National Snakebite Management Protocol, 2009. India is recognised as having the highest snakebite mortality in the world. Most of the fatalities are due to the victim not reaching the hospital in time and are preventable. Research has shown that PHC doctors do not treat snakebite mainly due to lack of confidence. At the secondary and tertiary care level Emergency departments, multiple protocols are followed mainly from western textbooks which are not appropriate for Indian settings. Anti snake venom (ASV) are administered when it is not required and/or in doses well in excess of the required amount. In response, Government of India, Health & Family Welfare Department with WHO, has prepared a National Snakebite Management Protocol to provide doctors and lay people with the best, evidence based approach to dealing with snakebite in India. The majority of current first aid methods adopted by victims such as tourniquets, cutting and suction and herbal remedies are completely ineffective and dangerous. It is now recommended to adopt what has been called the ‘Do it R.I.G.H.T.’ approach, stressing the need for Reassurance, Immobilisation as per a fractured limb, Getting to Hospital without delay and Telling the doctor of any symptoms that develop. 20 Minute Whole Blood Clotting Test (20WBCT) in the diagnosis and management of viperine bite- 10ml blood of victim in plain vial is checked for clotting after 20min. If not clotted- suggest viper. Pain management - never give NSAIDs- causes more bleeding. Never give morphine- can cause respiratory failure. ASV Administration Criteria-ASV should be administered if there is significant envenomation i.e. incoagulable blood shown by the 20WBCT or significant limb swelling for viperine bite, neurological signs for cobra & krait bite. ASV Dosage & Repeat Dosage-The recommended initial dose of ASV is 8-10 vials administered over 1 hour. Mode of administration of ASV is IV only. Dose of ASV is same in children, pregnant or elderly, because venom injected is of same amount, so ASV required is of same dose. Repeat doses for haemotoxic viperine snakes is based on the 6 hour rule. Repeat doses for neurotoxic snakes is based on the 1-2 hour rule. The maximum recommended dose for haemotoxic bites in 30 vials of ASV. The maximum recommended dose for neurotoxic bites is 20 vials of ASV. ASV Reactions- No ASV Test Doses are to be administered. At the first sign of an adverse reaction the ASV is halted-0.5mg Adrenaline is given IM- ASV remaining dose should be given- Avil & Effcorlin can be given to prevent ASV anaphylaxis. Neurotoxic Bite -neostigmine test-Despite the fact that the neostigmine test (Neostigmine 0.5mg IM with atropine 0.6mg IV) was actually an Indian discovery, it is still poorly used in India. Neostigmine works in cobra bite as cobra venom acts on post-synaptic neurons. Hemotoxic bites with correct signs of envenomation can be treated with 8-10 vials of ASV, stabilised if any ASV reaction occurs with adrenaline and then transferred to a higher centre with the ability to carry out the required blood tests to identify occult bleeding or renal impairment. Heparin has no role in curing DIC of snakebite, and can increase bleeding, so contraindicated in viperine bites. Botrophase should not be used as coagulant in controlling viperine bite bleeding, as it causes consumptive coagulopathy. Neurotoxic bites with correct signs of envenomation can be treated with 8-10 vials of ASV, stabilised if any ASV reaction occurs with adrenaline and administered the neostigmine test. If there is no evidence of impending respiratory failure, determined by patient ability to perform a neck lift the patient can be treated locally. If the patient is unable to perform a neck lift then they will be transferred to a higher centre with mechanical ventilatory capability. The rational application of ASV and repeat doses has resulted in patients being discharged earlier. Please forward this post to all groups having Doctors 🙏
Thank you sir for accepting my request and giving us consolidated information on this emergency topic. Tourniquet application over Snake bite this misconception still present in community, many doubts cleared in this vedio.Thank once again sir.
One thing you forget is how to differentiate pre and post synaptic bite? Ans. - cobra venom works on post synaptic neurons, so you can use neostigmine in cobra bite Neostigmine 0.5 mg IM and Atropine 0.6 mg IV
How can we understand its pre or post synaptic??. Thnku so much for this video.. its very very imp and might save lots of life.. Well im the student of BAMS 4th year, we also educate people to not to get involved with babas and tantra mantra.. we refer them to civil hospitals nearly everytime.. there is no shame in that.. but in india most poulation that encounters snake often is rural n they believe in babas n saperas more than doctors.. we need to teach them n educate them.. once again thats a wonderful video..
i asked may viewers regarding this, but as the audience is global now and most are of medical field, basic english everyone can understand as i also know only basic english
Thank you very much sir for sharing this great information in simple way... Nowadays it's very common problem due to rainy season... It's the right time for this video.
Nice video sir Sir patient bite hone ke baad panic hoke iska heartbeat tej ho gaya to kya kaarna cahiye please tell me Agar koi cycological patient ho to wo bites ke baad daar jayega na bahot Please tell me sir about this kiny 🙏🙏🙏🙏🙏🙏🙏
WHO guidelines textbook suggests administration of 0.25 ml Adrenaline subcutaneously before administration of ASV prevents anaphylaxis . Please comment
National Snakebite Management Protocol, 2009.
India is recognised as having the highest snakebite mortality in the world.
Most of the fatalities are due to the victim not reaching the hospital in time and are preventable.
Research has shown that PHC doctors do not treat snakebite mainly due to lack of confidence.
At the secondary and tertiary care level Emergency departments, multiple protocols are followed mainly from western textbooks which are not appropriate for Indian settings.
Anti snake venom (ASV) are administered when it is not required and/or in doses well in excess of the required amount.
In response, Government of India, Health & Family Welfare Department with WHO, has prepared a National Snakebite Management Protocol to provide doctors and lay people with the best, evidence based approach to dealing with snakebite in India.
The majority of current first aid methods adopted by victims such as tourniquets, cutting and suction and herbal remedies are completely ineffective and dangerous.
It is now recommended to adopt what has been called the ‘Do it R.I.G.H.T.’ approach, stressing the need for Reassurance, Immobilisation as per a fractured limb, Getting to Hospital without delay and Telling the doctor of any symptoms that develop.
20 Minute Whole Blood Clotting Test (20WBCT) in the diagnosis and management of viperine bite- 10ml blood of victim in plain vial is checked for clotting after 20min.
If not clotted- suggest viper.
Pain management - never give NSAIDs- causes more bleeding. Never give morphine- can cause respiratory failure.
ASV Administration Criteria-ASV should be administered if there is significant envenomation i.e. incoagulable blood shown by the 20WBCT or significant limb swelling for viperine bite, neurological signs for cobra & krait bite.
ASV Dosage & Repeat Dosage-The recommended initial dose of ASV is 8-10 vials administered over 1 hour.
Mode of administration of ASV is IV only.
Dose of ASV is same in children, pregnant or elderly, because venom injected is of same amount, so ASV required is of same dose.
Repeat doses for haemotoxic viperine snakes is based on the 6 hour rule.
Repeat doses for neurotoxic snakes is based on the 1-2 hour rule.
The maximum recommended dose for haemotoxic bites in 30 vials of ASV.
The maximum recommended dose for neurotoxic bites is 20 vials of ASV.
ASV Reactions- No ASV Test Doses are to be administered.
At the first sign of an adverse reaction the ASV is halted-0.5mg Adrenaline is given IM- ASV remaining dose should be given- Avil & Effcorlin can be given to prevent ASV anaphylaxis.
Neurotoxic Bite -neostigmine test-Despite the fact that the neostigmine test (Neostigmine 0.5mg IM with atropine 0.6mg IV) was actually an Indian discovery, it is still poorly used in India.
Neostigmine works in cobra bite as cobra venom acts on post-synaptic neurons.
Hemotoxic bites with correct signs of envenomation can be treated with 8-10 vials of ASV, stabilised if any ASV reaction occurs with adrenaline and then transferred to a higher centre with the ability to carry out the required blood tests to identify occult bleeding or renal impairment.
Heparin has no role in curing DIC of snakebite, and can increase bleeding, so contraindicated in viperine bites.
Botrophase should not be used as coagulant in controlling viperine bite bleeding, as it causes consumptive coagulopathy.
Neurotoxic bites with correct signs of envenomation can be treated with 8-10 vials of ASV, stabilised if any ASV reaction occurs with adrenaline and administered the neostigmine test.
If there is no evidence of impending respiratory failure, determined by patient ability to perform a neck lift the patient can be treated locally.
If the patient is unable to perform a neck lift then they will be transferred to a higher centre with mechanical ventilatory capability.
The rational application of ASV and repeat doses has resulted in patients being discharged earlier.
Please forward this post to all groups having Doctors 🙏
Thanks Dr Abhi . Noted .
Thanks a lot...,💯👏👌
Thank you sir for accepting my request and giving us consolidated information on this emergency topic. Tourniquet application over Snake bite this misconception still present in community, many doubts cleared in this vedio.Thank once again sir.
Thanks dr Rajesh , hope this will save some lives . Do forward to everyone you feel this will help
Superb Sir...
Much better than many comprehensive chapters in books on the topic.
Best part: Algorithm and First Aid
Thank you
Thanks a lot madam for the encouraging words . Do forward, who knows it may save some lives
U are the gem sir....Allah bless u ...n protects u Dr ankur Gupta sir ❤️
Every topic explained by you is amazing & very knowledgeable!!
Hatts off
One thing you forget is how to differentiate pre and post synaptic bite?
Ans. - cobra venom works on post synaptic neurons, so you can use neostigmine in cobra bite
Neostigmine 0.5 mg IM and
Atropine 0.6 mg IV
Very exhaustive presentation and explained with so much simplicity
... Very very important! Excellent information!
Awesome series sir very knowledgeable all session Thank you so much..🙏🙏👌 In hindi awesome..
Best medical channel
Thank u so much
Thank you sir for explain this in detail.....👌👌✌️✌️🙏🙏
Very brief and useful information.... Thanks so much sir 👌👌
Very well explained and will definitely help in better management of snake bite poisoning
Crisp and to the point. Thank you.
How can we understand its pre or post synaptic??.
Thnku so much for this video.. its very very imp and might save lots of life..
Well im the student of BAMS 4th year, we also educate people to not to get involved with babas and tantra mantra.. we refer them to civil hospitals nearly everytime.. there is no shame in that.. but in india most poulation that encounters snake often is rural n they believe in babas n saperas more than doctors.. we need to teach them n educate them.. once again thats a wonderful video..
Thanks Ajay
Only cobra bite is post synaptic bite.....so you can give neostigmine in cobra bite
@@doctorabhi8030 thnx doc
Superb...👌👌
Compact yet Comprehensive...
Nice thank you information
Absolutely amazing information 👏👌🙏
Thanks dr Rahul
sir very informative video please make a some more video in hindi Languages
i asked may viewers regarding this, but as the audience is global now and most are of medical field, basic english everyone can understand as i also know only basic english
Thank you very much sir for sharing this great information in simple way... Nowadays it's very common problem due to rainy season... It's the right time for this video.
Thank you Prashant for the kind words
Great lecture
Great job sir, 💯💯💯
Thanks aditya
very nice and informative sir.....
Thanks, sir for a very informative video.
Thanks it helped
Sir, please make a video on organophosphorus poisoning (pesticides)
amazing video sir 👍🙏
Very helpful thank you so much
Finally sir , great video 👌🏻
100% helpful 🤗
Glad it was helpful!
Sir pls make a vedio on sepsis septic shock Dic and it’s management your explanation way is very nice and useful so pls sir thank you
Thanks dr manish , your feedback noted .
Hindi names of snakes will help us more
i also don't know much, if you know please post.
Very good videos sir,
Excellent video sir. Waiting for more videos
Thanks Aneesh , soon new videos coming .
Sir, please make videon on hanging case management
Great sir
Thankyou very much sir
Most welcome
sir calcium gluconate bhi dete hai kya neurotoxic snake bite me
Nice video sir
Sir patient bite hone ke baad panic hoke iska heartbeat tej ho gaya to kya kaarna cahiye please tell me
Agar koi cycological patient ho to wo bites ke baad daar jayega na bahot
Please tell me sir about this kiny 🙏🙏🙏🙏🙏🙏🙏
assurance is the key. thanks
nice
Good sir,thank
How to use neostigmine in snake bite..? Doses & timing ."
Superb 👍
Thanks
sir lecture video on anti snake venom (asv)
Means it is in it , what specific u want ?
Thank u sir for helping
Glad it helped
cardiac failure me kaun sa injection denga chahiye
Tq sir
What should be the subcutaneous dose of adrenalin
Yeah
What should be the dose and frequency of neostigmine
Yeah
Sir , What all errors can occur in 20 mins whole blood clotting.
VERY THANKS SIR
Sir vedio thodi choti bnaya kriye ap
ty
Scorpion pe vedio banao sir
Sir how we identify that presynaptic Or postsynaptic neurotoxic
Actually there is no way .
Indication of HD
Sir meri sneak bite hua 16 July ko medical me admit hua treatment be kiya abhi meri peer me allergy hota hai kyu
Sir surgery lscs ki surgery ke baad hone vali emegency ko kaise mange kre sir plz reply sir fast
Depends on what complications happened?
Sir krait ne bite kiya tha 9 yers ka ldka h hypoxia ho gaya brain damege h 14 month ho gaye bas ladka rota h koi ilaj ho to bathe pl
All supportive , Nthg specific
Ph number pl
Dr. Ji please apna contect no do
❤🙏👌❤🙏👌
WHO guidelines textbook suggests administration of 0.25 ml Adrenaline subcutaneously before administration of ASV prevents anaphylaxis . Please comment
We don’t use frequently, used rarely in Indian settings
Can ASV be given after 24 hrs
Yes , its better to give (based on the clinical condition)
Hindi 🙂🙂
🤝😊
Kitna samay treatment ke liye jaruri hai??
Depends on clinical condition .