In case of neurotoxic bites all elapids and hydrophiids. Details of the bite site, the subjects activities at the time of the bite, local manifestations. A module on the management of snake bite cases for medial officers snakebite is a medical emergency. For neurotoxic elapid bites krait, cobra, king cobra pressure immobilization. However the true scale of mortality and acute and chronic morbidity from snakebite remains uncertain because of inadequate reporting. Indian common krait envenomation presenting as coma and. A clear and comphrensive discussion of snake bite and its management. As more and more cases of common krait ck bite are being diagnosed, it is now proved that, snakebite is not restricted to. The patient should be removed from the snakes territory, kept. These are unofficial estimates, for the asian subcontinent comprising india, bangladesh, pakistan and adjoining areas of approximately 1,00,000 fatalities per year. Snake bite management free download as powerpoint presentation. Introduction snake bite is an important public health hazard in bangladesh estimated an annual incidence of 623100,000 6,041 deaths annually. Dose of antivenom for the treatment of snakebite with.
Krait envenomation disguised as heat exhaustion in a. Initial first aid is directed at reducing spread of the venom and expediting transfer to an appropriate medical center 10, 11. Inspect the area of the biteinspect the area of the bite, looking for fang marks, which may appear to be a small abrasion or laceration. We enrolled 30 subjects of presumed snake envenoming krait 23 cases, cobra 7 cases. Diagnosis of species of the snake responsible for bite is, therefore, important for optimal management and can be strongly suspected from the patients. In anuradhapura, 210 farmers bitten by the common krait over a three year period were investigated prospectively from 1 january 1996. From the field to the hospital reginald g alex, professor, department of emergency medicine, christian medical college, vellore ramya i, professor, department of medicine, christian medical college, vellore mousumi sen, associate professor, department of forensic medicine, christian medical college, vellore anand zachariah, professor and head, department. The cobra and krait venoms are neurotoxic and cardiotoxic. Antivenom has been shown to be effective up to 2 days after sea snake bite and in patients still defibrinated weeks after viper bite. An inadequate understanding of appropriate snakebite treatment often delays proper treatment of those who are bitten. Recently, a study of snake bite mortality in india, based on verbal autopsy, estimated 46,000 deaths each year. In krait bites, cramping abdominal pain followed by diarrhoea and collapse may occur. Out of the 250 snake species identified in india only about twenty are poisonous. The common krait bungarus caeruleus, also known as indian krait or blue krait is a species of venomous snake of the genus bungarus found in the indian subcontinent.
Snake classification from images alex james corresp. Handling common poison cases and snake bites are wellknown medical emergencies across the country including west bengal, especially in rural areas. The antivenom available in the armed forces is a polyvalent equine antiserum. This publication aims to pass on a digest of available knowledge about all. Currently, treatment quality is highly varied, ranging from good quality in some areas, to very poor quality treatment in others. The study was conducted between april 2011 and march 20 at the snake bite treatment centre of damak red cross society, the snake bite management centre of charali, both in jhapa district, and the bharatpur district hospital, bharatpur, in chitwan district. Shochoureki doesnot respond to asv of indian origin.
Low back pain, indicative of a early renal failure or retroperitoneal bleeding, although this must be carefully investigated as many rural workers involved in picking activities complain of back pain generally. Management of snake bite national guideline 2014 dr. For russells viper bites, pressure pad with immobilization has proved safe and capable of preventing systemic uptake of venom. Management of poisonous snakebites chris cribari, md, facs clinical evaluation of the snakebite victim 1. Krait bites and their management bungarus caeruleus schneider, 1801 indian krait or common krait bungarus ceylonicus gunther, 1858 ceylon krait or sri lanka krait. Dubios sea snake fierce snake eastern brown snake blue krait black mamba tiger snake philippine cobra vipers death adder rattle snake most venomous snakes in the. Management of snake bite in india shibendu ghosh1, prabuddha mukhopadhyay2, tanmoy chatterjee 3 1associate professor, department of medicine, rims, raipur, chattisgarh. Guidelines for the management of snakebite in hospital issuu.
Envenoming by the common krait bungarus caeruleus and asian. Commonly the indian cobra najanaja, common krait bungaruscaeruleus. The venomous snakes most often encountered are the indian spectacled cobra naja naja, common krait b. Krait was the most common type of snake bite reported. Forhad uddin hasan chowdhury maruf assistant registrar medicine dhaka medical college hospital 2. Persistence of many myths and superstitions regarding snake bite management prevail in these areas further complicating emergency management. If you know the snake is not venomous, treat as a puncture wound. Management of snake bite cases and patients affected by common poisons puts the medical officer at emergency opd in rural, periurban and rural settings to a challenge. Sea snake envenomation causes headache, a thick feeling of the tongue, thirst, sweating and vomiting. Complete 10 vials in 1 hour look for signs of anaphylaxis second 10 vials can be considered after 6hrs depending on the severity of the envenomation. This study analysed the pattern of snakebites and their management in a. Antivenom should be administered to all patients with moderate to severe snake bite envenomation.
With early diagnosis and proper management, including administration of the appropriate dose of antisnake venom asv and adjuvant treatment with neostigmine, atropine. Antivenin administration in infants and small children this can be given directly with an infusion pump. Management of snakebite and research effective methods are immobilization of the bitten limb and transport to hospital on a stretcher. Since 1976, we have been studying the clinical effects, management, and prevention of envenoming by the big four cobra, krait, russells viper, and echis carinatus in rural maharashtra, india. Bites result in minimal local effects or are absent altogether. Make sure that the responsible snake or snakes have been appropriately and safely contained, and are out of danger of inflicting any additional bites. So far no automatic classification method has been proposed to. Local effects are seen in the former but not in the latter. The high fatality due to krait bite is attributed to the nonavailability of antisnake venom asv, delayed and inappropriate administration of asv, lack of standard protocol for management and. Wide experience in treating snake bite patients since last 18 years, with having very less mortality. Management of venomous snake bites in north america. The high fatality due to krait bite is attributed to the nonavailability of antisnake venom asv, delayed and. The objective of this article is to give an overview of field management, transport to the hospital, identification of critical conditions, initial stabilization, investigations and early management of snake bite.
In 59 snakebite victims, maximum data could be recovered. Assess abcs abcs and initiate appropriate resuscitation efforts. Kraits bungarus species uc san diego health sciences. With early diagnosis and proper management, including administration of the appropriate dose of antisnake venom asv and adjuvant treatment with neostigmine, atropine, and ventilation, we have. Kraits bungarus species in the event of an actual or probable bite from a krait, execute the following first aid measures without delay. Elapidae cobra, king cobra, krait, and coral snake. It is important to remember that nausea and vomiting are common symptoms of all severe envenomation. These snakes have heads that are of about the same width as their necks. Hence it is imperative to be thoroughly conversant with the clinical presentation and management of these cases. Krait envenomation is quite common in india, taiwan, vietnam, and other asian countries. A high incidence of snakebite envenomation has been reported from marathwada, maharashtra. Common krait bungarus caeruleus is the deadliest snake found commonly in the dry zone of sri lanka. If there is doubt about the snakes identity, treatment should be administered for an unidentified snake bite. Emergency treatment of a snake bite journal of emergencies.
For snake bite management, the current recommendations were. Clinical features and management of snake bite ncbi. There are several species of krait, but like most elapids, their venom is primarily neurotoxic. Guidelines for the clinical management of snake bites in. Altered consciousness and deep comma has been reported in 64 % of patient after common krait envenomation. Management of snakebite full background document ver. This study analysed the pattern of snake bites and their management in a rural area of india over a 10.
Cobras, king cobras, kraits, coral snakes and sea snakes, pressure immobilization sutherland method with long crepe or other elastic bandage510cm wide, several rolls and splint to be applied immediately to the bitten limb, starting at the digits and working up to the groin or arm pit. Kraits are in the elapidae family, the same as cobras and mambas. Basic first aid for snake bite envenomation objectives the aim of this component is to provide the student with a concise and rational approach to the diagnosis, treatment and patient management of. Guidelines for the clinical management of snake bite in the southeast asia region preface the geographical area specifically covered by this publication extends from pakistan and the rest of the indian subcontinent in the west through to the philippines and indonesia in the east, excluding tibet, china, taiwan, korea, japan, the eastern islands. Factors not contributing to outcome are size of the snake and time of bite daynight 2. All centres are located in the terai plains of nepal. It is a member of the big four species, inflicting the most snakebites on humans in india. Introduction early in 2009, snake bite was finally included in the whos list of neglected tropical diseases confirming the experience in many parts of south east asia region that snake bite is a common occupational hazard of farmers, plantation workers and. In our study none of the russells viper presented with neurotoxicity. Russells viper were innocuous when given intravenously. The attendingphysician shouldassesthebites, shape and number of pods which are. Guidelines for the management of snakebites world health. Department has prepared a national snakebite management. Management of venomous snake bite linkedin slideshare.
Krait, genus bungarus, any of 12 species of highly venomous snakes belonging to the cobra family elapidae. In a study by ha 2009 1, 60 krait envenomations were studied. In burma, russells viper bite is a common cause of acute kidney injury and is responsible for most of the estimated snakebite deaths each year. Apart from antivenom treatment, adequate supportive care including management of complications might help to decrease the mortality rate.
The dose of asv to be administered to a person is one of the biggest controversies in the management of snake bite envenomation. It may result in death or chronic disability even in active young people. Manual ventilation self ventilating anaesthetic bag has been effective. In the usa, there are about 45,000 bites and a few deaths each year. Common krait bungarus caeruleus bite in anuradhapura. Snake bite is a common and frequently devastating environmental and occupational. The majority are due to envenomation by neurotoxic kraits and cobras. Thus, vital signs and electrolytes should be frequently and closely monitored in these patients. Incidence of snake bite in india there is a huge gap between the number of snakebite deaths reported from direct survey and official data. Specific asv for sea snake and pit viper bite is not available in india. The results showed that the mortality rate was 7% out of all those bitten, with a mean age of the victims being 33 and 71% of the victims being males. Pelc slcp 1 management of snake bites in children in sri. Envenoming by the common krait bungarus caeruleus and. This is effective against the 4 most important venomous snakes in india, namely, cobra, common krait, russells viper and sawscaled.
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