VIPER SNAKE BITE
Samprikta Nag
3rd Year MBBS (SLMCH)
1. NOMENCLATURE
2. TYPES
3. GENERAL FEATURES
4. SYMPTOMS
Topics covered 5. DIAGNOSIS
6. MANAGEMENT
7. MEDICO LEGAL ASPECT
8. POST MORTEM FINDINGS
9. CASE
Phylum : Chordata
Class : Reptilia
Nomenclature Order : Squamota
Suborder : Serpentes
Family : Viperidae
TYPES OF VIPER
PITILESS VIPERS PIT VIPERS
RUSSELL'S VIPER SAW SCALED VIPER CROTALIDAE COMMON GREEN PIT
VIPER
S.
NO. FEATURE VIPER
Large,broader than the body,
1. Head
triangular,covered by small scales
G F
2. Body Short with narrow neck
E E
3. Pupils Verticle,slit like
N A
4. Maxillary bone Carries only poison fangs
E T
Fangs Canalised,long and movable
5.
Hemotoxic R U
venom
6.
7. Tail Tapering A R
8. REPRODUCTION Ovo-viviparous L E
9. Other teeth Absent S
10. ACTION Enzymatic damage to cell wall
11. SITE Endothelial cells of blood vessels
DISTAL END
TRIANGULAR HEAD SCALES
TWO PROMINENT FANG
MARKS
SINGLE ROW OF TEETH
MARKS
Gangrene of foot
Regional lymphadenopathy
Extensive necrosis
Persistent bleeding LOCAL
Compartment syndrome
SYMPTOMS
Reddish & painful
swelling Malignant edema
Blisters
Hematologic
abnormalities Epistaxis
DIC Intracranial Hemoptysis
Primary pathological
fibrinolysis hemorrhage
Hematuria
Dilated pupil Hemorrhage in renal
SYSTEMIC Hemorrhagic calyces
manifestations
SYMPTOMS
Ant. Pituitary
Hypotension hemorrhage
Purpuric spots
on skin
Tachycardia Bleeding from gums &
floor of mouth
DIAGNOSIS
VASCULOTOXIC TEST OTHER TESTS
20 mins whole blood clotting test
Repeated every 6 hours CBC
Clean and dry test tube Coagulation profile
ECG
Renal function test
Put whole blood
Urine analysis
Chest X-ray
Wait for 20 mins
Ultrasound of the bite site
BLOOD CLOTS: suggests no snake bite or venom Immunodiagnosis- immunological
belongs to another snake detection of venom antigen by
BLOOD DOESN'T CLOT: suggests viper snake ELISA
poisoning
DIFFERENTIAL DIAGNOSIS
BLISTERS,PAINFUL SWELLING ,EDEMA - necrotising fascitis (Streptococcus, Clostridium)
- chemical burns(acid, alkali, vesicants-mustard gas )
BLEEDING(gums,nose) - rodenticide poisoning, anticoagulant poisoning
- physical trauma (blunt force injuries, internal organ rupture)
- DIC- sepsis, trauma
PTOSIS,DILATED PUPILS,- cobra or krait bite
- OPC poisoning (pesticides,nerve agents)
RESPIRATORY DEPRESSION
- Guillain Barre Syndrome
- Myasthenia gravis
- botulism
TACHYCARDIA,HYPOTENSION - cobra or krait bite
- cardiotoxic poisoning (digitalis, OPC, cyanide)
INFLAMMATION,EDEMA,OOZING OF BLOOD,NECROSIS -Abrus precatorius poisoning
MANAGENENT
1. Field Management
follow RIGHT strategy
R: Reassure
I: Immobilize
GH: Go to the Hospital
T: Tell appropriate history and symptoms to the doctor
NO: Mistakes shouldn't be made
NO suction
NO ligature
NO torniqueut
NO electric shock
2. Hospital Management
ANTI SNAKE VENOM(ASV): key to the management
>given within 4-5 hours ofthe bite
>Source: HORSE HYPERIMMUNIZED SERUM
>can lead to allergies/anaphylaxis (Adrenaline given to counteract any allergies)
>given in severe local and systemic envenomation
>Duration: till clotting time becomes normal
Monitor the cardiac rhythm , oxygen saturation, urine output and vital signs
Measure limb circumference until swelling stabilizes
Fluid resuscitation
ATROPINE(0.6mg): controls muscarinic effect of Ach
Wound care: Application of dry, sterile dressing
(NOTE- NEOSTIGMINE-AChE inhibitor
used to reverse postsynaptic neurotoxic paralysis
generally not used in viper bite)
MEDICO LEGAL ASPECT
1. Homicidal and suicidal cases
2. Accidental deaths and compensation- Death due to snake bite
may lead to claims under insurance, govt.relief, etc
3. Occupational hazards- Several occupations are associated with
increased risk of snakebite: grass-cutting, working in rubber,
coconut, areca nut, and tea and coffee plantations.
4. Legal provisions- Deaths due to snakebite are regarded as
medicolegal in nature, and a forensic autopsy is mandatory
POSTMORTEM FINDINGS
Medullary hemorrhages in kidney
Intracranial hemorrhage Pituitary hemorrhage
Blisters
Dilated pupil
Gangrene of foot
CASE
A case of upper limb compartment
syndrome following a snake bite on the
right wrist of a five-year-old girl who
presented eight-hours after the snake
bite to the emergency department of
Nizwa Regional Referral Hospital. The
patient received early and appropriate
care but progressed to develop
compartment syndrome for which she
had to be taken to the operating theatre
for emergency fasciotomy.
