1. Dr. Rajeev
1

3. What the snakes do?
m
fro
are
They don’t bite! ites s. Only
eb
nak specie ous
They bite! ll s
of a omous venom mate
70% ‐ven
Some of them can not inject venom! by o
ites y enven
n
o b
n of
Some of them may inject but they… ll
50% s actua atient.
○ fail to do so! ie p
the
spec
Chamber empty
No time to succeed
○ Don’t want to do so
Some of them inject but half heartedly or don’t deliver the lethal dose
due to insufficient stock.
Few of them find themselves in “INDO-PAK final” and succeed to
perform like ‘Veeru’.
Problem starts here…
As the venom is in! and that’s in sufficient
quantity…
What the venom does?

5. lem
ob
pr of
e oup .
Th gr
t the ortality
ngs st m
mo he
sa
ain he hig ar.
rem ith t /ye
dia 000
es w
In
are .
0,
tri ~5 ry c bite
oun te: ima
c a r
th r ake
fP
y o eat sn
ea an
D
at m o not tr
gre ls d
A
pita
hos
5

6. The controversy
India is one of the world’s leading producers
of snake venom antiserum .
mortality does not rest in snake venom
antiserum shortage.
6

7. THE FATE
Patients are referred… to distant, better equipped
hospitals… and thus make journeys without the
cover of snake venom antiserum (ASV)…
REFRRED…
DEFFRREED…
REFFERRRRRRRED…
D… !
7

8. Crucial factors in decresing mortality
Availability of treatment, particularly close
to the scene of the bite. (access)
Confidence in (DOCTORS) being able to
treat the patient. (knowledge)
Equipments.
Medicines.
Referral facilities.
Please note: delayed access &/or
treatment increases the cost of treatment
and decreases chances of survival.
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11. 11

12. A death en route (DEnR) case (ID: 1949356/ 17.06.08) investigation revealed the pitfall. A
case of snake bite was taken up by Dediapada ambulance on the way to a remote village.
Relatives were coming towards the ambulance with the patient on a motorcycle. When the
EMT took up the case he was out of the coverage area. The patient was having the early
signs of neurotoxic envenomation (ptosis, agitation etc.) but hemodynamically stable. A
tourniquet was applied by relatives on the limb proximal to the site of bite. Frank edema
and bluish discoloration of skin distal to the tourniquet applied was there. The EMT was not
aware of the possibility of sudden deterioration after removal of the applied tourniquet
(JIMA JUNE 2007). The patient was looking so healthy that the EMT did not find the need of
providing oxygen. He removed the tourniquet in the ambulance & the patient deteriorated
suddenly. The patient became breathless & cyanosed. EMT started CPR. He was in coverage
area but was not able to contact ERCP as his hands were not free & he had not applied the
“HANDSFREE”. Oxygen/OPA/NPA/Ambus’ were Not Used. The doctor of CHC Dediapada
declared the patient “DEAD”. It all happened within 30 minutes. A patient having earliest
signs of neurotoxic envenomation died within 30 minutes...can you believe?
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13. 13

14. 14

15. 15

16. 16

17. Administer ASV
only if
you are sure
that there is
un neutralized, unbound venom
in the
blood or tissue fluid
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18. SNAKE BITE: EVIDENCE OF SYSTEMIC ENVENOMATION
causing neurological
causing haemostatic
impairment (neost.
disturbances i.e.,
test.pptx ) i.e., all cobras,
members of the viper kraits and rarely Russell’s
family. viper.
a 20WBCT indicating the signs will be visual,
initially involving muscles
incoagulable blood or
enervated by the cranial
evidence of spontaneous
nerves.
bleeding from gums. ptosis,
ophthalmoplegia,
difficulty in swallowing
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19. Nerve.mpg

20. SNAKE BITE: LOCAL SWELLING
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21. SNAKE BITE: LOCAL SWELLING
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22. SNAKE BITE: LOCAL SWELLING
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23. SNAKE BITE: Those who do not show manifestation
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26. 26

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30. 30

31. In the case of neurotoxic envenoming,
once the snake venom antiserum has
been administered, the next step is to
administer a neostigmine test to
establish if the victim reacts to
anticholinesterase.
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32. Neurological Assessment
Objective measures of neurological
impairment
as single breath count,
length of time upward gaze can be
maintained,
Assessment of imminent respiratory
failure
Ability to raise their head.
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35. 35