PROTOCOL FOR INITIAL MANAGEMENT OF SNAKEBITE HEALTH FACILITIES (PHC/CHC)

Scan Me
Suspected Snakebite
$ For Standard Treatment Guideline (STG) for Snakebite Management
Check Vitals
*Signs and symptoms of envenomation
Stabilize(ABCDE#) Local Symptoms (PONDS) Neurological Symptoms Hematological Symptoms
Stable Patient • Drooping of eyelids • Bleeding from ears, nose,
Unstable Patient Pain
• Difficulty in swallowing and throat, gums (any site)
Oozing speaking • Swelling and Blisters
Patient shows signs and symptoms of envenomation* Node enlargement • Neck muscle • Prolonged 20 min whole blood
weakness/difficulty in lifting clotting time
Discoloration head
Swelling • Difficulty in breathing
No Yes • Weakness in all 4 limbs
Kraits does not produce local symptoms,
can cause abdominal pain/vomiting
If victim does not show signs and
symptoms of envenomation after 24 Start ASV
hours of observation, then discharge For Syndrome wise management Please refer STG

#ABCDE (Airway Breathing Circulation Disability Exposure)

ASV Dosage (Neuroparalytic/ Vasculotoxic snakebite)
• Give TT only on deltoid region (IM) and not on gluteal
ASV 10 vials stat as infusion over 30 minutes followed by 2nd dose of 10
region
vials after 1 hour if no improvement within 1st hour.
• Give Antibiotics as needed
• Follow up and Discharge ($ refer STG, 2017, MoHFW).
ASV to be repeated for the patients who are not improving or worsening.
(For details refer STG, 2017, MoHFW).

Monitor for 2 hours for any immediate adverse reaction to ASV

If Adverse reaction occurs to ASV, Immediately STOP ASV temporarily

Adverse reaction No Adverse Reaction

Treatment for Adverse Reactions Complete the full dose of ASV, then refer to Higher Centre as per the Criteria as Under.
• Adrenaline (0.5 mg IM) injection (child- 0.01 mg/kg IM)– repeat dose after 5
1. Requirement of repeat dose of ASV
minutes if patient has not improved.
2. Development of compartment syndrome
• Inj. Hydrocortisone (100 mg IV) & for child- 2 mg/kg IV 3. Signs of Stroke
• Inj. Ranitidine (50 mg IV) 4. Signs of Acute Coronary Syndrome
• Inj. Chlorpheniramine (10 mg IV) & for child- 0.2 mg/kg 5. Acute kidney Injury, need for dialysis
• Nebulize with salbutamol, administer high flow oxygen, fluid bolus for shock 6. Persistent bleeding, need for blood transfusion
(Adults- 500-1000 ml and for child- 20 ml/kg) 7. Cellulitis/Gangrene, Progressive septicemia
8. Respiratory failure and prolonged need for Mechanical Ventilation

Once the Patient has recovered, the ASV to be restarted slowly for 10-15 Assess for signs of Recovery (Eg. Normalization of BP, Stoppage of Bleeding and Recovery of
mins., then the normal drip rate should be resumed. respiratory muscles etc.)/Adverse Reaction/Referral ($ For details refer STG, 2017, MoHFW)

Snake Bite Prevention and Control, NCDC, DGHS, MoHFW, GoI