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Snake biteSnake bite

There are about 2500 species of snake inThere are about 2500 species of snake in

the world, which are classified into ,the world, which are classified into ,

Elapid e.g. Cobra, King cobra, Krait,Elapid e.g. Cobra, King cobra, Krait,Tiger snake.Tiger snake.

Viperide e.g. Viper, saw scaled viper, pitViperide e.g. Viper, saw scaled viper, pit

viper.viper.

Hydrophilide e.g. Sea snakes.Hydrophilide e.g. Sea snakes.


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Traits Poisonous Non

Poisonous

1.Body scales Usually large Usually small

2.Head scales Usually small Usually large

3.Fangs Hallow like hypodermicneedles

Short & solid

4.Tails Compressed Not so muchcompressed

5.Bite marks 2 fang marks with or

without other teethmarks

2 fang marks with a

number of smallteeth marks


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CLASSIFICATION OF SNAKESCLASSIFICATION OF SNAKES

Elapid group - 1.CobraElapid group - 1.Cobra


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2.King cobra -2.King cobra -


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3. Krait -3. Krait -


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Viperide group -Viperide group -


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Hydrophilide group -Hydrophilide group -


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Snake venomSnake venom

It is the heterogeneous mixture ofIt is the heterogeneous mixture ofproteinsproteins produced &produced &stored in the specialized salivary glands. The freshlystored in the specialized salivary glands. The freshlysecreted venom is transparent, pale liquid & on drying itsecreted venom is transparent, pale liquid & on drying itbecomes yellowish, opaque, granular powder which remainbecomes yellowish, opaque, granular powder which remain

active for many years.active for many years.The proteins in the venom are in the form of enzymes,The proteins in the venom are in the form of enzymes,

peptides & polypeptides. It contains,peptides & polypeptides. It contains, Hyluronidase,Hyluronidase,fibrinolysin, phospholipase, haemorrhagin, leukolysin,fibrinolysin, phospholipase, haemorrhagin, leukolysin,cytolysin, Rhabdomyolysin, proteasescytolysin, Rhabdomyolysin, proteases etc.etc.


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Elapid venom Viper venom Sea snakevenom

Neurotoxic Vasculotoxic Myotoxic

Paralysis

Convulsions Ptosis

Localsymptoms are

mild as compareto others.

Coagulationdisorders

Bleedingtendency

Local

symptoms aresevere-cellulites

Generalizedmuscular pain

Myoglobinuria


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Treatment of snake biteTreatment of snake bite

Main principles of T/t are,Main principles of T/t are, ReassuranceReassurance Prevention of spread of venomPrevention of spread of venom

- Immobilization- Immobilization- Tourniquet- Tourniquet

- cleaning, incision, suction.- cleaning, incision, suction. Use of Antivenin (monovalent / polyvalent)Use of Antivenin (monovalent / polyvalent)

Atropine- Neostigmin regime in elapidsAtropine- Neostigmin regime in elapids I.V. Heparin in Viper bites.I.V. Heparin in Viper bites. General measuresGeneral measures


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Post mortem appearancesPost mortem appearances

Two bite marks may be found.Two bite marks may be found.Severe cellulites, hemorrhage can beSevere cellulites, hemorrhage can be

seen in viper bite.seen in viper bite.Where as in neurotoxic venom no definiteWhere as in neurotoxic venom no definite

signs except s/o asphyxia can be seen.signs except s/o asphyxia can be seen.

MEDICO LEGAL ASPECTMEDICO LEGAL ASPECT

Snake bite is generally accidental ,rarelySnake bite is generally accidental ,rarelyhomicidal, & very rarely suicidal. Sometimeshomicidal, & very rarely suicidal. Sometimesadopted for cattle killing.adopted for cattle killing.


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Ayurved viewAyurved view

Classification-Classification-A) Based on physical appearance-A) Based on physical appearance-

BaaOma sap-BaaOma sap-

saivaYasaivaYainaiva-Yainaiva-Ya

dvaI-krdvaI-kr -- 26 1226 12

maMDlaImaMDlaI - 22- 22 raijamantraijamant - 10 Total = 68 + 12 = 80- 10 Total = 68 + 12 = 80 vaOkrnjavaOkrnja - 10- 10


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sap-naama/

saM#yaa

sva$p

rsap`Qaanata

daoYa

p`kaop

kta

Potency

dvaI-krcobra

26

marks ofcross,makinghoods

kTu$xa

vaat Potentduringyoung age

maN

Bigpatches,

lustrouslook

Amla ]

NYavaI-

ip


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B) Based on Caste-B) Based on Caste-

1. Brahman1. Brahman

2.Kshatriya2.Kshatriya

3.Vaishya3.Vaishya4. Kshudra4. Kshudra

C) Based on Sex-C) Based on Sex-

1. Purush1. Purush2. Stree2. Stree

3. Napunsak3. Napunsak


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Fangs of SarpaFangs of Sarpa // dMYT/adMYT/aAcharya Charak described 4 FangsAcharya Charak described 4 Fangs

Side Fangs +ns of Venom

Left

Lower 1 drop

Upper 2 drops

Right

Lower 3 drops

Upper 4 drops


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Kinds of Snake biteKinds of Snake bite

Bite pattern Acc.toVagbhat

Acc.to Sushruta

Saliva of snake +, No bitemarks

tuNDaht

inaiva-Ya1 or 2 Fang marks, no

bleeding

vyaalaIZ1 or 2 Fang marks,

bleeding

vyaalauPt ridt3 fang marks, oozing ofblood dYTk


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dMYa hotudMYa hotu / Reasons of biting/ Reasons of biting AaharaqaM- Bayaad\ padspSaa-ditivaYaat\AaharaqaM- Bayaad\ padspSaa-ditivaYaat\

kRQa:kRQa: II

papvaRi


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ivaYavaoga laxaNaivaYavaoga laxaNa

vaoga dvaI-kr maNDlaI raijaman

1 r@tp`vaoSa kRYNa vaNa-ta, ippIilakapirsap-Nap`ittI

pItta,SaItjvar

paNDuvaNa-,raomahYa-

2maaMsap`vaoSa

AitkRYNataSaaoqaga`inqa

AitpItta dahdMSasqaanao Saaoqa

maaMsaiSaaqlata iSar:Saao

jaaDya


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vaoga dvaI-kr MmaNDlaI raijamant

6 majjaap`vaoSa ga`hNaIduiYTmaucCa-AMgagaaO

rvaAitsaar )dyaSaUla

ga`hNaIduiYTmaucCa-AMgagaaO


ga`hNaIduiYTmaucCa-AMgagaaO


7 Sauk` v aanavaa v aanavaa v aanavaa


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TreatmentTreatment

AristabandhanAristabandhan Achushan, Chedan, AgnikarmaAchushan, Chedan, Agnikarma RaktamokshanRaktamokshan ParishekaParisheka

VamanVaman AnjanAnjan Basti, VirechanBasti, Virechan NasyaNasya

UpadhanUpadhan ShamanShaman HridayarakshaHridayaraksha Mani prayogMani prayog

Stages Darvikar Mandali Rajimant


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Stages Darvikar Mandali Rajimant

1.Rakta dushti Roktamokshan Roktamokshan Roktamokshanagadpan(madhu+ghrit)

2. Mansa dushti Agadpan(madhu+mishri)

Agadpan,Yavagu(madhu+ghrit)

Vaman, Agadpan

3. Medodushti Nasya, Anjan Virechan, Yavagu Nasya, Anjan

4. Koshthapravesh

Vaman, Yavagu Vaman, Yavagu Vaman, Yavagu

5. Asthidushti Shitopachar,Virechan, Yavagu

Vaman, Yavagu Vaman, Yavagu

6. Majja dushti Shitopachar,Virechan, Yavagu

Kakolyadi gana,Agadpan

Tikshana Anjan

7.Shukra dushti Tikshana Anjan,avped nasya,

Agadpan

avped nasya

avped nasya


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Scorpion stingScorpion sting


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Clinical featuresClinical features

vaRiScakSca ivaYama tIxNama\ AadaOvaRiScakSca ivaYama tIxNama\ AadaOdhit vainhvat\dhit vainhvat\ II]Qva-maaraohit ixap`M dMSao]Qva-maaraohit ixap`M dMSao

pScaatu itYzitpScaatu itYzit IIIIdMSa: saVaoo|it$k\ SyaavastuVtodMSa: saVaoo|it$k\ SyaavastuVtosfuTitva casfuTitva ca II

- A.H.U. 37/6- A.H.U. 37/6

Scorpion poison is very sharp, potent in nature. It produces severe burningScorpion poison is very sharp, potent in nature. It produces severe burningpain which suddenly radiate upwards & then stagnate at the place of bite.pain which suddenly radiate upwards & then stagnate at the place of bite.The lesion is blackish in colour & associated with severe throbbing pain.The lesion is blackish in colour & associated with severe throbbing pain.


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Specific symptomsSpecific symptoms

maMdivaYa

Inflammation, burning pain onlesion, severe pain radiatingupwards, fever, perspiration.

maQyamaivaYa

Inflammation of tongue, anorexia,syncope.

]ga`ivaYa c/f resembles snake bite. Blisterformation on bitten area, burning,fever, hallucination, blackishblood discharge through nose,

mouth, hair ducts. Death.


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icaik%saaicaik%saa

vaRiScako svaodmaBya=gama\vaRiScako svaodmaBya=gama\GaRtona lavaNaona caGaRtona lavaNaona ca IIsaokana\ ca ]YNaana\ p`yauHjaItsaokana\ ca ]YNaana\ p`yauHjaIt

Baaojyama\ panama\ ca saip-Ya:Baaojyama\ panama\ ca saip-Ya: IIII ca.ica.23.173ca.ica.23.173sudationsudation on the bitten site, massage on all over body with theon the bitten site, massage on all over body with the

help of rock salt & ghee.help of rock salt & ghee. Parishek,Parishek,awgahanawgahan with the help ofwith the help ofhot & medicated water.hot & medicated water. GhrutapanGhrutapan as per patients agni bala.as per patients agni bala.

Treatment ofTreatment ofmaQyamaivaYamaQyamaivaYa && mahaaivaYamahaaivaYa is similar tois similar tosnake bite poisoning.snake bite poisoning.


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Specific treatmentSpecific treatment

maQyamamaQyamaivaYaivaYa //mahaivaYamahaivaYa

Swedan - around theSwedan - around thelesion by cow dug.lesion by cow dug.

Pratisaran - by haridra,Pratisaran - by haridra,saindhav, trikatu, shirishasaindhav, trikatu, shirisha

Lepa tulsi patra, bijouraLepa tulsi patra, bijoura

nimbu ras, gomutranimbu ras, gomutra Dugdhapan milk addedDugdhapan milk added

with ghrit, madhu,with ghrit, madhu,sharkara.sharkara.

maMdmaMdivaYaivaYa

Parishek by freshlyParishek by freshlyprepared oil /lukewarm oilprepared oil /lukewarm oil

Utkarika / Upanaha- usingUtkarika / Upanaha- usinganti poisonous dravyaanti poisonous dravya

Paan syrup preaperedPaan syrup preaperedby dalchini, ela, tejpan,by dalchini, ela, tejpan,nagkeshar, jaggary.nagkeshar, jaggary.

Dhoopan by feathers ofDhoopan by feathers ofpeacock, rock salt, oil &peacock, rock salt, oil &ghee.ghee.


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VenomVenom --

UsuallyUsually Neurotoxic & HaemotoxicNeurotoxic & Haemotoxic actionaction

(predominately neurotoxic). It is a potent(predominately neurotoxic). It is a potent

autonomic stimulator resulting in the release ofautonomic stimulator resulting in the release of

catecholamine from the adrenal glands & nervecatecholamine from the adrenal glands & nerveendings into circulation. It also has someendings into circulation. It also has some directdirect

effect on Myocardium.effect on Myocardium. Both these actionsBoth these actions

results in cardiac arrhythmias, hypertension &results in cardiac arrhythmias, hypertension &

later on hypotension, bradycardia.later on hypotension, bradycardia.


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Clinical featuresClinical features

Local Irritation, redness, severe burning painLocal Irritation, redness, severe burning pain

radiating from the site.radiating from the site.

Systemic Headache, nausea, giddiness,Systemic Headache, nausea, giddiness,

profuse perspiration, chest discomfort,profuse perspiration, chest discomfort,

paraesthesias, hyper salivation, coldparaesthesias, hyper salivation, cold

extremities, hypertension, pulmonary edema,extremities, hypertension, pulmonary edema,

myocarditis.myocarditis. Mortality rate in adults is negligible, ChildrenMortality rate in adults is negligible, Children

are more susceptible to death.are more susceptible to death.


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TreatmentTreatment

Stings of non lethal species require ice packs, analgesics,Stings of non lethal species require ice packs, analgesics,antihistaminic.antihistaminic.

Stings of lethal species Stings of lethal species

- Reassurance,- Reassurance,

- Application of pressure bandage, Ice packs at the sting site.- Application of pressure bandage, Ice packs at the sting site.

Immobilization of the partImmobilization of the part- Infiltration of anesthetic locally- Infiltration of anesthetic locally

- Antivenin therapy.- Antivenin therapy.

- Calcium gluconate for muscular cramps.- Calcium gluconate for muscular cramps.

- Nifedipine, nitroprusside, Prazocine for HT & pulmonary edema.- Nifedipine, nitroprusside, Prazocine for HT & pulmonary edema.

- Atropine for Bradycardia.- Atropine for Bradycardia.

- I.V. Fluids for fluid loss due to sweating & vomiting- I.V. Fluids for fluid loss due to sweating & vomiting

MEDICO LEGAL ASPECT MEDICO LEGAL ASPECT Scorpion sting is mostly accidental.Scorpion sting is mostly accidental.


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Spider biteSpider bite // laUta ivaYalaUta ivaYa


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Mythological origin ofMythological origin ofLutaLuta

as per sushrutaas per sushruta : Anger of Vasishtha rishi: Anger of Vasishtha rishi

II ( due to misbehavior of king( due to misbehavior of kingVishwamitra )Vishwamitra )

Increased perspirationIncreased perspiration II

Few drops of sweat drop on grassFew drops of sweat drop on grass

IIOrigin of LutaOrigin of Luta


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TypesTypes

As per Sushruta, total- 16As per Sushruta, total- 16

kRcCsaaQya laUtakRcCsaaQya laUta --88

AsaaQya laUtaAsaaQya laUta - 8- 8

As per Charak,As per Charak,

dUYaI ivaYadUYaI ivaYa laUtalaUta

p`aNahrp`aNahr laUtalaUta

As per Vagbhat,As per Vagbhat,

type fatalitytype fatality

1.tIxNa1.tIxNa within 7 days within 7 days

2.maQyama2.maQyama - within 7- within 7daysdays

3.Avar3.Avar - within 7 days- within 7 days

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