Poisons Of Animal Origin

Dr Priyal Jain Post Graduate

Deptt Forensic Medicine

UCMS amp GTBH Delhi

SnakesScorpionsBees amp WaspsCentipedesLizardsSpidersAntsCanthrides

SnakeElapidae Colubridae

Viperines Viperidae

Hydrophidae

A village person age about 44 yrs brought to casualty with alleged history of snake bite

Attendant killed offending snake and brought to casualty

Fangs

Snake BiteDry bite - 20 up to 75

Venom ApparatusVenom glands + maxillary Teeth(fangs)

Venom HemorrhaginsProteolytic EnzymesMyocardial DepressantNeurotoxins

SeveritySite Time Clothing Season Species

Cobra Naja Naja

King Cobra Naja Bangarus

Common Krait Bungarus caeruleus

Banded Krait Bungarus Fasciatus

SymptomsMainly Neurotoxic

15 ndash 30 min

30 ndash 60 min

1 ndash 2 hrs

Fatal dose 12-15 mg C 5-6 mg Krait

Fatal period frac12 hr to 24 hrs

Viper

SymptomsMainly Vesculotoxic

Fatal dose 15 ndash 20 mg

Fatal period 2 ndash 4 days

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

SnakesScorpionsBees amp WaspsCentipedesLizardsSpidersAntsCanthrides

SnakeElapidae Colubridae

Viperines Viperidae

Hydrophidae

A village person age about 44 yrs brought to casualty with alleged history of snake bite

Attendant killed offending snake and brought to casualty

Fangs

Snake BiteDry bite - 20 up to 75

Venom ApparatusVenom glands + maxillary Teeth(fangs)

Venom HemorrhaginsProteolytic EnzymesMyocardial DepressantNeurotoxins

SeveritySite Time Clothing Season Species

Cobra Naja Naja

King Cobra Naja Bangarus

Common Krait Bungarus caeruleus

Banded Krait Bungarus Fasciatus

SymptomsMainly Neurotoxic

15 ndash 30 min

30 ndash 60 min

1 ndash 2 hrs

Fatal dose 12-15 mg C 5-6 mg Krait

Fatal period frac12 hr to 24 hrs

Viper

SymptomsMainly Vesculotoxic

Fatal dose 15 ndash 20 mg

Fatal period 2 ndash 4 days

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

SnakeElapidae Colubridae

Viperines Viperidae

Hydrophidae

A village person age about 44 yrs brought to casualty with alleged history of snake bite

Attendant killed offending snake and brought to casualty

Fangs

Snake BiteDry bite - 20 up to 75

Venom ApparatusVenom glands + maxillary Teeth(fangs)

Venom HemorrhaginsProteolytic EnzymesMyocardial DepressantNeurotoxins

SeveritySite Time Clothing Season Species

Cobra Naja Naja

King Cobra Naja Bangarus

Common Krait Bungarus caeruleus

Banded Krait Bungarus Fasciatus

SymptomsMainly Neurotoxic

15 ndash 30 min

30 ndash 60 min

1 ndash 2 hrs

Fatal dose 12-15 mg C 5-6 mg Krait

Fatal period frac12 hr to 24 hrs

Viper

SymptomsMainly Vesculotoxic

Fatal dose 15 ndash 20 mg

Fatal period 2 ndash 4 days

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

A village person age about 44 yrs brought to casualty with alleged history of snake bite

Attendant killed offending snake and brought to casualty

Fangs

Snake BiteDry bite - 20 up to 75

Venom ApparatusVenom glands + maxillary Teeth(fangs)

Venom HemorrhaginsProteolytic EnzymesMyocardial DepressantNeurotoxins

SeveritySite Time Clothing Season Species

Cobra Naja Naja

King Cobra Naja Bangarus

Common Krait Bungarus caeruleus

Banded Krait Bungarus Fasciatus

SymptomsMainly Neurotoxic

15 ndash 30 min

30 ndash 60 min

1 ndash 2 hrs

Fatal dose 12-15 mg C 5-6 mg Krait

Fatal period frac12 hr to 24 hrs

Viper

SymptomsMainly Vesculotoxic

Fatal dose 15 ndash 20 mg

Fatal period 2 ndash 4 days

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Fangs

Snake BiteDry bite - 20 up to 75

Venom ApparatusVenom glands + maxillary Teeth(fangs)

Venom HemorrhaginsProteolytic EnzymesMyocardial DepressantNeurotoxins

SeveritySite Time Clothing Season Species

Cobra Naja Naja

King Cobra Naja Bangarus

Common Krait Bungarus caeruleus

Banded Krait Bungarus Fasciatus

SymptomsMainly Neurotoxic

15 ndash 30 min

30 ndash 60 min

1 ndash 2 hrs

Fatal dose 12-15 mg C 5-6 mg Krait

Fatal period frac12 hr to 24 hrs

Viper

SymptomsMainly Vesculotoxic

Fatal dose 15 ndash 20 mg

Fatal period 2 ndash 4 days

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Snake BiteDry bite - 20 up to 75

Venom ApparatusVenom glands + maxillary Teeth(fangs)

Venom HemorrhaginsProteolytic EnzymesMyocardial DepressantNeurotoxins

SeveritySite Time Clothing Season Species

Cobra Naja Naja

King Cobra Naja Bangarus

Common Krait Bungarus caeruleus

Banded Krait Bungarus Fasciatus

SymptomsMainly Neurotoxic

15 ndash 30 min

30 ndash 60 min

1 ndash 2 hrs

Fatal dose 12-15 mg C 5-6 mg Krait

Fatal period frac12 hr to 24 hrs

Viper

SymptomsMainly Vesculotoxic

Fatal dose 15 ndash 20 mg

Fatal period 2 ndash 4 days

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Cobra Naja Naja

King Cobra Naja Bangarus

Common Krait Bungarus caeruleus

Banded Krait Bungarus Fasciatus

SymptomsMainly Neurotoxic

15 ndash 30 min

30 ndash 60 min

1 ndash 2 hrs

Fatal dose 12-15 mg C 5-6 mg Krait

Fatal period frac12 hr to 24 hrs

Viper

SymptomsMainly Vesculotoxic

Fatal dose 15 ndash 20 mg

Fatal period 2 ndash 4 days

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

King Cobra Naja Bangarus

Common Krait Bungarus caeruleus

Banded Krait Bungarus Fasciatus

SymptomsMainly Neurotoxic

15 ndash 30 min

30 ndash 60 min

1 ndash 2 hrs

Fatal dose 12-15 mg C 5-6 mg Krait

Fatal period frac12 hr to 24 hrs

Viper

SymptomsMainly Vesculotoxic

Fatal dose 15 ndash 20 mg

Fatal period 2 ndash 4 days

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Common Krait Bungarus caeruleus

Banded Krait Bungarus Fasciatus

SymptomsMainly Neurotoxic

15 ndash 30 min

30 ndash 60 min

1 ndash 2 hrs

Fatal dose 12-15 mg C 5-6 mg Krait

Fatal period frac12 hr to 24 hrs

Viper

SymptomsMainly Vesculotoxic

Fatal dose 15 ndash 20 mg

Fatal period 2 ndash 4 days

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Banded Krait Bungarus Fasciatus

SymptomsMainly Neurotoxic

15 ndash 30 min

30 ndash 60 min

1 ndash 2 hrs

Fatal dose 12-15 mg C 5-6 mg Krait

Fatal period frac12 hr to 24 hrs

Viper

SymptomsMainly Vesculotoxic

Fatal dose 15 ndash 20 mg

Fatal period 2 ndash 4 days

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

SymptomsMainly Neurotoxic

15 ndash 30 min

30 ndash 60 min

1 ndash 2 hrs

Fatal dose 12-15 mg C 5-6 mg Krait

Fatal period frac12 hr to 24 hrs

Viper

SymptomsMainly Vesculotoxic

Fatal dose 15 ndash 20 mg

Fatal period 2 ndash 4 days

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Viper

SymptomsMainly Vesculotoxic

Fatal dose 15 ndash 20 mg

Fatal period 2 ndash 4 days

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

SymptomsMainly Vesculotoxic

Fatal dose 15 ndash 20 mg

Fatal period 2 ndash 4 days

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Sea Snake

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

SymptomsMainly Myotoxic

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

TreatmentFirst Aid

ldquoDo it RIGHTrdquo R Reassure the patientI Immobilise in the same way as a fractured

limb Use bandages or cloth to hold the splints not to block the blood supply or apply pressure Do not apply any compression in the form of tight ligatures they donrsquot work and can be dangerous

G H Get to Hospital Immediately Traditional remedies have NO PROVEN benefit in treating snakebite

T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Traditional Methods To Be DiscardTourniquetsCutting and Suction Washing the Wound Electrical Therapy and Cryotherapy Pressure Immobilization Method (PIM)

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Snake Bite Treatment Protocol Patient Assessment Phase On

arrival Pain Handling Tourniquets

Diagnosis Phase Investigations 20 Minute Whole Blood Clotting Test

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Other Useful Tests depending on availability 1048635 Haemoglobin PCV Platelet Count PT APTT FDP D-Dimer Peripheral Smear Urine Tests for Proteinuria RBC Haemoglobinuria Myoglobinuria Biochemistry for Serum Creatinine Urea Potassium Oxygen Saturation PRBP RR Postural Blood Pressure ECG

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Cobra Krait R Viper SSViper HNViper

Local Pain Tissue Damage YES NO YES YES YES

Ptosis Neurological Signs YES YES YES NO NO

Haemostatic abnorma liies NO NO YES YES YES

Renal Complications NO NO YES NO YES

Response to Neostigmine YES NO NO NO NO

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

ASV Administration Criteria

Systemic Envenoming

Evidence of coagulopathy Primarily detected by 20WBCT or visible spontaneous systemic bleeding gums etc

Evidence of neurotoxicity ptosis external ophthalmoplegia muscle paralysis inability to lift the head etc

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Severe Current Local envenoming Severe current local swelling involving

more than half of the bitten limb (in the absence of a tourniquet) In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species

rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet) Swelling a number of hours old is nogrounds for giving ASV

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Dose And RouteNeurotoxic Anti Haemostatic 8-10 Vials Children receive the same dose as adults

Bcit is to neutralize venom which is same amount in both

1 Intravenous Injection reconstituted or liquid ASV is administered by slow intravenous injection (2ml min) each vvial is 10ml of reconstituents

2 Infusion liquid or reconstituted ASV is diluted in 5-10mlkg of isotonic saline or glucose

All AVS over 1 hr in constant speed

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Neurotoxic Envenomation In neurotoxic envenomation neostigmine test is

done with 15 -20 mg of neostigmine IM together with 06mg of atropine IV

The paediatric neostigmine dose is 004mgkg IM and the dose of atropine in 005mg kg

Observe victim for 1 hour

If the victim responds to the neostigmine test then continue with 05mg of neostigmine IM frac12 hourly plus 06 mg of atropin IV over 8 hrs in continuous infusion

If there is no improvement in symptoms after one hour the neostigmine should be stopped

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Autopsy findinsFang mark 12 cm deep 25 cm deepFroth in mouth amp nostrilsChanges in Nissle granules in brain

matter acute granular degeneration of medula

Evidence of hemorrhage in git cerebrum respiratory and urinary tract serosal surfaces of organs sub endocardial hemorrhage regional lymphadenitis

Venom Extraction From blood urinewound

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Medico- Legal ImportanceAccidental Most commonSuicidal Queen CleopetraHomicidal Hannibal amp Antiochus

defeated Romans in a naval battle

Cattle Poison

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Scorpion

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Scorpion venomclear and colourless toxalbumin

that is more toxic than the snake venomThe small quantity of venom is injectedThe scorpion venom consists of a neurotoxinhaemolysins proteinases phospholipase Aleucocytolysin coagulinscholestrin and lecithin

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

SIGNS AND SYMPTOMS

site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site

The area is swollen reddened Increased temperature with chills and

headacheThere is feeling of giddiness and

faintingExcessive sweating and salivationMuscular cramps and convulsions

followed by unconsciousnessParesis and muscular weakness

persists for a weekDeath occurs in children from

pulmonary oedema and respiratory depression and it is rare in adults

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

TREATMENTApplication of tourniquet or pressure bandage

above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate borax or ammonia

The torniquet should be loosened for 1-2 minutes after every 10-15 minutes

Local infiltration of 5cocaine or lignocaine solution in and around the bite relieves pain

To treat shock 5 of 500ml of dextrose saline should be given iv along with glucocorticoids

imcalcium gluconate 10 ml of 10 solution should be given intravenously to combat muscular cramps

To prevent pulmonary oedema atropine sulphate should be administered

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Autopsy Findings

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Bee amp Wasps

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Produce a painful local reaction which recedes with time

An allergic phenomenon produced by them may kill the patient because of prior sensitization

Number of stings may be so great or the patient is so young as to be killed with primary toxicity

Signs and symptomsNausea and vomitingThoracic compressionCardiac irregularitiesPulmonary oedemaNephrosisCyanosis convulsions and deathThe fatalities may result a short while after the

infliction of stings

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Anaphylaxis Symptoms

Treatment

Autopsy Findings

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Centepedes

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Local swellingexcruciatin pain and necrosis paralysis and contracture of extremities cardiac irregularities arthritis and meningism may occursymptoms subside in 2to 3 days

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Lizards

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Spiders

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Brown Recluse Spider Loxasceles reclusaProtease esterrase other enzymesSphyngomyelinase B bind to cell

membranecauses neutrophilic chemotaxis

Vascular thrombosis 7 Arthus like reaction

Fever nausea vomiting arthralgiaHemolytic anemia ARFTreatment- supportive except YES to

Dapsone amp NO to Glucocorticoids

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Widow Spider Letrodactus mactans

Buttocks genitals2 small red marksAlpha latrotoxin leads to release of

neurotrnsmittersAntivenom available Indication- respiratory arrest

pregnancy seizuresRest treatment is symptomaic

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Marine Envenomation Invertebrates

hydroids fire coral jelly fish portuguese man-of-war sea anemones

Cnidocytes - stinging cellsCnidea - intacytoplasmic

stinging organ

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

SymptomsBurning pruritis parasthesia Redened darkened edematousNeurological cardiovascular GI

Renal Ocular Anaphylaxis

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

TreatmentApplication of Vinegar(5 aa)Rubbing alcohol baking soda lime

juice papainAneasthetic ointments

antihistaminic creamsteroid lotionsMorphine

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Sea urchins- Hollow venom filled calcified

spineshemolysin proteases

serotonins cholinergic substances

PainIf spine is retained near vital

structure than chances of granuloma

formation which should get operated

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Cone shellsPredator carnivorous mollusksNeurotoxic venom delivered through

harpoon like dartsWound perioral generalised

parasthesiaIn severe condition Bulbar

Dysfunction amp Systemic Muscular Paralysis

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Australian Blue Ringed OctopusNeurotoxin (maculotoxin) Na channel

blockage leads to peripheral nerve transmisson inhibit

Oral amp facial numbness to total flaccid palsy

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

VertebratesStingray - envenomation + traumatic

woundVenom ndash serotonin phosphodiesterase

5`nucleotidasePain Soft tissue swellingWeakness nausea vomiting diarrhea

hypotension syncope paralysis amp deathScorpion Fish - same as of stingray

Stonefish Scorpionfish lionfish Cat fish - same as of stingray

Oriental catfish Common seawater catfish

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

TreatmentHot water immersionNo to cryotherapyPain killer Inj TTAntivenom for stonefish amp serious

scorpion fish Other supportive care

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Mammals

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Ornithorhynchus anatinus

bull The venom apparatus is only present in malesa

bullCrural gland only secretes venom in breeding season

bull The use of the venom apparatus is probably related to combat with other males for territory or females

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Slow LorisNycticebus coucang

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Venomous and Poisonous Primate

Nycticebus coucang

Nycticebus coucang inhabits the rainforests of southeast Asia Assam Burma Thailand Indo-China certain Malayan states and East Indian Islands

bull They have a brachial organ a naked gland-laden area of skin on surface of the arm that is licked during grooming

bull When mixed with saliva the toxin can repel some predators

bull Anaphylaxis has been observed following loris bites

bull N coucang braAchial organ protein acts as an allergen

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You

Thank You

• Slide 1
• Slide 2
• Snake
• Slide 4
• Fangs
• Slide 6
• Cobra Naja Naja
• King Cobra Naja Bangarus
• Common Krait Bungarus caeruleus
• Banded Krait Bungarus Fasciatus
• Symptoms
• Viper
• Symptoms (2)
• Sea Snake
• Symptoms (3)
• Treatment
• Traditional Methods To Be Discard
• Snake Bite Treatment Protocol
• Slide 19
• Slide 20
• ASV Administration Criteria
• Slide 22
• Dose And Route
• Neurotoxic Envenomation
• Autopsy findins
• Slide 26
• Medico- Legal Importance
• Scorpion
• Scorpion venom
• SIGNS AND SYMPTOMS
• TREATMENT
• Autopsy Findings
• Bee amp Wasps
• Slide 34
• Anaphylaxis
• Centepedes
• Slide 37
• Lizards
• Spiders
• Brown Recluse Spider Loxasceles reclusa
• Widow Spider Letrodactus mactans
• Marine Envenomation
• Symptoms (4)
• Treatment (2)
• Slide 45
• Cone shells
• Australian Blue Ringed Octopus
• Vertebrates
• Treatment (3)
• Mammals
• Slide 51
• Slow Loris Nycticebus coucang
• Venomous and Poisonous Primate
• Slide 54
• Thank You