1. Management of Snakebite

2. Epidemiology: • Estimated 5.4 million bites per year. • 2.7 million envenomings. • 81,000-138,000 deaths annually. • Regions Most Affected: Sub-Saharan Africa, South Asia, Southeast Asia, Latin America.

3. Types of Venom: • Neurotoxic: Affects the nervous system (e.g., elapids like cobras, kraits). • Symptoms: Ptosis, diplopia, dysphagia, respiratory paralysis. • Haemotoxic: Affects blood coagulation and causes tissue damage (e.g., vipers like Russell's viper, saw-scaled viper). • Symptoms: Bleeding from gums/nose, hematuria, local swelling, blistering, necrosis. • Cytotoxic: Causes local tissue destruction (e.g., some vipers). • Symptoms: Severe pain, swelling, blistering, necrosis. • Myotoxic: Damages muscle tissue (e.g., sea snakes)

4. Factors Influencing Severity • Snake species, amount of venom injected, bite location, victim's age/health, time to treatment

5. Hospital Management: Initial Assessment & Monitoring • ABC (Airway, Breathing, Circulation) Assessment: Prioritize life threats. • Rapid History Taking: • Time of bite, circumstances, observed snake (if any). • First aid administered. • Pre-existing medical conditions.

6. Clinical Examination: • Local signs: Swelling, pain, bruising, blistering, fang marks. • Systemic signs: Ptosis, muscle weakness, bleeding from orifices, abdominal pain, nausea/vomiting

7. Baseline Investigations: • 20-minute Whole Blood Clotting Time (20WBCT): Crucial for haemotoxic bites. • Full Blood Count (FBC). • Renal function tests (Urea, Creatinine). • Electrolytes. • Creatine Kinase (CK) if myotoxicity suspected. • Urine dipstick for proteinuria/hematuria.

8. Continuous Monitoring • Vital signs, limb circumference, 20WBCT (repeated), neurological status, urine output. • Image: A medical team assessing a patient, a close-up of a 20WBCT test

9. Antivenom Therapy - The Cornerstone of Treatment • Mechanism of Action: Neutralizes circulating venom. • Types of Antivenom: • Monovalent: Effective against one species' venom. • Polyvalent: Effective against venoms of several species in a region. • )

10. Indications for Antivenom: • Systemic envenomation (coagulopathy, neurotoxicity, cardiovascular effects, renal failure). • Rapidly progressing local envenomation (severe swelling, blistering, necrosis

11. Administration: • Intravenous infusion, slow rate initially. • Dosage: Not weight-dependent; typically same for adults and children. • Premedication: Antihistamines, corticosteroids (controversial, discuss local guidelines)

12. Anaphylaxis and Serum Sickness: • Acute reactions: Occur within minutes to hours. Manage with adrenaline, antihistamines, corticosteroids. • Delayed reactions (serum sickness): Occur days to weeks later. Manage with antihistamines, corticosteroids.

13. Supportive Care and Complications Management • Fluid Management: Maintain hydration, manage hypotension. • Pain Management: Analgesics. • Wound Care: Clean, sterile dressings for local lesions. May require debridement or fasciotomy in severe cases (rarely). • Antibiotics: For secondary bacterial infections, not routinely for all bites. • Renal Failure Management: Dialysis if needed. • Blood Products: Fresh frozen plasma (FFP), cryoprecipitate if severe bleeding and antivenom alone is insufficient.

14. Complications: • Chronic pain, limb deformity. • Amputation. • Renal impairment. • Neurological deficits.

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