First aid on snake bite

SnakebiteSnakebite
By
Kamal Krishna
B.Ed. Session- 2012-13
DAV 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 AidKey Skill required for First Aid
 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.

TrainingTraining
 Basic 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 Disciplines
There 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 aidfirst 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 life
Some 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,

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 the upper jawHave long fangs which are normally folded up against the upper jaw
but, when the snake strikes, are erected .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

Viperidae
 Have 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 failure
Late onset envenoming No effective anti
venom
PIT VIPER

Generalised Symptoms and Signs
 General
 Nausea, vomiting, malaise, abdominal pain, weakness,
drowsiness, prostration
Elapidae 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
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 treatment
 Transport 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 case
 Obtain 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).

ReferencesReferences
Article By : Gaurav Akrani. This snake
article revised on 11th
December 2012.
Wikipedia
Powerpoint presentation of Dr.Pratheeba
Durairaj, M.D.,D.A,
By Mayo Clinic staff
Picture from Google from various
website

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