Criteria & Indication

• (+) local or systemic signs of envenomation

• In the absence of #1 and snake in unidentified – observe for at least 24

hrs.
– v/s: BP, RR, HR, O2 sat
– Swelling
– Local necrosis
– Abnormal bleeding
– Neurotoxic features
– Urine output

• After 24 hrs, can be sent home if 1 & 2 is negative & with normal lab
test results
– At least 4 hrs after the removal of all first-aid measures such as constriction band & splints.
 Therapeutic Management
Neutralized venom if envenomation has occurred

• Antivenom is useless against the venom of

other venomous snakes

• Contraindications to antivenom therapy

– History of sensitivity to horse serum
– Atopic individuals
 Treatment for the Bitten Part

• Wound management
– Blisters/bullae/”blebs” should not be de-roofed.
– Abscesses should aspirated and the pus cultured.
– Skin necrosis – surgical debridement is indicated
– Gangrene toes or limbs may be amputated.
 Guide to Tetanus Prophylaxis in Routine
Wound Management
Type of Injury Non-immune IMMUNE
INCOMPLETE
Booster > 10yr Booster of < 10yr

Clean minor DT/DPT (start TT - None None

wound active
immunization
series)

Tetanus prone DT/DPT + TIG* TT 5 yrs TT < 5yr

NONE

Neglected wound DT/DPT + TIG* TT + TIG* TT + TIG*

ATS may be used in the absence of TIG

** Immune individual – has received at least 3 doses of DPT of TT
 Rehabilitation
• In patients with severe local envenoming,
the limb should be maintained in a
functional position.
• Restoration of normal function in the
bitten part should be started by simple
exercises.
• Conventional physiotherapy.
 Discharge Assessment
• Implications of having had a snakebite
• Rehabilitation exercises
• Follow-up appointment
• Late serum sickness-type reactions
• Reducing the risk of further bites
THANKS