SnakebiteSnakebite

ByKamal KrishnaB.Ed. Session- 2012-13DAV PG College, Dehradun

Project submitted to:

Dr. Rupali Bahl

Asstt. Professor

DAV(PG) College, Dehradun

First AidFirst Aid

First aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed.

Some illnesses or minor injuries may not require further medical care.

It generally consists of a series of simple and in some cases, potentially life-saving techniques that an individual can be trained to perform with minimal equipment.

HistoryHistory The instances of recorded first aid were provided by

religious knights, such as the Knights Hospitaller, formed in the 11th century, providing care to pilgrims and knights, and training other knights in how to treat common battlefield injuries.

Organized societies were seen again in 1859 Jean-Henri Dunant organized local villagers to help victims of the Battle of Solferino, including the provision of first aid.

Four years later, four nations met in Geneva and formed the organization which has grown into the Red Cross, with a key stated aim of "aid to sick and wounded soldiers in the field". This was followed by the formation of St. John Ambulance in 1877.

American Red Cross. New techniques and equipment have helped make

today’s first aid simple and effective.

Aims of First Aid

summarized in three key points:- Preserve life: is to save lives.

Prevent further harm: -- The condition from worsening or -- Danger of further injury

Promote recovery:

First aid training also involves the prevention of initial injury and responder safety, and the treatment phases.

Key Skill required for First Key Skill required for First AidAid

Particularly the "ABC"s of first aid, ABC stands for Airway, Breathing, and Circulation. Obstruction (choking) is a life-threatening emergency.

Following evaluation of the airway, a first aid attendant would determine adequacy of breathing provide rescue breathing if necessary. Assessment of circulation, pulse checks.

Fourth step of "D" for Deadly bleeding or Defibrillation, "3Bs": Breathing,Bleeding, and Bones "4Bs": Breathing, Bleeding, Brain, and Bones).

Artificial respiration and chest compressions to someone who is not breathing and has no pulse, and the consideration of cervical spine injuries when ensuring an open airway.

Preserving Life In order to stay alive, all persons need to have

◦ an open airway—a clear passage where air can move in through the mouth or nose through the pharynx and down into the lungs, without obstruction. Conscious people will maintain their own airway automatically, but those who are unconscious (with a GCS of less than 8) may be unable to maintain a patent airway, as the part of the brain which automatically controls breathing in normal situations may not be functioning.

If the patient was breathing, a first aider would normally then place them in the recovery position. It also avoids a common cause of death in unconscious patients, which is choking on regurgitated stomach contents.

The airway can also become blocked through a foreign object becoming lodged in the pharynx or larynx, commonly called choking. The first aider will be taught to deal with this through a combination of ‘back slaps’ and ‘abdominal thrusts’.

Preserving Life (Contd….) Once the airway has been opened, the first aider would assess

to see if the patient is breathing. If there is no breathing, or the patient is not breathing normally, such as agonal breathing, the first aider would undertake what is probably the most recognized first aid procedure—cardiopulmonary resuscitation or CPR, which involves breathing for the patient, and manually massaging the heart to promote blood flow around the body.

The airway can also become blocked through a foreign object commonly called choking. The first aider will be taught to deal with this through a combination of ‘back slaps’ and ‘abdominal thrusts’.

Once the airway has been opened, the first aider would assess to see if the patient is breathing. ◦ If there is no breathing or not breathing normally, such as 

agonal breathing, the first aider would undertake — cardiopulmonary resuscitation or CPR, which involves breathing for the patient, and manually massaging the heart to promote blood flow around the body.

Promoting Recovery

The first aider is also likely to be trained in dealing with injuries such as cuts, grazes or bone fracture.

They may be able to deal with the situation in its entirety (a small adhesive bandage on a paper cut),

may be required to maintain the condition of something like a broken bone, until the next stage of definitive care (usually an ambulance) arrives.

TrainingTrainingBasic principles, such as knowing to use an adhesive

bandage or applying direct pressure.However, to provide effective, life-saving first aid

interventions requires instruction and practical training for Fatal illnesses and injuries, such as those require cardiopulmonary resuscitation (CPR); these procedures may be invasive, and carry a risk of further injury.

it is more useful if it occurs before an actual emergency, and basic first aid instructions over the phone while the ambulance is on the way.

Training is generally provided by attending a course, typically leading to certification..

First aid training by  Red Cross and St. John Ambulance etc. Commercial training.

Specific DisciplinesSpecific DisciplinesThere are several types of first aid (and first aider) which require

specific additional training. These are usually undertaken to fulfill the demands of the work or activity undertaken.

Aquatic/Marine first aid Battlefield first aid  Hyperbaric first aid -for SCUBA diving professionals Oxygen first aid is the providing of oxygen to casualties who

suffer from conditions resulting in hypoxia. Wilderness first aid- first aid may be delayed due to constraints

of terrain, weather, and available persons or equipment. Hydrofluoric Acid chemical industry. Mental health first aid -a mental health problem or in a crisis

situation. Equine first aid - first aid for horses, mules and donkeys

verinarian or othe r professional may be delayed.

Symbols

International Red Cross

Although commonly associated with first aid, the symbol of a red cross is an official protective symbol of the Red Cross. According to the Geneva Conventions and other international laws, the use of this and similar symbols is reserved for official agencies of the

Symbols contd……..Star of lifeSome organizations may make use of the Star of Life, although this is usually reserved for use by ambulance services

The internationally accepted symbol for first aid is the white cross on a green background shown below.

ISO First Aid Symbol

St. Andrew's First Aid Badge

First Aid in India Indian Red Cross Society

About Society : Indian Red Cross Society (IRCS) was established in 1920

under the Indian Red Cross Society Act and incorporated under Parliament Act XV of 1920. The act was last amended in 1992 and of rules were formed in 1994.

The IRCS has 35 State / Union Territories Branches with their more than 700 districts and sub district branches.

Condition that often require first Aid Altitude sickness-swelling of the brain or lungs.

Anaphylaxis, - shock, allergens such as insect bites or peanuts. Battlefield first aid—shrapnel, gunshot wounds, burns, bone

fractures, etc. and damage by large scale as a bomb blast. Bone fracture, Burns Cardiac Arrest, which will lead to death unless CPR preferably

combined with an AED is started within minutes. Choking, blockage of the airway (lack of oxygen ) Childbirth. Cramps in muscles Diving disorders, drowning or asphyxiation. Gender-specific conditions, such as dysmenorrhea and 

testicular torsion. Heart attack, Heat stroke, also known as sunstroke or hyperthermia,

Condition that often require first Aid (Contd….)

Heavy bleeding, treated by applying pressure (manually and later with a pressure bandage)

Hyperglycemia (diabetic coma) and Hypoglycemia (insulin shock).

Hypothermia, or Exposure, occurs when a person’s core body temperature falls below 33.7°C (92.6°F).

Snake, Insect and animal bites and stings. Joint dislocation. Poisoning by injection, inhalation, absorption, or ingestion. Seizures, or a malfunction in the electrical activity in the brain. Muscle strains and Sprains, a temporary dislocation of a joint Stroke, a temporary loss of blood supply to the brain. Toothache, Wounds and bleeding,

Snake bite

Aims of first aid

Attempt to retard systemic absorption of venom

Preserve life and prevent complications before the patient can receive medical care(at a dispensary or hospital)

Control distressing or dangerous early symptoms of envenoming

Arrange the transport of the patient to a place where they can receive medical care

ABOVE ALL, DO NO HARM!

Classification of poisonous snake There are two important groups (families) Elapidae have short permanently erect fangs This

family includes the cobras, kraits, coral snakes and the sea snakes.

Viperidae Have long fangs which are normally folded up against Have long fangs which are normally folded up against

the upper jaw but, when the snake strikes, are erected the upper jaw but, when the snake strikes, are erected ..

King Cobra and VipersKing Cobra and Vipers

Spectacled Cobra

Elapidae KRAITS (genus Bungarus)

B caeruleus common krait [all over India ] paired white bands & large hexagonal scales in top of the snakes

B fasciatus banded krait [black & yellow band –W.B,M.P,A.P,BIHAR ,ORRISSA]

Short, permanently erect, fangs of a typical elapidae

ViperidaeHave long fangs which

are normally folded up against the upper jaw but, when the snake strikes, are erected .

Russell’s vipers details of fangs

Key Identification Feature- large plate scales on the head.

Encountered under bushes and leaf litter or in bushes. Haemotoxic venom. Causes Renal failureLate onset envenoming No effective anti venom

PIT VIPER

Generalised Symptoms and Signs

GeneralNausea, vomiting, malaise, abdominal pain,

weakness, drowsiness, prostrationElapidae have short permanently erect

fangs This family includes the cobras, kraits, coral snakes and the sea snakes.

Cardiovascular (Viperidae) Visual disturbances, dizziness, faintness,

collapse, shock, hypotension, cardiac arrhythmias,

pulmonary oedema, conjunctiva oedema KRAIT bites : nocturnal, indoor, unprovoked

& painless COBRA & VIPER bites : painful & accompanied by neuroparalysis,

coagulopathy

Generalised Symptoms by Fang marks Contd…)

But many cases the treatment is given on suspected snake bite on the basis of general Symptoms despite no fang mark on body

Very Important (Must Read)

Local symptoms and signsLocal symptoms and signs

• Fang marks • Local pain• Local bleeding • Bruising• Lymphangitis• Lymph node enlargement• Inflammation (swelling, redness,

heat)• Blistering • Local infection, abscess formation• Necrosis

Physical Examination Vital signs, airway, breathing, circulation Fang marks or scratches (determine coral snake

bite pattern by expressing blood from the suspected wound)

Local tissue destruction◦ Soft pitting edema that generally develops over

6-12 hours but may start within 5 minutes◦ Bullae◦ Streaking◦ Erythema or discoloration◦ Contusions

Systemic toxicity◦ Hypotension◦ Petechiae, epistaxis, hemoptysis◦ Paresthesias and dysthesias - Forewarn

neuromuscular blockade and respiratory distress (more common with coral snakes)

Following the immediate pain of mechanical penetration of the skin by the snake’s fangs, there may be increasing local pain (burning, bursting, throbbing) at the site of the bite.

Local swelling that gradually extends proximally up the bitten limb.

Tender, painful enlargement of the regional lymph nodes draining the site of the bite

Bites by kraits, sea snakes and Philippine cobras may be virtually painless and may cause negligible local swelling.

Symptoms and signs vary according to the species of snake responsible for the bite and the amount of venom injected

Symptoms and signs When venom has been injected

Symptoms and signs (Contd….) When venom has not been injected

Some people who are bitten by snakes or suspect or imagine that they have been bitten, may develop quite striking symptoms and signs, even when no venom has been injected. This results from an understandable fear of the consequences of a real venomous bite.

Anxious people may overbreathe so that they develop pins and needles of the extremities, stiffness tetany of their hands and feet and dizziness.

Others may develop vasovagal shock after the bite or suspected bite - faintness and collapse with profound slowing of the heart.

Others may become highly agitated and irrational and may develop a wide range of misleading symptoms.

If a snake bites youIf a snake bites you

Remain calm. Immobilize the bitten arm or leg, and stay as quiet as

possible to keep the poison from spreading through your body.

Remove jewelry before you start to swell. Position yourself, if possible, so that the bite is at or

below the level of your heart. Cleanse the wound, but don't flush it with water, and

cover it with a clean, dry dressing. Apply a splint to reduce movement of the affected area,

but keep it loose enough so as not to restrict blood flow.There are so many cases when poor access both to

health services and first-aid medical treatment lead to fatal result with victim.

Do’s

Cleanse the wound, but don't flush

it with water, and cover it with

a clean, dry dressing. Apply a splint to reduce movement of the affected

area, but keep it loose enough so as not to restrict blood flow.

Don't use a tourniquet or apply ice. Don't cut the wound or attempt to remove the

venom.

Don't drink caffeine or alcohol. Don't try to capture the snake, but try to remember

its color and shape so you can describe it, which will help in your treatment.

Don’ts

Tight (arterial) tourniquets are not recommended- WHY?

Confining this toxin in a smaller area, by use of compression techniques creates a greater risk of serious local damage.

When the tourniquet is removed there is the problem of the venom rapidly entering the system and causing respiratory failure in the case of neurotoxic bites

The Viper’s venom contains pro-coagulant enzymes which cause the blood to clot. In the small space below the tourniquet the venom has a greater chance of causing a clot. When the tourniquet is released the clot will rapidly enter the body and can cause embolism and death.

Lastly, there has been a great deal of research showing that tourniquets DO NOT stop venom from entering the body

Don’ts Contd…)

Another source of symptoms and signs not caused by snake venom is first aid and traditional treatments.

Constricting bands or tourniquets may cause pain, swelling and congestion.

Ingested herbal remedies may cause vomiting. Instillation of irritant plant juices into the eyes may

cause conjunctivitis. Forcible insufflations of oils into the respiratory tract

may lead to aspiration pneumonia, bronchospasm, ruptured ear drums and pneumothorax.

Incisions, cauterization, immersion in scalding liquid and heating over a fire can result in devastating injuries.

Don’ts Contd…)

Recommended first aid methods• Reassure the victim who may be very anxious• Immobilise the bitten limb with a splint or

sling (any movement or muscular contraction increases absorption of venom into the bloodstream and lymphatics)

• Consider pressure-immobilisation for some elapid bites

• Avoid any interference with the bite wound as this may introduce infection, increase absorption of the venom and increase local bleeding

Pressure immobilisation method An elasticated, stretchy, crepe

Bandage,approximately 10 cm wide and at least 4.5 metres long should be used.

If that it not available, any long strips of material can be used.

The bandage is bound firmly around the entire bitten limb, starting distally around the fingers or toes and moving proximally, to include a rigid splint.

The bandage is bound as tightly as for a sprained ankle, but not so tightly that the peripheral pulse (radial, posterior tibial, dorsalis pedis) is occluded or that a finger cannot easily be slipped between its layers

Management of snake bite

First aid treatmentTransport to hospital Rapid clinical assessment and resuscitation Detailed clinical assessment and species

diagnosis Investigations/laboratory tests Antivenom treatment Observation of the response to

antivenom:decision about the need for further dose(s) of antivenom

Supportive/ancillary treatment Treatment of the bitten part Rehabilitation Treatment of chronic complications

History of caseObtain a description of the snake or capture it, if possible, to

determine its color, pattern, or the existence of a rattle.Most snakes remain within 20 feet after biting.Assess the timing of events and onset of symptoms. Inquire

about the time the bite occurred and details about the onset of pain. Early and intense pain implies significant envenomation.

Local swelling, pain, and paresthesias may be present.

Systemic symptoms include nausea, syncope, and difficulty swallowing or breathing.

Determine history of prior exposure to antivenin or snakebite. history of allergies to medicines

history of co morbid conditions or medications (eg, aspirin, anticoagulants such as warfarin or GPIIb/IIIa inhibitors, beta-blockers).

References References Article By : Gaurav Akrani. This

snake article revised on 11th December 2012.

WikipediaPowerpoint presentation of

Dr.Pratheeba Durairaj, M.D.,D.A,By Mayo Clinic staffPicture from Google from various

website