Summary:
This conversational data reflects frontline and experiential insights on snakebite envenomation, particularly in Indian rural and urban settings. It highlights the risks of venomous snakes like vipers, cobras, kraits, and discusses the challenges in managing bites, including anti-snake venom (ASV) availability, misuse, and variable efficacy. The necessity of timely ASV administration is emphasized along with supportive treatments like dialysis and ventilation. There is discourse on traditional healer roles and AI-assisted diagnostic tools (like image recognition apps) to distinguish snake species for accurate treatment. The discussion also reflects skepticism toward western evidence-based medicine models while valuing empirical knowledge in local contexts. Key complications such as delayed venom effects and ARF (acute renal failure) emerge as critical concerns in treatment outcomes.
Keywords:
- Snakebite envenomation
- Anti-snake venom (ASV)
- Viper, Cobra, Krait, Python
- Hemotoxic, Neurotoxic venom
- Acute renal failure (ARF)
- Supportive care (dialysis, ventilation)
- Traditional healers
- AI diagnostics in medicine
- Empirical vs. Evidence-Based Medicine
- Public health and snakebite management
Conversational Transcripts:
[04/08, 05:35]hu1: Facing a snake 1st time in my life
[04/08, 05:35]hu1: Not going to hide it. Saw death with fear in my eyes. Was already calculating money will and which hospital would be best for ASV - Anti Snake Venom
[04/08, 05:35]hu1: ASV is manufactured only in King Institute, Guindy. Due to lack of expertise in treating snake bites, Dr especially in ICUs tend to overuse it. Stock runs out fast
[04/08, 05:35]hu1: Simply coz their venom is deadly. Vipers are hemolytic cobra krait are neurotoxin. 30 max, it kills. They evolved to use it to hunt for food. We are the one intruding on their environment
[04/08, 05:35]hu1: This fellow is a baby python. 3 foot Mama had visited kutchen few weeks ago. So I told thomas to call the local snake catcher and find their nest. Atleast 20 eggs and babies will be there for sure
[04/08, 05:40]hu1: RFS - reason for sharing: Google AI was used by a friend to parse my video and correct me that this is a baby reticulated python and not a viper.
How can we deliver this in my ED? Every practising Dr should have this astra in kitty to assist. Isabel healthcare was a beginning, POEM & PROSE were tried, Infobutton was cool, Watson was to send all doc home. Aint happen 😉🤔😆
[04/08, 05:40]hu1: AI HAL built into an app that any doc can download that can read a pic or video and give DD
[04/08, 05:42]hu1: Hence dogs have been with man since stone ages for their pure loyalty. Unbelievable how this 14 year old grandpa protected us, ignoring his masters commands
[04/08, 08:46]hu4: Reminds me of my days at Amrita, you know snakes just get into the house and go to the opposite side and it's very common. These include Cobra too!
My son was 6 months old and one day a snake passed by, i was in hospital and my wife's shouting made my neighbours rush in. Thier first reaction was: laughter!
They said it's very common for snakes including venomous ones to come into home but nothing to be worried.
After that we have had 4 encounters in 6 months!!!!
[04/08, 09:01]hu3: Traditional healers also treat snake bites. Using herbs. Covered under QCI certification schene!!!
[04/08, 09:42]hu1: I don't know what they treat. I can tell you if bitten don't experiment. Atleast we know ASV works
[04/08, 09:49]hu3: Someone shld study what they do!!!
[06/08, 06:34]hu1: Google helped allay my fear that it could be a viper. This is baby python
[06/08, 06:34] ATP: Try it. Just check with perplexity or grock
[06/08, 08:44]hu2: Pythons move sluggishly while vipers are swift
[06/08, 09:02]hu1: True
[06/08, 09:01]hu1: Viper venom is hemotoxic, kills in few hours
[06/08, 09:15]hu2: Yes we regularly manage these patients.
Here's a past case report from our open EMR archive 👇
https://nikhilasampathkumar.
After 4 days:
[11/08, 06:38]hu1: Grew up on CLRI campus. Have been exposed to snakes since childhood, have a healthy respect for them. We intrude into their space. Never the other way. As a medStudent and intern managed many cobra, krait, sawtooth scaled viper and russels viper victims in Porur. It was a very rural ecosystem at that time. These are the 4 species that are poisonous. Rest are safe. Indian python is not big enough to be a threat to us. Those in South Asia and Brazil are evil. Anaconda is similar.
My fear of snakes hence is from knowing the consequences of a bite. I think we all should be safe rather than sorry.
[11/08, 06:38]hu1: https://chennaisnakepark.in/
[11/08, 06:44]hu1: These are the points where a reliable authentic source of information both for the healer and the one seeking help goes a long way in allaying unnecessary fear.
We have seen people horrified after a snake bite. Sometimes the venom is retained in muscle and gets released when we mobilize patient in wards. I have seen patients die after 10 days of cobra bite.
Our Kings Institute Guindy Chennai produces ASV - Anti Snake Venom by injecting venom from these 4 dangerous species unto horses. Their body produces antibodies that are then purified and used to help manage human snake bites.
Cobra Krait are neurotoxic. Vipers are hemotoxic. Pythons and Anacondas are constrictors. All of them have this capability to hunt prey and feed. We come in the middle...and then complain 🙄
[11/08, 06:48]hu1: My military school seniors were having a laugh saying: ithna chota snake se darr gaya. Don't be fooled by size. Vipers are about 20 cm but easily take down a man.
Both are very painful death, whether neuro or hemo toxic. ASV is not 100% effective and some patients react to this foreign protein.
Prevent 》Treat. Always
[11/08, 08:32]hu2: We have lots of cobras in our garden!
https://www.facebook.com/
[11/08, 08:34]hu1: U r a brave man. The hatchlings carry venom like their mama. Don't make me come to kukatpally to treat you. 🤦🏽♂️
[11/08, 08:39]hu1: ASV is not effective at all!
Most of the successes of snake bite management appears to be due to supportive management like dialysis and ventilation. People have brought down the dose of ASV by 50 to 70% in controlled trials and the effect appears same. http://www.ncbi.nlm.nih.gov/
The above are trials based in India. It is possible that the low dose anti-venom could have been gradually in subsequent trials brought down to zero!
[11/08, 08:40]hu1: We live far from Kukatpally, in a village near Hyderabad
[11/08, 08:44]hu1: I object milord. ASV does save lives. Dialysis and Ventilation are like 7th 8th step in a path from 0 to 10. I despise going there
[11/08, 08:45]hu1: Keep away from those critters Prof. Your students ❤️ you
[11/08, 08:46]hu2: Check out the evidence!
[11/08, 08:46]hu2: Yes cobras are very sensitive creatures. Even when we work in the garden they either slither away further or provide a distinct hiss like warning
[11/08, 09:23]hu1: I am a practioner of empirical & experience. EBM is a western concept. We can debate how much it is relevant to the orient. Occidental <> Oriental are north and south poles. Twine rarely converge.
Conversational Transcripts from another group:
[15/08, 10:01]hu5: Real snake bite
[15/08, 12:52]hu2: Did they see the snake or bring a picture of it?
[15/08, 13:11]hu5: Yes they killed it, person who got bitten ran back and killed the snake
[15/08, 13:27]hu5: Our patients often bring their snake's photograph that helps to plan their care pathway in a better way👇
https://pajrcasereporter.
[15/08, 14:27]hu5: Same description patient was giving
[15/08, 14:28]hu5: Russell's viper?
[15/08, 14:31]hu5: Many differentials:
https://researchmatters.in/
Difficult to confirm without a picture.
The above link again took us back to anti-venom RCTs and here's some discussion Transcripts from decades ago:
From Hu2
Date: Tue, 19 Feb 2008, 21:59
We used to see a very interesting envenomation in Nepal which was from a semi poisonous green pit viper.
The envenomation was chiefly manifested in local swelling and a deranged coagulation and was never life threatening.
We also had the opportunity to report an unusual complication of antivenom (the use of which was perhaps as we learned gradually not required for that kind of envenomation and the local physicians never used it). The report is available here:
http://www.blackwell-synergy.
Now that you mention it I wonder if it had anything to do with quality control issues although the antivenom in question was from Serum Institute of India, Pune.
The other issue I had in mind was the rationale behind antivenom (although I guess it may not be relevant to the topic but would be glad if somebody threw more light on it). The antivenom which we so very unquestioningly administer in snake bites ( presumably poisonous) has often been challenged to be of dubious value as there have been no RCTs (randomised control trials) to demonstrate its efficacy (which again cannot be conducted for obvious reasons). It has been postulated that the management of snake bite may be very well accomplished by supportive therapies such as ventilators for respiratory paralysis and dialysis for renal failure. Perhaps we could have a quick feedback on this before we move on to the issues enumerated by Hu7
Hu2 on August 15, 2011
Hu9 it would be great if you could search this issue of 'antivenom evidence' further. I can provide whatever articles i have on the topic.
Also wonder what is the evidence on 'nitroglycerine?'
Hu2 on August 15, 2011
Hu9 it would be great if you could search this issue of 'antivenom evidence' further. I can provide whatever articles i have on the topic.
Also wonder what is the evidence on 'nitroglycerine?'
Hu2 on August 15, 2011
Hu9 it would be great if you could search this issue of 'antivenom evidence' further. I can provide whatever articles i have on the topic.
Also wonder what is the evidence on 'nitroglycerine?'
Hu2 on August 15, 2011
Hu9 it would be great if you could search this issue of 'antivenom evidence' further. I can provide whatever articles i have on the topic.
Also wonder what is the evidence on 'nitroglycerine?'Hu2 on August 15, 2011
Hu9 it would be great if you could search this issue of 'antivenom evidence' further. I can provide whatever articles i have on the topic.
Also wonder what is the evidence on 'nitroglycerine?'
[04/08, 05:35]hu1: Facing a snake 1st time in my life
[04/08, 05:35]hu1: Not going to hide it. Saw death with fear in my eyes. Was already calculating money will and which hospital would be best for ASV - Anti Snake Venom
[04/08, 05:35]hu1: ASV is manufactured only in King Institute, Guindy. Due to lack of expertise in treating snake bites, Dr especially in ICUs tend to overuse it. Stock runs out fast
[04/08, 05:35]hu1: Simply coz their venom is deadly. Vipers are hemolytic cobra krait are neurotoxin. 30 max, it kills. They evolved to use it to hunt for food. We are the one intruding on their environment
[04/08, 05:35]hu1: This fellow is a baby python. 3 foot Mama had visited kutchen few weeks ago. So I told thomas to call the local snake catcher and find their nest. Atleast 20 eggs and babies will be there for sure
[04/08, 05:40]hu1: RFS - reason for sharing: Google AI was used by a friend to parse my video and correct me that this is a baby reticulated python and not a viper.
How can we deliver this in my ED? Every practising Dr should have this astra in kitty to assist. Isabel healthcare was a beginning, POEM & PROSE were tried, Infobutton was cool, Watson was to send all doc home. Aint happen 😉🤔😆
[04/08, 05:40]hu1: AI HAL built into an app that any doc can download that can read a pic or video and give DD
[04/08, 05:42]hu1: Hence dogs have been with man since stone ages for their pure loyalty. Unbelievable how this 14 year old grandpa protected us, ignoring his masters commands
[04/08, 08:46]hu4: Reminds me of my days at Amrita, you know snakes just get into the house and go to the opposite side and it's very common. These include Cobra too!
My son was 6 months old and one day a snake passed by, i was in hospital and my wife's shouting made my neighbours rush in. Thier first reaction was: laughter!
They said it's very common for snakes including venomous ones to come into home but nothing to be worried.
After that we have had 4 encounters in 6 months!!!!
[04/08, 09:01]hu3: Traditional healers also treat snake bites. Using herbs. Covered under QCI certification schene!!!
[04/08, 09:42]hu1: I don't know what they treat. I can tell you if bitten don't experiment. Atleast we know ASV works
[04/08, 09:49]hu3: Someone shld study what they do!!!
[06/08, 06:34]hu1: Google helped allay my fear that it could be a viper. This is baby python
[06/08, 06:34] ATP: Try it. Just check with perplexity or grock
[06/08, 08:44]hu2: Pythons move sluggishly while vipers are swift
[06/08, 09:02]hu1: True
[06/08, 09:01]hu1: Viper venom is hemotoxic, kills in few hours
[06/08, 09:15]hu2: Yes we regularly manage these patients.
Here's a past case report from our open EMR archive 👇
https://nikhilasampathkumar.
After 4 days:
[11/08, 06:38]hu1: Grew up on CLRI campus. Have been exposed to snakes since childhood, have a healthy respect for them. We intrude into their space. Never the other way. As a medStudent and intern managed many cobra, krait, sawtooth scaled viper and russels viper victims in Porur. It was a very rural ecosystem at that time. These are the 4 species that are poisonous. Rest are safe. Indian python is not big enough to be a threat to us. Those in South Asia and Brazil are evil. Anaconda is similar.
My fear of snakes hence is from knowing the consequences of a bite. I think we all should be safe rather than sorry.
[11/08, 06:38]hu1: https://chennaisnakepark.in/
[11/08, 06:44]hu1: These are the points where a reliable authentic source of information both for the healer and the one seeking help goes a long way in allaying unnecessary fear.
We have seen people horrified after a snake bite. Sometimes the venom is retained in muscle and gets released when we mobilize patient in wards. I have seen patients die after 10 days of cobra bite.
Our Kings Institute Guindy Chennai produces ASV - Anti Snake Venom by injecting venom from these 4 dangerous species unto horses. Their body produces antibodies that are then purified and used to help manage human snake bites.
Cobra Krait are neurotoxic. Vipers are hemotoxic. Pythons and Anacondas are constrictors. All of them have this capability to hunt prey and feed. We come in the middle...and then complain 🙄
[11/08, 06:48]hu1: My military school seniors were having a laugh saying: ithna chota snake se darr gaya. Don't be fooled by size. Vipers are about 20 cm but easily take down a man.
Both are very painful death, whether neuro or hemo toxic. ASV is not 100% effective and some patients react to this foreign protein.
Prevent 》Treat. Always
[11/08, 08:32]hu2: We have lots of cobras in our garden!
https://www.facebook.com/
[11/08, 08:34]hu1: U r a brave man. The hatchlings carry venom like their mama. Don't make me come to kukatpally to treat you. 🤦🏽♂️
[11/08, 08:39]hu1: ASV is not effective at all!
Most of the successes of snake bite management appears to be due to supportive management like dialysis and ventilation. People have brought down the dose of ASV by 50 to 70% in controlled trials and the effect appears same. http://www.ncbi.nlm.nih.gov/
The above are trials based in India. It is possible that the low dose anti-venom could have been gradually in subsequent trials brought down to zero!
[11/08, 08:40]hu1: We live far from Kukatpally, in a village near Hyderabad
[11/08, 08:44]hu1: I object milord. ASV does save lives. Dialysis and Ventilation are like 7th 8th step in a path from 0 to 10. I despise going there
[11/08, 08:45]hu1: Keep away from those critters Prof. Your students ❤️ you
[11/08, 08:46]hu2: Check out the evidence!
[11/08, 08:46]hu2: Yes cobras are very sensitive creatures. Even when we work in the garden they either slither away further or provide a distinct hiss like warning
[11/08, 09:23]hu1: I am a practioner of empirical & experience. EBM is a western concept. We can debate how much it is relevant to the orient. Occidental <> Oriental are north and south poles. Twine rarely converge.
Conversational Transcripts from another group:
[15/08, 10:01]hu5: Real snake bite
[15/08, 12:52]hu2: Did they see the snake or bring a picture of it?
[15/08, 13:11]hu5: Yes they killed it, person who got bitten ran back and killed the snake
[15/08, 13:27]hu5: Our patients often bring their snake's photograph that helps to plan their care pathway in a better way👇
https://pajrcasereporter.
[15/08, 14:27]hu5: Same description patient was giving
[15/08, 14:28]hu5: Russell's viper?
[15/08, 14:31]hu5: Many differentials:
https://researchmatters.in/
Difficult to confirm without a picture.
The above link again took us back to anti-venom RCTs and here's some discussion Transcripts from decades ago:
From Hu2
Date: Tue, 19 Feb 2008, 21:59
We used to see a very interesting envenomation in Nepal which was from a semi poisonous green pit viper.
The envenomation was chiefly manifested in local swelling and a deranged coagulation and was never life threatening.
We also had the opportunity to report an unusual complication of antivenom (the use of which was perhaps as we learned gradually not required for that kind of envenomation and the local physicians never used it). The report is available here:
http://www.blackwell-synergy.
Now that you mention it I wonder if it had anything to do with quality control issues although the antivenom in question was from Serum Institute of India, Pune.
The other issue I had in mind was the rationale behind antivenom (although I guess it may not be relevant to the topic but would be glad if somebody threw more light on it). The antivenom which we so very unquestioningly administer in snake bites ( presumably poisonous) has often been challenged to be of dubious value as there have been no RCTs (randomised control trials) to demonstrate its efficacy (which again cannot be conducted for obvious reasons). It has been postulated that the management of snake bite may be very well accomplished by supportive therapies such as ventilators for respiratory paralysis and dialysis for renal failure. Perhaps we could have a quick feedback on this before we move on to the issues enumerated by Hu7
Hu2 on August 15, 2011
Hu9 it would be great if you could search this issue of 'antivenom evidence' further. I can provide whatever articles i have on the topic.
Also wonder what is the evidence on 'nitroglycerine?'
Hu2 on August 15, 2011
Hu9 it would be great if you could search this issue of 'antivenom evidence' further. I can provide whatever articles i have on the topic.
Also wonder what is the evidence on 'nitroglycerine?'
Hu2 on August 15, 2011
Hu9 it would be great if you could search this issue of 'antivenom evidence' further. I can provide whatever articles i have on the topic.
Also wonder what is the evidence on 'nitroglycerine?'
Hu2 on August 15, 2011
Hu9 it would be great if you could search this issue of 'antivenom evidence' further. I can provide whatever articles i have on the topic.
Also wonder what is the evidence on 'nitroglycerine?'
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