIQUET ABOVE THE SITE

  • IF THE PATIENT COMES WITH A TOURNIQUET alwaysCHECK FOR VASCULARITY
  • Do not suck out venom
  • Do not incise the bite wound nor apply any chemicals
asv anti snake venom
Asv- anti snake venom
  • Antivenom is immunoglobulin (usually the enzyme refined F(ab)2 fragment of IgG) purified from the serum or plasma of a horse or sheep that has been immunized with the venoms of one or more species of snake.
  • Monovalent or monospecific antivenom
  • Polyvalent
  • India –polyvalent is available which act against the venom of commonly found snakes in india
indications of asv
Indications of asv
  • Neurotoxicity
  • Bleeding/coagulopathy
  • Myoglobinuria/haemoglobinuria
  • Cardiac toxicity
  • Local swelling involving more than half of the bitten limb
  • Rapid extension of swelling
  • Development of an enlarged tender

Lymph node draining the bitten limb

  • ARF
dosage
dosage
  • 10 vials polyvalent asv(irrespective of body weight and age)
  • 2nd dose - overt bleeding is present

10 vials

OR

Do 20 minute clotting time and give

2 vials Q6H till the coagulation

parameters are normal

how to give asv
How to give asv ?
  • No test dose is required
  • One vial is added with 100 ml of normal saline. After 10 -15 minutes 9 vials can be added in the same fluid over one hour
asv reaction
Asv reaction
  • Urticaria ,itching ,fever , shaking chills ,nausea ,vomiting ,diarrhoea abdominal cramps ,tachycardia hypotension , bronchospasm and angioedema
  • ASV is discontinued
  • 0.01mg/kg of Adrenaline is given

(1:1000)as IM should be given

long term reaction
Long term reaction
  • 100mg of Hydocortisone(2mg/kg) and

10mg of H1 antihistamine

(children- 0.2mg/kg) IV

2nd dose of Adrenaline 0.5 mg (1:1000) IM

can be repeated

Patient is recovered ASV can be restarted slowly within 10 – 15 minutes

timing of asv
Timing of asv
  • Best effect – used within 4 hours
  • Can be administered upto 48 hours
  • Efficacy is seen upto 6- 7 days
response to asv
Response to asv
  • Normalization of BP
  • Bleeding stops within 15 – 30 mts
  • Normalization of coagulation parameters within 6 hours
  • Neurological sign will be resolving within 30-48 hours
neuroparalytic symptoms
Neuroparalytic symptoms
  • Neostigmine -0.05mg to 0.1mg/kg every 4 hours
  • Atropine 0.02mg/kg (5minutes prior to neostigmine)

Watch for ptosis

complications
complications
  • Shock
  • Renal failure
  • Myocardial failure
  • Shock lung
  • Bleeding
capillary leak syndrome
Capillary leak syndrome
  • PUFFINESS
  • CHEMOSIS
  • PAROTID SWELLING
  • Rx - methyl prednisolone

(10mg/kgQ8H) x 3days

slide31

If renal function is normal

Start with volume expanders(20ml/kg of isotonic soln)

Corrected? Symptoms of other

shock

hypovolemic shock

cardiogenic shock
Cardiogenic shock
  • Raised JVP
  • Oedema
  • Signs of pulmonary oedema
  • Feeble heart sounds
  • Changes in ecg
  • Start Dobutamine Drip

(5-10microg/min)

Uncorrected-Neurogenic

shock

neurogenic shock
Neurogenic shock
  • Dopamine drip(10-12microg /min)
  • BP is coming up

Nor adrenaline (0.1- 0.5 microgram/kg)

renal failure
Renal failure
  • Early dialysis
myocardial failure
Myocardial failure
  • Treat cardigenic shock
  • Treat ccf
  • Avoid fluid overload
  • Oxygen inhalation
shock lung
Shock lung
  • Tacypnea
  • Hypoxemia
  • Unexplained drowsiness
  • Mild acidosis
  • treatment-o2inhalation

cpap

ventillation

bleeding
bleeding
  • Correct coagulation failure
  • FFP-10ml/kg
  • Correct platelet deficiency
  • Whole blood– frank bleeding