 2,00,000 snake bites and 15-20,000 deaths per year  Males : Females :: 2:1  Majority of bites occur on the lower extremities  50% of bites by venomous snakes are dry bites –negligible envenomation

 POISONOUS / NON POISONOUS  LAND / WATER (FRESH / SALT WATER)

ElapidaeCobra ; kraitsNeuro toxc, cardiotoxic Viperidae (Vipers) Russell’s viper, Saw scaled vipers, Pit vipers Hemotoxic HydrophidaeSea snakesMyotoxic Krait and Russells’ viper more toxic than cobra

 The location of the bite (fatty tissue absorbs the venom more slowly than muscle tissue)  Whether disease-causing organisms are in the venom  The size and weight of the victim  The general health and condition of the victim  How much physical activity the victim engaged in immediately following the bite (physical activity helps spread venom)

FANG MARKS : classically, two puncture marks separated by a distance varying from 8mm to 4cm, depending upon the species involved. However a side swipe may produce only a single puncture, while multiple bites could result in numerous fang marks

 Two distinct fang marks about half an inch apart at the bite site, which may or may not bleed (in some cases there may be only one fang mark)  Immediate and severe burning pain and swelling around the fang marks, usually within 5 minutes but sometimes taking as long as 4 hours to develop (swelling may affect the entire arm or leg)  Purplish discolouration and blood-filled blisters around the bite, usually within 2 to 10 hours  Numbness around the bite

 Local effects  Systemic effects: - Neurotoxic - Haemotoxic - Cardiotoxic

Elapid Bites ( Krait ; Cobra)  Local features -indistinct fang marks -burning pain -swelling and discoloration -serosanguinous discharge  Pre paralytic stage : emesis -headache

 Elapid Bites ( Krait ; Cobra)  Paralytic stage: -Ptosis -Opthalmoplegia -Drowsiness -Dysarthria -Dysphagia -Convulsions -Bulbar paralysis -Respiratory failure

COBRA ENVENOMATION  Cardiotoxicity  Cardiac depression  Cardiogenic / vasogenic shock  Systolic cardiac arrest

VIPERID BITE (VIPER) Local features:  Rapid swelling  Discolouration  Blister formation  Bleeding from bite site  Severe pain

Systemic features (hemotoxic)  bleeding from nose  Hemoptysis  Bleeding gums  Hematuria  purpuric spots  Renal failure

Myotoxic  Local features : minimal swelling and pain  Systemic features : Muscle pain and stiffness  Myoglobinuria, renal tubular necrosis

 Snakes don’t bite out of whim  Usually forced to bite  Venom has evolved as a mechanism to subdue prey and snakes need to conserve their venom for that purpose

Things you should do:  Make sure the victim and others are a safe distance away from the snake and try to memorize its appearance  STAY CALM and in control. Take charge of the situation and reassure the victim  Remove Watches, rings, bangles and anything else that will become constrictive if the limb was to swell up.  Try to immobilise the victim. Never let him/ her run and only allow them to walk if unavoidable.

 In case of neurotoxic bites (All elapids and hydrophiids: Cobras, King cobras, kraits, coral snakes and sea snakes), pressure immobilization (Sutherland method) with long crepe or other elastic bandage(5=10cm 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.  Don’t waste time with trying to get any elaborate first aid done.  Get to hospital as soon as is safely possible.  Note the time of the bite and the progression of any visible symptoms.  Give the doctor a brief and detailed description of the bite and symptoms.  Antisnake venom serum is the only proven cure for venomous snakebite

Things'Not'to'Do :  Never try to suck out the venom  Never make an incision  Never go to traditional healers or try home remedies  Tie tourniquets or use ice  Never clean out or tamper with the site of the bite  Never try and catch the snake or kill it  All the above actions do not work and often cause more damage than good.

 Made from equine serum  Polyvalent against cobra, viper (russell and saw scaled), krait  1ml neutralises :  0.6mg Cobra ; 0.45mg Krait  0.6mg Russells; 0.45mg Saw scaled Lethal dose :  Cobra -0.12gm, Krait 0.06gm, Russels 0.15gm

 As always, prevention is better than cure.  Take care when clearing vegetation, raking dry leaves in your garden.  Supervise kids in the outdoors, especially in a green neighborhood.  Use torch/flashlight at night and keep wearing shoes. Check shoes before wearing them.  Watch your step and see before you sit!  Keep your backyard free of junk and make sure your solid waste is managed properly.  If you see a snake, do nothing. Let it go. Do not try to pick it up or kill it. If a snake has entered Your premises, call professional snake rescuers.