SNAKE BITE

 Presented by:
 Arturo Niño G. Lajada III
 Maria Abegail U. Batioco
 Krissa Marie C. Paña
 Jessica O. Ruga
 Monica Angelique P. Salayo
EPIDEMIOLOGY:
 Burden of human suffering:
In 2009, snake bite was recognized for the first time by WHO as a
neglected tropical disease.

In tropical countries, it is largely an occupational disease for agricultural

workers, and, as a result, can affect food production.

Snake bite causes substantial human mortality and disability—physical

and psychological—but its recognition as an important international
public health issue has been hindered by insufficient epidemiological
data.

South and southeast Asia were identified as having the highest snake
bite incidence and associated mortality
Did You Know That?
 Though the exact number of snake bites is unknown, an estimated
5.4 million people are bitten each year with up to 2.7 million
envenomings.
 Around 81 000 to 138 000 people die each year because of snake
bites, and around three times as many amputations and other
permanent disabilities are caused by snakebites annually.
 Bites by venomous snakes can cause paralysis that may prevent
breathing, bleeding disorders that can lead to a fatal hemorrhage,
irreversible kidney failure and tissue damage that can cause
permanent disability and limb amputation.
 Agricultural workers and children are the most affected. Children
often suffer more severe effects than adults, due to their smaller
body mass.
 Here in the Philippines, the highest cases are in Bohol.
DEFINITION:
 A bite from a snake, whether venomous (such as a
rattlesnake, copperhead, cottonmouth water
moccasin, or coral snake) or non-venomous
requires immediate medical attention. If venomous,
the venom will eventually travel within the
circulatory system. Bringing the venom to the brain
causing neurotoxicity.
How to identify venomous snakes
 Some harmless snakes have evolved to look almost identical
to venomous ones. Thus making identifications difficult.
 Unfortunately, there is no simple rule for identifying a
dangerous venomous snake, except through observations
and laboratory examination.
Types of Venomous Snakes:
There are about 3,000 species of snakes; fewer than 200 of these
cause severe envenomation in humans. Venomous snakes belong to
4 families:
 Atractaspididae: burrowing asps, mole vipers, Natal black snake,
stiletto snakes
 Colubridae: arboreal back-fanged snakes, including boomslangs
 Elapidae: cobras, kraits, mambas, coral snakes, Australasian
snakes, sea snakes
 Viperidae: Old World vipers and adders, American rattlesnakes,
moccasins, lance-headed vipers, Asian pit vipers
How Snakes Envenomate:
Venom is produced in a modified salivary gland and injected with
needle-sharp fangs that have a venom groove or channel.
 Atractaspididae have long front fangs that impale the victim.
 Colubridae have short, fixed back fangs that are not very efficient in
envenoming large prey, but several species, notably the African
boomslang, have caused severe envenomation in humans.
 Elapidae have short, fixed front fangs that inject venom or, in the
case of spitting cobras, spray venom into the eyes of their prey or
aggressor.
 Viperidae have long, hinged front fangs that inject venom deeply.
RISK FACTORS:
Modifiable Non-modifiable
Local Density of Snake Population Age (toddler-old aged)
Activities that bring people into Gender (Male)
contact with snakes
Aggressiveness or timidity of the
species of snake
SIGN AND SYMPTOMS:
 Fang marks in the skin
 Bleeding from wound
 Burning sensation of the affected skin
 Blurred vision
 Convulsions
 Diarrhea
 Dizziness
 Excessive sweating
 Fainting
 Ecchymosis
 Fever
 Increased thirst
 Collapse (hypotension, shock)
 Nausea
 Vomiting
 Diarrhea
 Severe headache
 “Heaviness” of the eyelids
 Inappropriate drowsiness
 PATIENT’S ACCOUNT:

Name: PATIENT X
Age: 67 years old
Address: 021 Piesces St. Kataasan, Taliptip, Bulacan
Status: Widowed
Birthplace: Bulacan
Date of Birth: April 27, 1952
Occupation: Jeepney Driver
Educ.Attainment: Elementary Grad.
Nationality: Filipino
Religion: Catholic
Chief Complaint: Snake bite at the R-hand 3rd digit

Admitting Diagnosis: Abrasion R-hand 3rd digit Allegedly

Secondary to Snake Bite without signs of Envenomation

Admission: June 25, 2019 at 10:45PM

Attending Physician: Rontgene M. Solante, M.D

LIFESTYLE:
Retired Jeepney Driver
Carnivorous
Picky-eater
Alcoholism
Cigarette Smoker
Gardening
Playing with his grandchildren
PAST HEALTH HISTORY:
 15 years heavy smoker
 Alcoholic drinker last intake afternoon at 3PM
before the incident happens
PRESENT HEALTH HISTORY:
 Abrasion R-hand 3rd digit Allegedly Secondary to Snake Bite without
signs of Envenomation

Latest Vital Signs:

 Temp – 36
 RR – 24 cpm
 PR – 82 bpm
 BP – 130/90 mmHg
FAMILY HISTORY:

MOTHER SIDE FATHER SIDE

Legend: hypertension
WIFE
diabetes

PATIENT X
PHYSICAL ASSESSMENT:
Physiological Changes of aging

1. Integumentary system:
• 2 fang marks on the right hand 3rd digit
• Loss of pigment in hair and skin
• Increased nail thickness
• Long nails with black crowns on top
• Thinning of the epidermis
• Decreased skin turgor
• Loss of elasticity and subcutaneous fat
• Wrinkling of the skin
2. Neurological System:
 Aware of time, place and person
 Able to answer questions appropriately
 Slowed reflexes
 Dizziness

3. Musculoskeletal system:
 Decrease ROM
 Decreased in physical strength
 Increased brittleness of the bone

4. Cardiopulmonary system:
 Energy and endurance diminishes
 Decreased strength and function of respiratory muscles
 Increased blood pressure
5. Respiratory System:
 Decreased respiratory effort

6. Hematological and Immune System:

 Decreased resistance to infection and diseases
 Prone to increase blood clotting

7. GIT
 Digestive disturbances
 Decreased stomach emptying time
 Increased tendency towards constipation
 Difficulty in chewing and swallowing food
8. Endocrine System:
 Decreased metabolic rate

9. Renal System:
 Decreased capacity of the bladder

10. Reproductive System:

 Decreased testosterone production

11. Special Senses:

 Presbyopia and cataract formation on both eyes
PSYCHOSOCIAL ASPECT OF
AGING:
1. Adjustment to retirement and loss of income
2. Changes in role function
3. Coping with change and new life situations
4. Changes in social life
5. Diminished quantity and quality of relationships
6. Coping with loss
7. Adjustment to potential deterioration in physical and mental health and
well-being
8. Threat to independent functioning
9. Loss of skills and competencies developed in early life
NEUROLOGICAL ASSESSMENT:
Eyes Opening Verbal Response Motor Response
4 5 6
TOTAL: 15
 Assessment of Severity of Envenomation
No envenomation Absence of local or systemic reactions, fang
marks+/-
Mild envenomation Fang marks, moderate pain, minimal local
edema (0-15 cms), erythema+ ,
ecchymosis+/-, no systemic reactions.
Moderate envenomation Fang marks+ , severe pain, moderate local
edema (15-30 cms), erythema+ ,
ecchymosis+ , systemic weakness, sweating,
syncope, nausea, vomiting, or
thrombocytopenia & anemia.

Severe Envenomation Fang marks+ , severe pain, severe local

edema (>30cms), erythema+ , ecchymosis+ ,
hypotension, parasthesia, coma & respiratory
failure.
ANATOMY:
PATHOPHYSIOLOGY:
 Snakes that inject venom use modified salivary glands. Venom is a
modified form of saliva and probably evolved to aid in chemical
digestion. Varying degrees of toxicity also make it useful in killing prey.
During envenomation (the bite that injects venom or poison), the
venom passes from the venom gland through a duct into the snake's
fangs, and finally into its prey. Snake venom is a combination of
numerous substances with varying effects. In simple terms, these
proteins can be divided into 4 categories:

1. Cytotoxins cause local tissue damage.

2. Hemotoxins cause internal bleeding.
3. Neurotoxins affect the nervous system.
4. Cardiotoxins act directly on the heart.
NEUROTOXICITY
DRUGS:
 Anti-tetanus (2 shots - IM)

 Tetanus is a bacterial infection that can be transmitted to the

person who was bitten. The tetanus vaccine will only prevent this
bacterial infection (which is deadly without treatment) but if the
snake was venomous, it will not treat the venom itself; the venom
requires anti-venom specific to the type of snake.

 Non-venomous snake bites still present some danger from

infection (such as salmonella and tetanus) which would be the
reason for getting a tetanus shot (depending on the last
administration of the vaccine, tetanus boosters every 10 years for
adults.)
TRIVIAS AND FACTS:
ROLE OF ANTIVENOM:
 The only specific antidote to the toxins in snake venom is hyper
immune globulin from an animal that has been immunized with the
appropriate venom.

 According to Albert Calmette’s introduction of serum antivenimeuse for

the treatment of envenoming in 1895 was quickly accepted without
formal clinical trials.

 More than a century later, immunoglobulin antivenoms are accepted as

essential drugs but reappraisal is needed.

 The limitations of antivenom treatment should be recognized. Patients

with respiratory, circulatory, and renal failure need urgent resuscitation
as well as antivenom.
 Ophidiophobia or ophiophobia - Fear of snakes
 Philippines is home to more than 175 snake species.
 Reticulated pythons (Python reticulatus) are the only pythons that
inhabit the rainforests of the Philippines. The longest snake species in
the world, reticulated pythons may reach more than 25 feet in length
and weigh more than 300 pounds. 
 Pythons and Black Mamba are one of the deadliest snakes in the
world.
 TREATMENT:
First aid treatment is carried out immediately or very soon after the bite
before the patient reaches a dispensary or hospital.
 Reassure the victim who may be very anxious.
 Immobilize the whole of the patient’s body by laying him/her down in a
comfortable and safe position. Make sure to immobilize the bitten limb
with a splint or sling.
 Apply pressure if necessary.
 Avoid any interference with the bite wound (incisions, rubbing, vigorous
cleaning, massage, application of herbs or chemicals) as this may
introduce infection, increase absorption of the venom, and increase
local bleeding.
 Bring the patient to the hospital.
 Antivenom is the only effective antidote for snake venom.
MEDICAL TREATMENT
 CALL 911 IF: 
 There is any chance that the snake is venomous
 The person has difficulty breathing
 There is loss of consciousness

1. Note the Snake's Appearance

 Be ready to describe the snake to emergency staff.

2. Protect the Person

 While waiting for medical help:
 Move the person beyond striking distance of the snake.
 Have the person lie down with wound below the heart.
 Keep the person calm and at rest, remaining as still as possible to keep venom from
spreading.
 Cover the wound with loose, sterile bandage.
 Remove any jewelry from the area that was bitten.
 Remove shoes if the leg or foot was bitten.
DON'T s
 Do not make the patient tired.
 Do not use tourniquet.
 Do not use ice pack on the bite marks.
 Do not puncture, pinch, or scrape bitten area.
 Do not suck in venom from the patient’s open wound.
 Do not give medication not prescribed by the doctor.
 Do not elevate the wound at the same level or higher than
the chest/heart area.
MANAGEMENT
 First aid treatment
 Transport to hospital
 Rapid clinical assessment and resuscitation
 Detailed clinical assessment and species diagnosis
Investigations/laboratory tests
 Anti-venom treatment
 Observing the response to anti-venom
 Deciding whether further dose(s) of anti-venom are needed
 Supportive/ancillary treatment
 Treatment of the bitten part
 Rehabilitation
 Treatment of chronic complication
CONCLUSIONS:
Snake bite is a neglected disease that
afflicts the most impoverished
inhabitants of rural areas in tropical
developing countries. It is an unusually
challenging medical problem that
deserves further investigation after the
prolonged neglect by medical science.
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Acute pain After 1 hour of Assess level of To properly After 1 hour of
“I can feel a related to nursing pain through plan pain nursing
sharp pain on affected area of intervention the PQRST management intervention the
my finger” snake bite patient’s pain strategies patient’s pain
will be relieved has been
Help patient To distract and relieved
Objective: find divisional focus patient’s
Presence of activities attention away
discolorations from the pain
Swelling on Teach patient To help calm
affected area deep breathing patient in
exercise episodes of
Guarding frustration
behavior
Provide and The pain will be
Irritability ambient exaggerated if
environment external
stressors are
bothering
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Provide The medication
analgesic when will help relieve
patient request the pain felt by
during the patient
episodes of
intolerable pain
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Impaired skin After 8 hours of Monitor site for Inspecting After 8 hours of
“sobrang kati integrity related nursing discoloration, affected site nursing
nang sugat to compromise intervention the swelling, can identify intervention the
nato” of the patient will be warmth, pain, impending patient has
Integumentary able to or other signs problems early been able to
Objective: system participate in of infection. and make participate in
2 fang marks preventive appropriate preventive
found on R- activities nursing health activities
hand 3rd digit management
plan
Scab formation Teach patient To identify the
on affected how to assess presence of
area and monitor for infection
signs of
Increased temp infection
of affected area
Tell patient to As it can cause
avoid rubbing injury and delay
area. healing
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Encourage To help and
patient to promote
increase healing
protein intake

Instruct patient, To educate

and his family patient how to
proper wound manage
care, wounds
including hand independently
washing, and reduce the
wound risk of infection
cleansing,
dressing
changes, and
application of
topical
medications
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Risk for After 8 hours of After 8 hours of

“na mamaga infection nursing nursing
yung kagat” related to soft intervention the intervention the
tissue damage patient will patient has
remain free of been free of
Objective: infection infection
2 fang marks
found on R-
hand 3rd digit

Black crows on
fingernails

Presence of
swelling

Scab formation
on affected
area
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Knowledge After 1 hour of After 1 hour of

“Yung kinagat deficit towards nursing nursing
ako nang ahas, first aid intervention the intervention the
nimasahe ko” management patient will gain patient has
for snake bites knowledge gained
Objective: related to about first aid knowledge
misinformation management of about first aid
snake bite management of
snake bite
 NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Anxiety related After 3 hours of After 3 hours of

to possible nursing nursing
amputation intervention the intervention the
Objective: patient will be patient has
able to cope effectively
with his coped with his
upcoming upcoming
operation operation
References:
 https://www.who.int/
 https://disasters2.jimdo.com/snakebite/
 http://apps.searo.who.int/PDS_DOCS/B4508.pdf
 https://sciencing.com/philippine-snakes-species-7000.html
 http://www.apiindia.org/pdf/medicine_update_2011/97_advance
s_in_management.pdf
 https://tripprep.com/library/snakebites/traveler-summary