AGAD TANTRA - Dr. SATISH SHINDADKAR (best ebook reader for chromebook TXT) 📗

cells) near the location of the snake bite. This may require plastic surgery or, in severe cases, amputation.

Myotoxins:

Myotoxins can cause permanent damage by destroying muscle cells and causing pain and muscle weakness. They may also damage your kidneys, which filter waste products from your blood, causing your urine to be very dark.

POISONOUS SNAKES:

Indian (Spectacled) Cobra :

Distinctive Features: Medium-sized to large; smooth, shiny scales; wide head and neck; wide black band on underside of neck; distinctive hood marking on top of neck.

The Spectacled Cobra is a smooth-scaled snake with black eyes, wide neck and head and medium body. Colouring varies form black or dark brown to yellowish white. The underside is usually white or yellowish with a wide dark neck band. The body is generally covered with a speckled white or yellow pattern, sometimes forming ragged bands.

The Indian (Monocled) Cobra :

Distinctive Features: Medium-sized; smooth, shiny scales; wide head and neck; distinctive hood marking different from that of the spectacled cobra.

Description: The skin of the Monocled Cobra is shinier, the hood rounder and smaller and the head smaller than is that of the spectacled cobra. The colour varies widely, from yellowish to greenish brown to black, with ragged bands.

King cobra :The king cobra is the world's longest venomous snake, with a length between 3 to 5.6 m (18.5 ft.) and typically weighs about 6 kg.In spite of their large sizes, typical king cobras are fast and active.

The skin of this snake is olive-green, tan, or black, and it has faint, pale yellow cross bands down the length of the body. The belly is cream or pale yellow, and the scales are smooth. The head of a mature snake can be quite massive and bulky in appearance, though like all snakes, they can expand their jaws to swallow large prey items. The male is larger and thicker than the female. The average lifespan of a wild king cobra is about 20 years.

A king cobra, like other snakes, receives chemical information via its branched tongue, which picks up scent particles and transfers them to a special sensory receptor located in the roof of its mouth. This is similar to the human sense of smell. It also uses its keen eyesight - king cobras are able to detect moving prey almost 100 m [330 feet] away.

King cobras are able to hunt throughout the day, although it is rarely seen at night.

Defence :

The king cobra can be highly aggressive. When concerned, it rears up the anterior portion (usually one-third) of its body when extending the neck, showing the fangs and hissing loudly. It can be easily irritated by closely approaching objects or sudden movements. When raising its body, the king cobra can still move forward to strike with a long distance and people may misjudge the safe zone. The king cobra may deliver multiple bites in a single attack.

A good defence against a cobra for anyone who accidentally encounters this snake is to slowly remove a shirt or hat and toss it to the ground while backing away.

Venom :

The venom of the king cobra consists primarily of neurotoxins, but it also contains cardio toxic and some other compounds.

This species is fully capable of delivering a fatal bite and the victim may receive a large quantity of venom with a dose anywhere from 200–500 mg or even up to 7 ml. large quantities of antivenom may be needed to reverse the progression of symptoms developed if bitten by a king cobra.

During a bite, venom is forced through the snake's 1.25 to 1.5 cm fangs into the wound, and the toxins begin to attack the victim's central nervous system. Symptoms may include severe pain, blurred vision, vertigo, drowsiness, and paralysis. Then cardiovascular failure and the victim fall into a coma. Death soon follows due to respiratory failure. Moreover, envenomation from king cobras is clinically known to cause renal failure as observed from some snakebite precedents of this species.

Untreated bite has a mortality rate of 50-60%. Bites from a king cobra may result in a rapid fatality which can be as early as 30 minutes.

Cobra Facts:

King Cobras are just one type of cobra. 

King Cobras are the only snake in the world that builds a nest for their young, just like a bird, but on the ground.

Cobras are the only snake in the world that can spit their venom, and they are accurate up to about half their own length into the eyes of its victims, causing temporary blindness and great pain. Venom coming in contact with human eyes causes an immediate and severe irritation of the conjunctiva and cornea that, if untreated, may result in permanent blindness.

King Cobras are the longest venomous snake in the world!  The average male grows 18 feet long, and some have been known to grow more than 20 feet long.

Cobras are not blind, in fact they see very well even at night.

Cobras typically live to 20 years old or more in the wild.

Cobra’s venom is not the strongest there is, but cobras can inject so much venom in a single bite that they can kill an elephant.  Sea snakes have deadlier venom, and rattlesnakes have weaker venom. 

Most cobras are shy, and run and hide when people are around.  The exception is King Cobras, who are aggressive, and will rear up and stand their ground when challenged.

Cobras are not poisonous, they are venomous.  This means that even though they have deadly venom in their sacs, the rest of the snake is edible.

Many snake charmers remove the fangs or the venom sacs from their snakes, because it is too dangerous.  This practice is illegal, and is considered inhumane to the snake.

Cobras eat birds, fish, frogs, toads, lizards, eggs and chicks, small mammals such as rabbits and rats, and even other snakes.

Cobras are very intelligent, and can learn quickly, which helps them avoid dangerous areas.

Cobras can hear, although they sense sound through contact with the ground much better than humans.

Cobras don't always inject venom when they bite something.  They can do a "dry bite" if they want to.

Baby cobras have full strength venom and can defend themselves fully like their parents.

A common misconception is those baby snakes are deadlier than adults. While not proven scientifically, it would seem that an adult cobra can control the amount of venom delivered, if any, with each bite, depending on the threat it feels. A baby snake has no control over the amount of venom delivered by its bite, thus always giving a full dose. A baby cobra is fully able to defend itself in as little as three hours after entering the world.

The best special medicine given to cobra bite victims, called "antivenin", is made from cobra venom.

Russell's viper : Vipera russelli

Distinctive Features: Medium-sized to large; strongly keeled scales; distinctive bright chain pattern; large triangular head.
Russells Vipers are heavy, rough-scaled snakes with vertical eye pupils and generally a very bright pattern. The body colour is usually brown or yellowish and the pattern is composed of dark, round spots edged with white and black. Colour variation is common, and the best recognition characters are the short, fat body, the triangular-shaped head and very regular chain like pattern. The bright symmetrical spots on Russells Viper's back make them easy to differentiate.

Symptoms:

Pain at the site of the bite and immediately followed by swelling of the affected extremity.

Bleeding is a common symptom, especially from the gums and in the urine, and sputum may show signs of blood within 20 minutes post-bite.

Drop in blood pressure, and the heart rate falls.

Blistering occurs at the site of the bite.

Necrosis is usually superficial and limited to the muscles near the bite, but may be severe in extreme cases.

Vomiting and facial swelling occur in about one-third of all cases.

Kidney failure also occurs in approximately 25-30 percent of untreated bites. Severe disseminated intravascular coagulation also can occur.

Severe pain may last for 2–4 weeks.

Death from septicaemia, kidney, respiratory or cardiac failure may occur 1 to 14 days post-bite or even later.

Saw scaled viper :Echis carinatus

Distinctive Features: small; strongly keeled scales; head wider than neck; dull colour; cross mark on top of head distinctive.
Description: A rough scaled snake with large eyes, wider head than neck and stocky body. The scales are heavily keeled. The body is brown, greyish or sandy with a darker zigzag pattern on the back and a distinct cross or lance mark on the head. The underside is white with brown speckles. The tail is short and stubby. Size ranges between 38 and 80 cm in length, but usually no more than 60 cm.Head distinct from neck, nose very short and rounded.

Venom:

This species produces on the average of about 18 -72 mg of dry venom by weight. The lethal dose for an adult is only 5 mg.

Symptoms:

Swelling and pain, which appear within minutes of a bite.

Swelling may extend up the entire affected limb within 12-24 hours and blisters form on the skin.

Hematemesis, melena, haemoptysis, haematuria and epistaxis 

also occur.

Almost all patients develop oliguria or anuria within a few hours to as late as 6 days post bite.

Banded Krait –Bungarus fasciatus :

Distinctive Features: Medium-sized to large; smooth, shiny scales: wide bright yellow and black bands on back.

Description: The Banded Krait is a large, conspicuous yellow and black banded snake with a prominent backbone, blunt tail and rounded head slightly distinct from the body. The bands are faded on the underside.

Common Krait –Bungarus caeruleus :

Distinctive Features: Medium-sized; smooth, glossy scales; head slightly wider than neck: jet-black, usually with distinct white cross lines.

Description: Common Kraits are smooth, glossy bluish-black snakes with the rounded head slightly distinct from the neck. The body colour varies from a dark steely blue-black in a specimen which has freshly shed its skin to a pale faded bluish grey in one just about to shed. There are normally about 40 thin white cross bands. The young and some adults may have white spots along the first third of the backbone in place of the cross lines. The underside is white.

Krait bite - Symptoms &Signs:

Minimal or no local signs, Abdominal Pain, Ptosis, Dysarthria, Dysphagia, Chest pain, quadriplegia, Parotid swelling, Respiratory paralysis, death.

Note:

Slow development of signs generally within 3 to 4 hrs. But delayed signs observed up to 56 hrs.

Slow recovery

Worst type of snake bite.

MANAGEMENT OF SNAKEBITE

Immediate action after bitten:

Remain calm and do not panic.

All snake bites are not poisonous. 

Try to remember the snake's shape, size and colour.

Keep the part of your body that has been bitten as still as possible to prevent the venom spreading around your body.

You may want to secure the bitten body part with a sling (a supportive bandage) or a splint (a rigid support that helps keep the body part stable). However, do not make the sling or splint so tight that it restricts your blood flow

Remove any jewellery or watches from the bitten limb because they could cut into your skin if the limb swells

Do not attempt to remove any clothing.

First aid

Stop absorption of venom and prevent life-threatening complications.

Assure the victim (70% of all snakebites are by non-venomous snakes and 50% of bites by venomous species are dry bites)

Immobilize the affected limb (by bandage or clothes to hold splint, but tight arterial compression is not recommended)

Promptly transfer of victim to hospital

Investigations :CBC, BT,CT - 20 min WBCT, Urine, ECG, Bl. Grouping, LFT, Blood Urea, Sr. creatinine,Sr. Na+, Sr. K+, X-ray chest, Coagulation profile, Blood gas analysis etc. should be done.

Tourniquet should not be released immediately before administration of ASV because patient may develop fast & severe envenoming.

Management - General

I.V. saline

TT, antibiotics, anti-inflammatory, anxiolytics, don’t allow pt. to sleep

Observation minimum for 24 hrs. in every case, if doubt observe up to 48 hrs.

Diet advise :- Normal diet if no complications, NBM if pt. has vomiting, GI bleeding or neuroparesis, low K+ & calculated fluids if renal failure.

Management - Specific ASV Schedule

IV route only, polyvalent.

Dose of ASV is still empirical.

Average yield of venom per bite:

Cobra 60 mg., R-Viper 63 mg., Krait 20 mg., Saw-scaled 13 mg.

(Fatal dose 12mg.,15mg.,6mg., 8mg. respectively.)

1 ml of Polyvalent ASV will neutralize 0.6 mg Cobra & R-Viper, 0.45 mg of Krait & Saw-scaled venom.

ASV Sensitivity Test:

20 to 30 min prior to therapy, Not always reliable, Not possible in emergency, Many studies have not recommended. 13% anaphylaxis in personal experience previously.

Now we are using prophylactic 0.25 cc subcut. Adrenaline before ASV (if not contraindicated) & observed drastic reduction in anaphylaxis.

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वृश्

चिक (Scorpion)

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