SNAKES

Dr AMIR
• More than 3500 spcs of snakes in the world
• 350 spcs- poisonous (200 Spc. Can cause
death)
• Most of the snakes are non venomous
• Non venomous- regal python, Anaconda (giant
constrictors)
Regal python- largest snake in the world
Leptotyphlops carlae (10 CM)
• 15000- 20000 peoples die
• About 2 lakhs snake bites
• Most of this deaths are preventable
• Timely and appropriate treatment
• preventive measures
• Snakes (also referred to as serpents) are
limbless creatures with elongated bodies
covered with scales.
• The body is divided into head, trunk, and tail.
• External ears are absent.

• The eyes of a snake lack eyelids, each being

covered by a transparent scale.
• Pupils may be round or elliptical.
• The tongue is forked and can be flicked in and
out of the mouth rapidly.
• Picks up scent particles from the exterior and
transfer them to the Jacobson’s organ in the
roof of the mouth.
 Poisonous or non poisonous

• If the belly scales are small like those on the back, are
moderately large, but do not cover the entire breadth
of the belly, the snake is not poisonous.
• If the belly scales are large and cover the entire
breadth of the belly, the snake is usually poisonous.
• If the scales on the head are small, the snake is
poisonous and one of the vipers.
• If the scales on the head are large and without any
special feature, it is not poisonous.
• If the third labial touches the eye and nasal shields, it
is poisonous, being a cobra, king cobra or a coral
snake
• If there is a conspicuous opening or ’pit’ between the
eye and nostril, it is poisonous and one of the pit
vipers.
• Upper jaw has a pair of teeth into fangs that are
grooved (Cobra) or channelized (viper)-
POISONOUS
• All teeth are uniform and small in size and there are
no fangs. Usually there are 4 longitudinal rows of
teeth in upper jaw and 2 rows in lower jaw- NON
POISONOUS
 CLASSIFICATION
• Based on their morphological characteristics
including arrangement of scales, dentition, osteology,
myology, sensory organs, etc. snakes are categorized
into several families.
• Venomous species are usually confined to 5 families -
Colubridae, Elapidae, Viperidae, Hydrophiidae, and
Atractaspidae.
 COLUBRIDAE

• Only a few of these can cause significant injury to

humans.
• May have modified salivary glands producing toxins,
but without true fangs. Effect caused by other teeth to
provide an entry track for their “venom”(not expected
to be lethal.)
• Eg. parrot snake, rat snake, mountain racer
 ELAPIDAE

• Include “cobra” type snakes, common in Asia &

Africa.
• Small to moderate sized fangs at the front of the
mouth, possibly the “true fangs”
• Major cause of human morbidity & mortality.
• Eg. cobras, kraits, coral snakes and mambas.
 VIPERIDAE
• Well-developed, longer fangs on hinged maxillae,
allowing rotation (elevation) & glands typically larger.
• Heat-sensing pitorgans at the front of the head, giving
some degree of IR/ heat sensitive “vision”.
• Major cause of snakebite in the Americas, Africa,
Europe and Asia.
• Eg vipers, pit vipers, and rattle snakes.
 HYDROPHIIDAE

• These are sea snakes .

• Closely related to the cobras, with similar fang
structure, but live most or all of their lives in an
aquatic, usually marine environment.
• They are a significant cause of envenoming amongst
fisherman in the Indian and Pacific oceans. Eg:
Stoke’s sea snake.
 ATRACTASPIDAE

• These are side fanged viper like snakes confined to

Africa and the Middle East.
• Long front fangs used for immobilising their prey by
a side-swiping motion. These fangs often protrude
from the corner of the partially closed mouth.
• Eg. mole vipers
 COBRA
Scientific Name
• Naja naja.
Other Common Names
• Indian Cobra.
Geographical Distribution
• All over India.
Nature of Venom
• Neurotoxic.
• Grows up to 5 to 6 feet in length, with a distensible
neck that can be expanded into a hood.
• On the dorsal side of the hood, there may be a
monocellate (monocle) or binocellate (spectacle)
mark.
• The most important distinguishing feature of
this snake is the fact that the 3rd supralabial
shield touches the eye and nose shield
 VIPERS
Scientific Name
• Echis carinatus.
Other Common Names
• Carpet viper; “Phoorsa”.
Geographical Distribution
• All over India (especially plains and deserts).
Nature of Venom
• Vasculo- and haemotoxic.
• The head is triangular with small scales.
• A characteristic whitish, arrow-shaped or crow’s foot
mark is often present on the head.
• The pupils are vertical. Scales are serrated.
• Aggressive snake and may bite on the slightest
provocation.
• There are 3 rows of chained dark spots over
the entire body.
 COMMON KRAIT
Scientific Name
• Bungarus caeruleus.
Other Common Names
• Indian krait.
Geographical Distribution
• All over India.

Nature of Venom
• Predominantly neurotoxic.
• Most venomous snake of India.
• A chain of hexagonal large scales throughout the mid
dorsal aspect of the body.
• The subcaudals (ventral scales distal to the vent) are
undivided, unlike other elapids.
• The 4th infralabial scale is the largest of the
infralabials.
TREE SNAKE
 Snake venoms
• Neurotoxic Venom

• Origin—Common in Elapidae snakes, e.g. krait, cobra, etc.

• Action— on the motor nerve cells and results in muscular paralysis.

• Symptoms at bite site—Local manifestations are least with

• neurotoxic venom snake bite.

• Other symptoms—Convulsions may be seen with Cobra

venom(Krait venom produces only paralysis).

• Haemotoxic Venom
• Action—Cytolysis of endothelium of blood vessels,
Lysis of red cells and other tissue cells and
coagulation disorders.
• Severe swelling with oozing of blood and spreading
cellulitis at bite site.
• Necrosis of renal tubules, and
• Functional disturbances like convulsions, due to
intracerebral haemorrhage.
• Myotoxic Venom
• Origin—Common in hydrophidae or sea snakes
• Action—Produces generalized muscular pain,
followed by:
• Myoglobinuria within 3 to 5 hours.
• Death usually occurs due to respiratory failure.
MANAGEMENT OF SNAKE BITE
• 1. To allay the anxiety and fear
• 2. Prevention of the spread of venom (first aid
measures)
• 3. Antivenom treatment
• 4. General measures.
 . Prevention of the spread of venom (first
aid measures)
• Do not tamper with the bite wound, except wipe with
a damp cloth to remove the venom lying on the skin
surface.
• Immobilisation of the bitten limb.
• Transport the patient to a medical facility
immediately.
 Tourniquets
• Do not apply tourniquets, ligatures, or constricting
bands unless the snake is a neurotoxic & envenomating.
• Avoid this for long periods.

• Opening of the tourniquet will cause the rush of blood

to the site and hence the rapid spread of venom,
therefore, the antivenom treatment should be applied
before releasing the tourniquet.
 Dangers of Tourniquets
• Ischaemia and gangrene

• Damage to superficial peripheral nerves,

• Increased fibrinolytic activity in the occluded limb.

• Congestion, swelling, and increased bleeding from the

occluded limb.
• Shock on releasing a tight tourniquet.

• Intensification of local effects of venom in the occluded

limb.
• Alternatively a firmly applied crepe bandages
exerting a compression of approximately 55 mm Hg
may be used after bites by neurotoxic elapids and sea
snakes and may left in place for several hours.
 ANTISNAKE VENOM

• Indications
• Most commercial antivenoms are of equine origin
and carry a risk of anaphylactic, anaphylactoid and
delayed hypersensitivity reactions.
• Local envenoming is probably not reversible unless
antivenom is given within a few hours of the bite.
• Intravenous route is the most effective, and it should
be administered after dilution
• Initially, the infusion may be regulated at 15–20
drops per minute. The rate can be progressively
increased so that the infusion is completed in 1–2
hours.
 Polyvalent antivenom
• Hyper immunization of horse
• Injection of venom in to a horse
• Antivenom therapy
• Confirm the case
• effective against Big 4
• Antivenom is short supply, limited shelf life
• Criteria
• prolonged hypotension
• leucocytosis, acidosis, ECG changes,
haemolysis, pregnant women and children
• Timing- immediate
• Allergy test- 0.02ml of antivenom (sub Cut.)
• Desensitisation- Admin. 0.1ml increase the
dose every 15 minute(0.2ml,0.5ml etc)
• Allergic reaction- adrenalin+anti histamine
(IV)
• Dose- 5ml/min over a period of 30 minutes
• Adverse reaction of antivenom
• early reaction
• cough, urticaria, tachycardia, N,V, Headache,
fever
• Rx- Anti histamine, adrenalin
• Pyrogenic reaction
• Serum sickness- Antihist, cortico.
 Other measures
• IV fluids, vasopressors,.

• Whole blood or fresh frozen plasma, if there are clotting

abnormalities and anomalous bleeding.
• Use cholinergics to reverse the neurotoxic features of elapid
bites.
• Renal failure to be tackled

• Oxygen, assisted ventilation

• A fasciotomy may be required in very rare cases.

Hospital measures
 observe every case of snake bite
 check, BP, RS, Pulse rate, WBC count, Blood
urea, creatinine, EEG, ECG, vomiting
Diarrhea, urine output, bleeding etc
 PM Appearance

• Bite marks
• In case of viper bite, there is swelling and cellulitis
about the bitten part. Local appearances are more
striking due to considerable oozing of blood from the
site of puncture. The blood is generally fluid and
haemolysed causing early staining of the blood
vessels.
• In case of elapids, where the venom is
predominantly neurotoxic, there may not be
definite local appearances and the cause of
death may be difficult to approach except for
the signs of asphyxia
• Snake specific venom antigens have been detected in
wound swabs, aspirates or biopsies, serum, urine,
CSF and other body fluids.
• Of the various techniques for the detection of snake
specific venoms, radioimmunoassay (RIA) is
probably the most sensitive and specific.
MLI
• 1. accidental cases-
• 2. homicide- throwing venomous snake
• 3. suicide- rare…..”case of Cleopatra”
• 4. kill cattle
 Myths
• If you kill a snake its mate will follow you and
take revenge

• The bronze back tree snake claimed to not only

kills humans but also climb a tall tree there after
to watch its victims funeral !!!!

• The vine snake is said to be so vicious that after

kills the victim, it pokes the eyes out
• Snake are fond of milk

• Snakes dance to the music

• The red sand boa is reputed to have 2 heads,

one at each end. It is said that for 6 months in
a year it goes in one direction and for the
remaining 6 months, in the opposite direction
 Precautions against snake bite
• Learn ad recognize venomous snakes in your
locality
• Keep your house, workplace, institution clean
and free from debris
• Snake – infested area care should be taken to
prevent entry of snake
• Don’t grow plants inside the house
• Don’t gather fire wood after dark
• Don’t put hand inside the hole or burrows
• Don’t sleep on the floor
• Don’t walk in the dark
• Don’t bath in ponds, streams and river in the
evening
 Toxicity table
• Fatal dose: cobra 12mg-----------120 mg
russell’s 15mg--------40-50mg
krait 6mg of dried venom---

12mg
• Fatal period: cobra ½ - 6 hr
viper 1-2 days
 Warning signals
Hissing
Hood raising
Coiling of body “s”
Flattening of the body
Vibration of tail
If a snake is likely to strike keep a distance away
from it (8 Ft/sec)
 younger one and newly hatched
 Case report
• According to an Aug. 22 report by the Daily
Mirror, the chef had been preparing snake
soup when he was bitten by the severed head
of an Indochinese spitting cobra. The snake
reportedly had been decapitated some
20 minutes before the bite occurred. The chef
died before emergency workers could get to
him, the Mirror reported.
• Take care while handling dead snake or
severed head one
 mouth will shut up- reflex action
 pretend dead
Snake become harmless- if you remove its fangs ?
• Don’t try to handle a snake