Snake Bites

Question 1

Types of snakes

Answer 1

• Elapidaes; cobra and mambas,
• Viperidae; Adders and Vipers,
• Back- fanged snakes: Boomslang and vine snakes

Question 2

Snake venom and types of snakes

Answer 2

Neurotoxic: Mamba and non-spitting cobra
Haemotoxic: boomslang and vine snake
Cytotoxic: puff adder and spitting cobra

Question 3

Snake bite syndromes (3)

Answer 3

Progressive pain and swelling- cytotoxic
Progressive weakness- neutotoxic
Bleeding- haemotoxic

Question 5

Clinical features of mamba and non spitting Cora snake bites

Answer 5

• Progressive descending flaccid paralysis,
• Transient paraesthesia of the tongue and lips,
• Blurred and double vision and ptosis, dilated pupils
• Paralysis of facial muscle and other cranial nerve palsy
• Difficult in swallowing and increased oropharyngeal secretions,
• Respiratory distress and failure

Question 6

Clinical features of boomslang and vine snakes bites

Answer 6

Non-specific GI symptoms, headache, dizziness and fainting
• Blood oozing from fang punctures or other wound sites,
• Bleeding post-bite occurs with 6- 24 hours
• Late Systemic haemostatic manifestations: more than 24 hours to
days.
• Bleeding includes gingival, epistaxis, purpura, hematemesis, melena,
haematuria, extensive ecchymosis

• Severe cases : SAH, or Intracerebral haemorrhage, DIC with multiple
organ failure.
• 20 minute whole blood clotting test: incoagulable blood is a cardinal
sign of consumptive coagulopathy.

Question 8

Indications for snake antivenom

Answer 8

• Life saving drugs
• Stop progression of rapid swelling
• Prevent or reverse inability to breathe
• Stop bleeding
• 2 types of antivenom locally manufactured : Polyvalent and
Monovalent Boomslang antivenoms

Polyvalent • Indicated in
• Anticipated severe envenomation
• Presence of severe envenomation

Question 9

Signs of anticipated severe envenomation

Answer 9

PPS
• Rapid swelling: 15 cm or more within an hour
• Extremities: swelling extending to elbow or knee within 3-4 hrs

PW
• Triad
• Perioral paraesthesia ,
• Excessive salivation,
• Sweating and/or difficulty in breathing.

Bleeding
• Continuous oozing bleeding from fang punctures,
• Severe headache, dizziness, Loc , convulsions