Snakes!

[Tejas@perioimpl]

Guys,

Since we have a three day Offroad trip happening on 25-27 june 2010, i need a comprehensive list of pointers. WE have approx 100 people attending and we are going through forested areas.

Questions:
- which are the indigenous snakes / scorpions that we may encounter in the western ghat regions (more towards bombay-lonavla-karjat-alibaugh)
- what anti venom should we carry
- what immediate things to do if someone is bitten (and we cannot identify the snake if poisonous or not) till the victim is transported to the nearest hospital
- any other points you that may come to mind.

[princezahed]

Originally Posted by Tejas@perioimpl

Guys,

Since we have a three day Offroad trip happening on 25-27 june 2010, i need a comprehensive list of pointers. WE have approx 100 people attending and we are going through forested areas.

Questions:
- which are the indigenous snakes / scorpions that we may encounter in the western ghat regions (more towards bombay-lonavla-karjat-alibaugh)
- what anti venom should we carry
- what immediate things to do if someone is bitten (and we cannot identify the snake if poisonous or not) till the victim is transported to the nearest hospital
- any other points you that may come to mind.

Look our for the Big 4 of India - indian Cobra, russels viper, saw scaled viper and the common krait. I think that if you encounter snakes, it would mostly be the cobra along with other forms of viper's apart from the russells viper like the bamboo pit viper and other harmless snakes like keelbacks, rat snakes etc.

- Stay away from snakes as much as possible. Look out for snakes that have flat triangular shaped heads. These would be from the viper family and do no mess with them. Even if they dont kill you, they could give a very bad bite .

- I dont think carrying anti venom is needed, but if you can the do so. You may be able to procure it at some big medical stores,though do not use it for any bites unless you are confirmed of the species.

- Incase someone gets bitten, see if anyone can identify the snake. If you cant then try and kill it so that you can take it back to the hospital with you. Open the dead snake's mouth ( if anyone can ) and check to see if it has teeth or fangs. Fangs would suggest it is a venomous species.

- Make sure the victim doesnt panic. More often it is the panic that kills, not the venom. Dont rush the victim around too much and let him/her lie in one place as much as possible. Tie a cloth above the bite,neither too hard nor too loose. DO NOT try old movie stuff like cutting the wound with a blade and sucking the blood out, it would just give chance for infection. Keep the victim's head higher than the rest of his/her body. Try to get them to the nearest hospital ASAP. All district hospitals are required to stock anti venom.

- Most bites occur below the knees,around the ankle region so try and get everyone to wear atleast ankle length or longer boots.

Keep the number of some snake expert in hand so that you can call him in case of a bite. He/She would be able to identify the snake more often than not just by your description on the the phone

[Tejas@perioimpl]

We have been suggested the following to keep handy:

Polyvalent snake antivenom – Usefule in bites of Saw-scaled Viper Echis carinatus, Russell's Viper Daboia russelli, Spectacled Cobra Naja naja & Common Krait Bungarus caeruleus

What are your thoughts on this?

PS: Thanks a million for the info princezahed.

[pramodkumar]

Originally Posted by princezahed

You may be able to procure it at some big medical stores,though do not use it for any bites unless you are confirmed of the species.

The Anti venoum in india is not available at retail chains, they are only avaialble at GOVT hospitals as far as i know.

The anti venom is equally dangerous like the venoum and can kill a person easily so not to be administered just like that and more over the shots are intra venus and i am not sure if everyone can administer a intra venus shot.

Originally Posted by Tejas@perioimpl

We have been suggested the following to keep handy:


What are your thoughts on this?

PS: Thanks a million for the info princezahed.

In india we have the big 4 as prince mentioned, so the antivenom is made by mixing venoum from all 4 snakes and injecting to a horse and extracting the antibodies it generates.

The snakes of your region are what prince mentioned, better to stay away from them unless you can identify them. There are snake identification guides sold at most popular bookshops and they are also available in color so making your job easier. The pics of the big 4 has been posted earlier in this thread itself.

Pramod

[Tejas@perioimpl]

Thanks.

The only issue now is to find out how to get the antivenom. We have Dr. Mohan with us on the trip who's an MD (General Medicine) and manages an ICU. So that solves one of our problems!

[pramodkumar]

Originally Posted by Tejas@perioimpl

Thanks.

The only issue now is to find out how to get the antivenom. We have Dr. Mohan with us on the trip who's an MD (General Medicine) and manages an ICU. So that solves one of our problems!

I think that solves all your problems, BTW lets pray everyone is safe and you dont have to do what you are reading

Its available at all rural health centers or the nearest district hospital, stocking it is not permitted so if a bite case is reffered to them they will administer the required dose, anybite can give you atleast one hour to reach medical help if the patient is kept stable, Take the snake bite kit along, this had crepe bandages and suction device to suck out the venom out of the bite area, this does not mean total solution but can slow down the effect. The kit is available internationally but not sure how to get it here though. As prince mentioned you can tie a crepe bandage across the effected area and slow down the blood circulation till medical help is available.

Pramod

[motocamp]

I think playing it safe is a very good idea.

I wear 12 inch high macintosh gumboots or 9 inch high army boots depending on the weather which will normally protect you from the usual strike region.

Also picking up rocks is a very bad idea,i know someone who almost got bitten in rajmachi by what i think was a russels viper under a rock which we tried to move out of the way .It was definately poisoneous as it had a large diamond shaped head.

I shudder to think of the consequences of getting bitten far away from medical help

[pramodkumar]

This what i find on a fine day at work, One of my recent rescues. Picked it up after pinning down the head, Boy it was fast and baged it without stressing the snake, later released at a perfect habitat away from people.



Just hot linking it posed in the non auto image thread as clever said its got some photographic value.

Pramod

[Dreamy]

It indeed is a striped keelback and is non venomous. And they DO NOT Bite. I have handled this species at our plantation in Coorg. They are docile snakes.

Dear princezahed does striped keel back act dead when you handle it, just curious haven't seen it playing dead.
dear tejas as pramod has mentioned antivenom is equally dangerous, best thing is to wear gum boots and avoid rocky shady areas, usually due to vibrations of you stamping should scare away the snakes, unless its a surprise and sudden encounter.
as prince said be weary of venomous 4,
venomous snakes which can be encountered in western ghat region of mumbai are cobra, krait, russell's viper, saw scaled viper, malabar pit viper and bamboo pit viper.
One of our senior Dr had advised administrating adrenaline subcutaneously before administrating anti-venom to avoid or reduce adverse effect of anti-venom.
check this link it may be of some help Prevention Against Snake Bite on Flickr - Photo Sharing!

[pramodkumar]

Originally Posted by Dreamy

Dear princezahed does striped keel back act dead when you handle it, just curious haven't seen it playing dead.
dear tejas as pramod has mentioned antivenom is equally dangerous, best thing is to wear gum boots and avoid rocky shady areas, usually due to vibrations of you stamping should scare away the snakes, unless its a surprise and sudden encounter.
as prince said be weary of venomous 4,
venomous snakes which can be encountered in western ghat region of mumbai are cobra, krait, russell's viper, saw scaled viper, malabar pit viper and bamboo pit viper.
One of our senior Dr had advised administrating adrenaline subcutaneously before administrating anti-venom to avoid or reduce adverse effect of anti-venom.
check this link it may be of some help Prevention Against Snake Bite on Flickr - Photo Sharing!

Thanks for the amazing link, learned quite a lot which might come in handy

Pramod

[motocamp]

I think they do play dead, the snake in the picture only moved when i actually pushed it with a stick, it was so immobile i thought it was dead.

[star_aqua]

I think it is better to post the same info here as wel for the benifit of reading and documenting here.

Anti Sera

The product is prepared from hyperimmunised equines against the venoms of the four most commonly encountered poisonous snakes.

* Cobra (Naja-Naja)
* Common Krait (Bungarus Caeruleus)
* Russell's Viper (Vipera Russelli)
* Saw Scaled Viper (Echis Carinatus)

Plasma obtained from the hyperimmunized equines is enzyme refined, purified and concentrated. Each ml. of the reconstituted Anti Snake Venom Serum neutralizes not less than the following quantities of standard venoms when tested in white mice.
-
Cobra
0.6 mg
Common-Krait
0.45 mg
Russell's Viper
0.6 mg
Saw scaled Viper 0.45 mg

Snake venom envenomation is serious and could be life threatening.
In case of Cobra and Krait poisoning, constitutional symptoms are more prominent than local pain and swelling. General intoxication is soon followed by a sense of creeping paralysis begining in the legs and ascending to the head by way of trunk. Paralysis of the muscles of the eyelids, staggering gait, incoordination of speech, paralysis of the limbs, drooping of the head and complete paralysis of all volunatry muscles develop. Nausea and vomiting frequently occur. Breathing gets more and more difficult and finally stops. In the case of Krait poisoning, in addtion there are convulsions and violent abdominal pains due to internal harmorrages.

In cases of Russell's and Saw-scaled Viper poisoning, the local symptons are prominent and severe. There is great and persistent pain and intensive swelling at the site of the bite. The venom of the viper contains several enzymes which may possibly act synergistically to produce shock, consumption coagulopathy, spontaneous haemorrhages in the organs and tissues, acute necrosis and death. There is constant and incessant oozing of blood from the punctures. Sloughing occurs permitting other infections. The constitutional symptoms are characterised by haemorrhages, both external and internal. Haemorrhages in the abdomen are responsible for pain, tenderness and vomiting. Death is due to heart failure, there is no paralysis. The venoms of Cobra and Krait act very rapidly if a large amount of venom is absorbed into the circulation. Hence it must be understood that unless the absorption of the venom into the circulation is retarded by ligation, the anti-snake-venom-serum does not get a fair chance to neutralise the venom and save the victim.

Treatment of Snake Bite

First-Aid

1.
Keep the patient calm let the patient lie down to ensure that the bitten part is at rest with minimal activity in a well ventilated quiet place.
2.
Clean the bitten part by washing with care without disfiguring or defacing bite mark. Apply a broad and firm antiseptic dressing/bandage.

Specific Serum Treatment

1. Immediate neutralisation of the circulating venom is of utmost importance.

2. For fast effect, the Anti Snkae Venom Serum should be injected intravenously as soon as possible after the bite. As a first dose, at least 20 ml. of the reconstituted serum should be injected intravenously very gradually (for every 1 ml per minute).

3. The second dose should be repeated two hours after the first dose or even earlier. If the symptoms persist. If the symptoms, which vary with different snake venoms, indicate persistence of venom action, further doses should be repeated aftr every six hours until the symptoms disappear completely.

4. At present, there is no simple method to measure the amount of circulating venom in the body, therefore the antivenin dose cannot be accurately recommended. It has been found that the clotting time returns to normal about two hours after the neutralisation of venom therefore repeated testing of clotting time after the antivenom therapy is necessary. Close monitoring of the patient's condition with urine output, BP,pulse, respiration and urea and electrolyte estimations must be done. Local pain and necrosis at the site of bite may need attention, but is usually not very serious except in special circumstances such as a bite on the digit which can become gangrenous.

5. In case of Viper bite, some of Anti Snake Venom Serum should also be injected around the site of the snake bite additionally to prevent gangrene which is one of the more distructive effects of localised Viper Venom on tissue.

6. First Aid treatment should never be relaxed even when the serum is administered. Intravenous injection of a reconstituted Anti Snake Venom Serum in equine serum sensitive subjects can produce very severe serum reactions and even acute anaphylaxis. Further care should be taken to prevent these reactions.

7. Intravenous injection is the most effective but if expert medical aid is not available the serum may be administered by a subcutaneous or through intramuscular route. It is more efficacious to dilute the serum 5-10 times with normal or glucose saline and be administered as slowly as possible.

Associated Treatments

1. In case of Russell's and Saw-scaled viper envenomation, sedatives such as small doses of barbiturate and/or analgesics (e.g. aspirin) may be given to relieve nervousness and pain.

2. In case of syncope / shock, strychnine,pituitrin or other general stimulants like coramine may be used. The use of corticosteroids would help minimise serum reaction and other minor allergic reactions.

3. Treatment of antibiotics may also be given to combat local sepsis in severely envenomated cases, infusion of a large amount of physiological saline or transfusion of blood or plasma may not only bring substantial releif but may be life saving in borderline cases.

4. Cases of respiratory paralysis should be treated by tracheostomy and artificial respiration.

5. Anti Tetanus injection may be given.

Directions for Use

Reconstitution of Lyophilised Serum

1. Draw 10 ml. of sterile water for injection in a sterile syringe.
2. Transfer the sterile water from the syringe to the serum vial and shake well till the contents dissolve.
3. Let the vial stand for one minute for the serum to clear. The reconstituted serum will become crystal- clear and ready for injection. Froth and undissolved particles, if any, should be left in the vial.
4. For the second and subsequent injections, you will have more time to dissolve the lyophilised serum. For these add 10 ml. sterile water for injection to the serum vial and rotate it between the palms of your hands until the serum is fully dissolved, and let the vial stand for serum to clear.

Storage

Liquid serum is very unstable at room temperature. It requires storage at 0° to 4°. Even then it deteriorates, and 2 years from the date of manufacture, the serum becomes unfit for use. In India, proper cold-storage facilities are not freely available and, therefore, liquid serum may only be stored at the risk of very rapid deterioration. Lyophilised serum obviates this difficulty. It is many times more stable than liquid serum. It should retain its potency for 5 years even if stored in any cool dark place. Thus Anti Snake Venom Serum can be made available for use far away from cold-storage facilities. It can be safely kept at rural dispensaries and even carried in a haversack if an occasion demands it. However, it is preferable to store it in a refrigerator if one is available.

Prevention of Serum Reaction

Before injection of Anti-Snake Venom Serum, it is necessary to enquire from the patient:

1. Whether he has had injections of serum (eg. anti-tetanus or anti-diphtheria serum) before.
2. Whether there is personal or familial history of allergy, i.e. asthma, eczema or drug allergy.
The sensitivity of the patient to Anti-Snake Venom Serum is tested by injecting subcutaneously 0.1 ml of this serum diluted 1:10. The patient should be observed for 30 minutes for local and general reactions. If the test dose shows either local reaction such as flare or general anaphylactic reaction such as pallor, sweating, nausea, vomiting, urticaria, and fall of blood pressure, these should be countered immediately by intramuscular injection of 1 ml of 1:1000 adrenaline and with corticosteroids which should be always kept handy.
In allergic or sensitive patients, it is better to inject the Anti-Snake Venom Serum under cover of anti-histaminics such as antistine (100 mg.) and hydrocortisone (100 mg.) intramuscularly 15 to 30 minutes before the administration of Anti-Snake Venom Serum. The administration of adrenaline and hydrocortisone may be repeated if necessary.
When symptoms of snakebite are severe it may not be advisable to wait for 30 minutes to observe reactions to test-dose of serum. In such cases it may be better to inject 1 ml. of 1:1000 adrenaline intramuscularly at the same time as the serum in order to lessen the risk of anaphylaxis. Half the dose of adrenaline may be repeated 15 minutes later if necessary.

Packing

One dose vial of lyophilised Anti-Snake Veno Serum with 10 ml. ampoule of Sterile water for injection.


--
Warm Regards
Karthik Prabhakar

Source: Prevention Against Snake Bite on Flickr - Photo Sharing!

[rhandle]

Originally Posted by pramodkumar

This what i find on a fine day at work, One of my recent rescues. Picked it up after pinning down the head, Boy it was fast and baged it without stressing the snake, later released at a perfect habitat away from people.



Just hot linking it posed in the non auto image thread as clever said its got some photographic value.

Pramod

Such a beautiful snake. I guess it is Russel viper. I wish to learn how to handle snakes one day and I would do that.

[supremeBaleno]

Originally Posted by pramodkumar

Boy it was fast and baged it without stressing the snake, later released at a perfect habitat away from people.

Where do you find such a place (ie. away from people) in Kerala ?

Man, even when coiled, that snake looks dangerous.

What snake was it anyway ?

[princezahed]

Originally Posted by Dreamy

Dear princezahed does striped keel back act dead when you handle it, just curious haven't seen it playing dead.

the striped keelback does not play dead when you handle it. I have even posted some pictures of a striped keelback that I had stumbled upon in this thread.

Originally Posted by pramodkumar

The Anti venoum in india is not available at retail chains, they are only avaialble at GOVT hospitals as far as i know.

The anti venom is equally dangerous like the venoum and can kill a person easily so not to be administered just like that and more over the shots are intra venus and i am not sure if everyone can administer a intra venus shot.

They are available at govt hospitals only, but u can also get them in case you are a herpetologist or someone who deals with snakes and bites often.the exact procedure on obtaining it even iam not sure of.I dint mean your normal medical stores.