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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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Thank You