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00:00My dear friends the next category is animal irritant poison. Friends in animal irritant
00:06poison the first is BB. BB is BV. Okay so you can remember it is blister beetle. Blister beetle.
00:16If BB cuts you, cuts means katna, it causes cantharide poisoning.
00:22Katna for it causes cantharide poisoning. Very very important. Now sir BB is stylish or you can
00:33remember it is Spanish fly. So all are very simple trick. BB cutthi hai cantharide and it's a stylish
00:41it's a Spanish fly. You can see this picture. This is a picture of BB which is Spanish fly it causes
00:48cantharide poisoning. Now my dear friend these all are name of the BB. Yes. Friends the active
00:55principle active principle for this is cantharidine. The active principle of this is cantharidine.
01:05And look sir one beetle. One beetle contain 0.2 to 0.7 milligram of cantharidine. One beetle.
01:19Okay Indian fly contain 3% of cantharidine. Indian fly contain 3% of cantharidine. And friend locally
01:32locally it produces blister. That's why it is known as blister beetle. Painful blister. That's why
01:42it is blister beetle. But sir if you are taking orally oral intake. Now sir if it is oral intake
01:49my dear friend it increases your libido. Libido is a male power male sexual power. So I would say
01:57it is aphrodisiac. It increases libido. It is aphrodisiac. Doctor it causes priapism.
02:07Doctor it causes priapism. It increases libido, aphrodisiac, priapism. What is priapism? Again painful erection
02:15of penis. Painful erection of penis is caused by BB. BB. Fatal dose my dear friend. It is around 15 to
02:2830 milligram of cantharidine. Yes my dear friend. 15 to 30 milligram of cantharidine. And remember one
02:40more thing. Cantharidine is also a nephrotoxic. Cantharidine is also a nephrotoxic. It can cause
02:48chronic renal failure. Uremia. It can cause chronic renal failure. You will have the symptom of loin
02:57pain. And there is a uremia, hematuria. These will symptom are important symptom of nephrotoxicity.
03:03Nephrotoxicity. So anyway sir this is BB. This is BB blister beetle which is a Spanish fly or it is
03:12a very very important causing cantharide poisoning. BB kaat khaegi. That's a cantharide poisoning.
03:19Simple. Now I am coming to the next poison that is scorpion. Now sir you can remember one thing
03:25scorpion has C. Pele. Pele. What do we use a word for scorpion? It's a bichuna. It belongs to
03:32B for bichu. B for buchdi family. B for buchdi family. And doctor sir it is a venominatus
03:40venominatus arachnida. Arachnida group it belongs to. Venominatus arachnida. Arachnida. A-R-A-C-H
03:49arachnid. And doctor sir what is the characteristic feature of arachnid? It has the group has
03:54eight legs. The group of so what is the characteristic feature of arachnid? It has
04:01eight legs. This is a feature of arachnida. So it is a venominatus arachnid group. And one
04:10another venominatus arachnid group is spider. We'll discuss. So both belongs to same group.
04:17The poisonous arachnida group. The poisonous arachnida group. It's a b for bichu. It belongs
04:22to this one. Scorpion C. C my dear friend. Very very important. The mechanism of action C. It causes
04:30it causes uncontrolled release of catecholamine. It causes uncontrolled release of. This becomes C.
04:42That is catecholamine. Catecholamine. Very very important. C is done. Sir another is N. It acts on
04:52or it affects sodium potassium channel. So that is also very very important.
04:58N. My dear friend. N. You can remember it is neurotoxin.
05:05It is neurotoxin. The another toxin is hemotoxin. So two type of toxin we have. Neurotoxin and
05:14hemotoxin. Neurotoxin and hemotoxin. Amount is comparatively less. And observe. This neurotoxin
05:23resembles cobra. Cobra. And the neurotoxin of the spider also. Very very important sir. But sir
05:30remember the amount is less. That's why it's not very much fatal. We have two kind of bichu or the
05:37scorpion. The number one is black. And number two is Indian red scorpion. Indian red scorpion.
05:46The geological name is mesobuthus tumulus. The geological name is mesobuthus tumulus.
05:59Buthas buthib family. It's a bichu. It's a bichu. Dok sir. Because of uncontrolled release of
06:07catecholamine. I am coming to a very very important word. It causes autonomic storm. It causes autonomic
06:13storm. And Dok sir. There will be two symptoms. The one will be local symptom. What is local symptom?
06:20Pain, swelling and blister. This will be the local symptom. Jahan pe kata pain, swelling and blister
06:26will be there. But now I am coming to the systemic symptom. The catecholamine release.
06:30Catecholamine release. It will cause sweating, palpitation, chest pain, madriasis. And one thing
06:36which I discussed in canthrite poisoning also. It causes priapism. The painful erection of penis.
06:43That is autonomic storm. So these are the symptom of autonomic storm. Now the treatment is just like a
06:49snack poisoning my dear friend. Immobilize the patient. For pain we can give the NSAID.
06:55ASV. ASV sir. It is not anti-snake venum. It is anti-scorpion
07:02venum.
07:07And the alpha blocker. One very effective question. It is alpha blocker we give that is prajocene.
07:14The alpha blocker we give that is prajocene is an effective drug in bichu, buthadi, b bichu, b buthadi, c catecholamine release and neurotoxin or hemotoxin.
07:26So it belongs to arachnida group. Now sir, the spider is also the venomous arachnid groups. As I told you, the arachnida has eight legs insect.
07:37Now, the toxin is, again, it's very, very important. It is neurotoxin mainly.
07:46Neurotoxin. And it has two properties. Same like the scorpion. It has two properties. The one is locally necrotic property.
07:55And the second, which is of my favorite MCQ, the excitatory neurotoxin.
08:01Excitatory neurotoxin.
08:03So it's almost same like scorpion, the property of the neurotoxin.
08:07And my dear friend, this question comes in exam.
08:10The most poisonous spider is black widow.
08:13The most poisonous spider is black widow.
08:20And you can get a question one more, my dear friend.
08:23For spider, what treatment we give?
08:25It is antihistaminics.
08:32Antihistaminics.
08:32If there is infection, antibiotics.
08:36Answer by D.
08:37You can remember, we can give one more treatment.
08:39That is Dapsone.
08:41So, sir, here I am emphasizing on a point that is Dapsone.
08:45And on scorpion, we have seen a drug that is prajocene.
08:50So prajocene is there and Dapsone is here.
08:53This is spider.
08:54The most poisonous spider is black widow.
08:57Black widow.
08:59Very, very important MCQ.
09:01Now, sir, I am coming to the fourth one.
09:04Because I have discussed the three.
09:05The Spanish fly is done.
09:06The scorpion is done.
09:08The spider is done.
09:08But the most important comes here.
09:11That is snack poisoning.
09:12The study of snack poisoning.
09:14This branch is known as ufio-logy.
09:19This branch is known as ufio-logy.
09:22Look, sir, there are many groups of snakes.
09:25But I am coming to the three groups.
09:27The one is viperidi.
09:29Viperidi contain viper.
09:31That's a rustle viper.
09:32Or you can remember sauce-scaled viper.
09:37Viper.
09:38And just remember V for viper.
09:41V for viper.
09:43V for it would be vasculotoxic.
09:46Vasculotoxicity.
09:47Now, alipidi.
09:50My dear friend, alipidi is cobra and common karit.
09:53The karit or common karit, we can use the both word.
09:56Yes.
09:59Common karit.
10:00Cobra or common karit.
10:02Or king cobra.
10:03Look, sir, co for cobra.
10:06Co for common karit.
10:08Co for coma.
10:09That means these are neurotoxic.
10:14Co for cobra.
10:16Co for common karit.
10:17Co for coma.
10:18These are neurotoxic.
10:19As for sea snake, my dear friend, that is hydrophedic group.
10:23Hydro is a water.
10:24That's a sea snake.
10:26Sea snake act on skeletal muscles.
10:29Skeletal muscles.
10:31So definitely it will be myotoxic.
10:36Myotoxic.
10:37There are two more groups.
10:38One is colubridi and cotaledi.
10:41Cotaledi and colubridi.
10:42Cotaledi has a pit wiper and colubridi has bird's neck.
10:46But, sir, don't go in that detail.
10:48These are three main groups of the snake.
10:52In India, the five are the dangerous poisonous snake.
10:56And definitely, first I'll write down the cobra.
11:01Second, I'll write down the common karit.
11:04The third, I'll write down the russle viper.
11:09And the fourth is so-skilled viper.
11:16So-skilled viper.
11:17Now, what are the fetal dose?
11:19Fetal dose.
11:20My dear friend, if you want to go in detail, karit fetal dose is 6 mg.
11:27And cobra fetal dose is 12 mg.
11:316 and 12.
11:32Russell has many muscle.
11:35That's a trick to remember.
11:36Russell viper, many muscle.
11:38That's a maximum.
11:38It's a 15 mg.
11:40Russell has many muscle.
11:42That's a 15 mg.
11:43And, sir, saw-skilled viper, you can remember by a trick.
11:49The name is H's.
11:51H's.
11:52E for H's.
11:53E for 8 mg.
11:55These are the fetal dose of different snake.
11:58Most poisonous snake by fetal dose.
12:01The most poisonous snake by fetal dose.
12:05It is karit, my dear friend.
12:08Most poisonous snake is karit.
12:11Now, you must be thinking, sir, you have added 4 only.
12:15You can add the 5th also.
12:18King cobra.
12:20King cobra.
12:21The fetal dose is same 12 mg.
12:23But the amount will be more.
12:26Definitely, the amount of king cobra will be more than the cobra.
12:32Okay.
12:32Now, I am coming to some important concept.
12:35Most poisonous snake, as far as fetal dose is concerned, it's a karit.
12:39But, which is the most dangerous snake?
12:45The most dangerous snake is cobra.
12:49Because, the amount which is pitted, it is almost 200 to 250 mg of venum.
13:00And even, my dear friend, it is more, even more in, it is even more in king cobra.
13:07Around 400 mg.
13:08Or 450 mg.
13:11So, my dear friend, this is very, very important.
13:14The amount.
13:16If you had a question, which is the most poisonous snake?
13:18This is karit.
13:19Most dangerous snake.
13:20If cobra and king cobra, both are given an option, you can pick the king cobra.
13:24But, sir, if only cobra is given, then you can.
13:26Because, the amount of venum, 200 to 250 mg venum, that is injected by cobra in your body.
13:34In your body.
13:36Now, sir, what are the differences of poisonous and non-poisonous snake?
13:40Sir, poisonous snake, head scale are small.
13:45Here, non-poisonous snake, head scale are large.
13:48There are a few exceptions, I will tell you.
13:50Belly scale are large.
13:55Belly scale are small.
13:58And, sir, if you see, the belly scale of the poisonous snake,
14:02this covers the entire breadth of belly.
14:08This covers the entire breadth of belly in poisonous snake.
14:16So, belly scale is covering the entire breadth of belly.
14:20Here, it is small, my dear friend.
14:23Yes.
14:24Now, sir, tail.
14:25Tail is compressed in poisonous snake.
14:33Compressed.
14:34It is not compressed, my dear friend, in non-poisonous snake.
14:39Fangs, my dear friend, fangs.
14:42The two fangs marked spatially, which are actually a hypodermic, two fangs marked, fangs are teeth.
14:55Which are actually just like a hypodermic needle.
15:00So, hypodermic needle, like injection mark, or two fangs, two teeth, hypodermic needle, just like this.
15:08These are two fangs marked.
15:10Here, multiple teeth are there, my dear friend.
15:14Multiple teeth are there.
15:16Multiple fangs are there.
15:17Bite mark.
15:18So, if you have two hypodermal needle-shaped fang mark, so there will be two bite mark only.
15:25But there will be multiple bite mark.
15:30Multiple bite mark.
15:34The poisonous snake are nocturnal.
15:37These are diurnal.
15:39You can see every time.
15:41That's a non-poisonous snake.
15:43But, sir, as I told you, the head scales are small.
15:47But what is the exception, my dear friend?
15:49What is the exception of head scales?
15:52Sir, there are two poisonous snakes where head scales are large.
15:59Two poisonous snakes where, or two venomous snakes where head scales are large.
16:08Look, sir, these are, the number one is cobra, and number two is common kareth.
16:16Common kareth.
16:17Kareth or common kareth.
16:19Now, sir, cobra, you can remember, we are starting with the cobra.
16:24C.
16:24C is the third alphabet.
16:26C, third.
16:30Supralabial.
16:33Is large.
16:35And it touches.
16:36Eye shield.
16:41Third.
16:43Supralabial.
16:44Is large.
16:45And it touches eye shield.
16:46So, automatically, in cobra, it's a third supralabial.
16:50Is large.
16:50In common kareth.
16:52Fourth.
16:57Infralabial.
16:58Is large.
16:59Very simple.
17:00Sir.
17:00These are the two exceptions.
17:02Infralabial means below lip.
17:04Supralabial is above lip.
17:06Above lip.
17:07It touches the eye shield.
17:09That is third.
17:09So, yeah, it's going to be a trick.
17:11C for cobra.
17:12Sab se, pal, we are talking about cobra.
17:12We are talking about cobra.
17:14C is the third alphabet.
17:16Third supralabial is large.
17:17In common kareth.
17:18Fourth infralabial is the largest.
17:20Large.
17:21Or you can see, that is largest.
17:23Yes.
17:23So, these are two exceptions where head scales are large.
17:27You can remember, this is a trick I told you.
17:30It's very simple.
17:30Otherwise, the head scales are small in the poisonous neck.
17:33Now, sir, you can see, this is king cobra.
17:36And this is cobra.
17:37And I will emphasize on this word.
17:40This is known as hood.
17:42And this is known as spectacle.
17:47This is known as spectacle.
17:48Now, sir, see the difference of cobra and king cobra.
17:53Sir, the name of the king cobra is Oophiofagus.
18:02Hanna.
18:04The name of cobra is Naja, Naja, Naja, Naja.
18:11Look, sir, it is Oophiofagus.
18:14So, by name itself suggests Oophiology is a study of snack.
18:17So, one thing is clear.
18:19It eats snakes, my dear friend.
18:21Very, very simple.
18:22Oophiofagus, Hanna.
18:24Sir, the length is almost 15 to 20 feet.
18:29It is just 5 feet.
18:30Look, sir, this is the longest poisonous snake.
18:35That is cobra.
18:36Sorry, king cobra.
18:37Longest poisonous snake.
18:40Hood, my dear friend.
18:41Hood is present in both.
18:43Hood is present in both.
18:44Hood, this one.
18:45But, sir, hood is large in size in cobra.
18:49Comparatively to king cobra.
18:52Spectacle and binoculate mark.
18:54I already showed.
18:55This is present in cobra.
18:57Not in king cobra.
19:00Inject venum.
19:01That is more.
19:02That is less.
19:04That is more.
19:05And that is less.
19:06Definitely, the fatality is more in king cobra.
19:10Compared to the cobra.
19:11I already told you the amount of venum injected in one bite.
19:17There is one more variety of spit cobra that doesn't inject.
19:22It spit the venum.
19:25It spit the venum.
19:27And if it spit the venum in your eyes, it causes ophthalmia.
19:31It causes ophthalmia.
19:36That is spitting the venum.
19:37It is another cobra which is known as spit cobra.
19:40Spit cobra.
19:42So, these are some questions you can get regarding the king cobra, Oophagos and cobra, Naja, Naja, Naja, Naja.
19:50Now, I am coming to Kareth.
19:55It is Sir Bungarus Cyrelius.
20:03It is Bungarus Cyrelius.
20:07Cyrelius.
20:08Dr. Sarkar, the name is Bungarus Cyrelius.
20:11It has hexagonal scale with white band.
20:21With white band.
20:23I already told you it belongs to elepedi group and neurotoxin.
20:28Bungarus.
20:28So, one thing is clear.
20:30The toxin is known as Bungarotoxin.
20:36The toxin is known as Bungarotoxin.
20:39Bungarotoxin.
20:41It is Bungarus Cyrelius.
20:43Now, Sir, this is common Kareth.
20:45You can see the hexagonal scale with white band.
20:48With white band.
20:50Russell Viper.
20:51I already told you Viper is V for Viper, V for Vesculotoxin.
20:55The name is Debioreselli.
20:58Russell with muscle.
20:5915 mg is a fetal dose.
21:02Sir, Venum.
21:02V for Venum.
21:04It is V for Vesculotoxin.
21:08V for Venum.
21:09It is Vesculotoxin.
21:11Very, very important word.
21:12Viper.
21:13V, V.
21:14Russell Viper.
21:15You can see the three row of the brown spot.
21:19And observe generally, these brown spots are diamond shape.
21:24You can see the one row on the upper part.
21:31One row on the top.
21:34And two rows on the lateral part.
21:38These are three rows of brown shape diamond color scale.
21:43It is very, very important.
21:46Very, very important.
21:47So, these are three rows.
21:49It's a Russell Viper.
21:50It is brown colored diamond shape scale are seen in Russell Viper.
21:56Now, sir.
21:58The source scale Viper.
22:00The name I already told you.
22:02H is.
22:05Carinatus.
22:06And I already told you the trick.
22:08E for H is.
22:09The fetal dose is E for 8 mg.
22:12Venum.
22:12Without any doubt.
22:13It is.
22:16Vesculotoxin.
22:17V, V.
22:19Vesculotoxin.
22:19Now, my dear friend.
22:23It is source scale Viper.
22:25Source scale Viper.
22:26As you can see.
22:27There are multiple scale.
22:28Which are angulated scale.
22:30Scale at an angle.
22:32And these are coiled around.
22:34The Viper is coiled around with each other.
22:36Giving wrestling sound.
22:38Wrestling sound.
22:40Wrestling sound.
22:42So, this is source scale Viper.
22:45Hump nose Viper.
22:47However, this is hypnil, hypnil.
22:50You can remember H hump.
22:52H hypnil, H hypnil, hypnil, hypnil, hypnil.
22:56It is a snout.
23:00Forms hump.
23:02The snout of the snake forms hump.
23:05Hypnil, hypnil, hump nose Viper.
23:07Another important Viper.
23:09Now, sir.
23:11C snake has a flat tail.
23:14It belongs to hydrophedic group.
23:16I already told you.
23:17It is a.
23:18As for sea snake, scletal muscle.
23:20It is causing peddling.
23:23Peddling.
23:23It's a myotoxic.
23:25I already told you.
23:26Sea snake is myotoxic.
23:29It is myotoxic.
23:31Now, sir.
23:32Python.
23:32Python is non-poisonous.
23:36Or non-venomato snake.
23:38Here, what it causes?
23:40It encircles you.
23:41Python kya karta?
23:42It encircles you and causes traumatic asphyxia.
23:50It encircles your body, causes traumatic asphyxia.
23:56Python.
23:57Traumatic asphyxia.
23:59Python, which we now call it.
24:00Now, sir.
24:02I am coming to the poisonous snake.
24:04Very, very important, my dear friend.
24:08Venomato snake.
24:10Gland and fang.
24:11I already told you.
24:12Fang, we use the word for teeth.
24:15Teeth.
24:16And, Oksa, actually, the gland are modified salivary gland.
24:25These are modified salivary gland.
24:28And the fang, which are poisonous fang or teeth.
24:31These are actually the maxillary teeth.
24:35These are the upper teeth, maxillary teeth.
24:37So, what happens?
24:38See, this is your fang.
24:39This is the teeth.
24:40So, in this fang or teeth, your duct opens of salivary gland.
24:45So, as I told you, the teeth are maxillary teeth and salivary gland duct opens in this maxillary teeth.
24:59Salivary gland.
25:00So, whenever the snake bites you, this poison goes inside your body through skin puncture.
25:11Through skin puncture.
25:16It means it has to be punctured for poison to go in your body.
25:21The venom to go in your body.
25:22Poison or venom.
25:24Now, sir.
25:26If you ingest this venom, generally, there is no effect.
25:31It means, sir.
25:31Agar aap is venom ko pe jau.
25:33If you drink this venom, there is no effect.
25:36Because it will be lysed by your GI enzyme.
25:40It's a protein.
25:41It will be lysed by your GI enzyme.
25:43But if there is ulcer in the GI tract, then it will cause the effect.
25:49Because it will go through the blood.
25:52Through the ulcer.
25:53Otherwise, it will be lysed.
25:54Because it's a protein, it will be lysed your GI enzyme.
25:58But this is the mechanism of what is fang and what is the gland which produces venum.
26:03These are modified salivary gland.
26:06And the duct of the gland opens in the fang.
26:09Fang are the teeth.
26:11Maxillary teeth.
26:13Now, sir.
26:14What are the sign and symptom?
26:16If you had a question, the most common sign and symptom is fright.
26:21And because of the fright, you see the anxiety, chest pain and palpitation.
26:28Anxiety, chest pain and palpitation.
26:29So, the most common sign is anxiety, chest pain and palpitation.
26:35Most common symptom is fright.
26:36And this is the most common cause of death in snack poisoning.
26:41Why?
26:42Because 70% to 80% snack are non-poisonous or non-venomitus.
26:52Non-venomitus.
26:53And still, person dies.
26:55The reason is anxiety, fear, fright.
26:58And also, out of the poisonous snack, 20% of the venom or venomous are dry bite.
27:10It means the 20% of the venomous snack, dry bite.
27:15And, of course, dry bite is most commonly seen in cobra.
27:19Dry bite is most commonly seen in cobra.
27:2120% of the venomous snack bites are dry bite.
27:24There is no poison in that bite.
27:26So, 70% to 80% are non-poisonous.
27:30Out of this, it is 20% are dry bite.
27:33So, that's why I am telling you the most common cause of death is fright.
27:37And, of course, snack bite, snack bite, if there is a venomous injection in your body,
27:44this is known as envenomation.
27:47And what is envenomation?
27:48All the clinical spectrum, their local symptom, systemic symptom, local envenomation, local symptom, systemic clinical symptom.
28:03Look, the study is known as, the study is known as ufiotoxemia.
28:12The study is known as ufiotoxemia.
28:15Ufio is related with snack.
28:17Toxemia is a toxic effect that is known as envenomation.
28:22That is known as envenomation.
28:24The clinical spectrum, the clinical feature of the toxin, the venom, this is known as ufiotoxemia.
28:31So, ufiology is a study of snack.
28:34And ufiotoxemia is a clinical spectrum by envenomation.
28:39Now, sir, sign and symptom.
28:41If you want to go through the sign and symptom, these are local.
28:44Yes, my dear friend.
28:45Local symptoms are very simple.
28:46Pain, swelling, blister.
28:49Pain, swelling, blister.
28:51But now remember, sir.
28:53If the bleeding increases or bleeding is there on the local site.
28:56And if there is a regional lymphadenopathy.
29:00These are some very, very characteristic signs.
29:03And my dear friend, if you have painful progressive swelling, painful progressive swelling, in these cases, you should start ASV, anti-snack venum.
29:17So, doctor, under what condition you can start?
29:25Number one, this painful progressive swelling.
29:27Or if the bleeding is increasing continuously or if the bleeding is increasing continuously or sometime with regional lymphadenopathy.
29:33You can start ASV, anti-snack venum.
29:36Local symptoms are maximum with viper.
29:40And my dear friend, sometime even there is no bite mark.
29:45And no symptom, no pain, no swelling.
29:52That can be seen in kareat, my dear friend.
29:55That can be seen in kareat.
29:57So, be careful because both questions can come in the exam.
30:00Local symptoms are maximum in viper.
30:03And local symptoms are very much less.
30:07Or even sometime, no, that is common kareat.
30:10That is common kareat.
30:11So, this is very, very important.
30:13First, see the local symptom.
30:14Now, sir, I am coming to the neurotoxic snake.
30:18That is elepedi group.
30:20And everyone knows elepedi group are cobra, king cobra or common kareat.
30:26Now, sir, the most important symptom is tosis.
30:29Tosis is drooping of eyelid.
30:35Tosis is drooping of eyelid.
30:40Your eyelid is dropped, my dear friend.
30:46Bilateral drooping of eyelid.
30:48This is known as tosis.
30:51See, second diplopia.
30:54Diplopia, another very, very important one.
30:56Because of paralysis of, paralysis of extraocular muscles.
31:04Extraocular muscles.
31:05Dysphasia.
31:07Paralysis of pharyngeal muscles.
31:12Dysphonia.
31:13Awaaj mein chanj honanda.
31:14Change in the sound.
31:16Paralysis of vocal cord.
31:18Paralysis of extraocular muscles.
31:21Paralysis of pharyngeal muscles.
31:23Paralysis of vocal cord.
31:24So, dysarthria.
31:26Slurred speech.
31:27Paralysis of tongue muscles.
31:30Dysarthria.
31:32Dyspnea.
31:33Dyspnea.
31:34That is paralysis of respiratory muscle.
31:42Dyspnea.
31:43Strider.
31:44Yes, my dear friend.
31:45These all are seen.
31:47That is dyspnea and strider.
31:49Respiratory difficulty.
31:51Respiratory difficulty can be seen.
31:53Descending paralysis.
31:54Doc, sir.
31:54You can see all are D.
31:57All are D.
31:58Descending paralysis.
32:00Now, sir.
32:01Death is due to.
32:02Because respiratory muscles are involved.
32:04Respiratory failure is seen.
32:06Death is due to respiratory muscle paralysis.
32:10That is leading respiratory failure.
32:13Respiratory muscle paralysis.
32:16That is leading respiratory failure.
32:18Treatment.
32:18So, doc, sir.
32:19If there is a.
32:20These are neuroparalytic symptoms.
32:22These are very important.
32:23We should provide mechanical ventilation.
32:26We should provide mechanical ventilation.
32:28Because it is a respiratory failure.
32:31Mechanical ventilation has to be provided.
32:33And after this.
32:35Go for ASV.
32:38Anti-snake venum.
32:39Because that is a very, very important part.
32:41Then.
32:42Very, very important drug.
32:44Which I will discuss in detail.
32:45In the treatment part.
32:47Neostigmine.
32:49With the combination of atropine.
32:52Neostigmine.
32:53With the combination of atropine.
32:55Very, very important, sir.
32:58Very, very important.
33:00Now, sir.
33:02If neuroparalytic symptom.
33:05Without.
33:06Without local finding.
33:08My dear friend.
33:09Neuroparalytic symptom.
33:10Without local finding.
33:12That means.
33:13That means.
33:14It is a karet.
33:14Because I told you no local finding.
33:16Here you will go for mechanical ventilation.
33:19Plus ASV.
33:21Plus ASV.
33:24Anti-snake venum.
33:26I will go in detail also.
33:28Why we are using neostigmine.
33:29In that case.
33:30Or something case.
33:31We are not using.
33:32This is very, very important.
33:35Okay, dear friends.
33:36Now, my dear friend.
33:37If you want to see.
33:38These are the sign and symptom.
33:40Neurotoxic snack.
33:42Now.
33:43In neurotoxic snack.
33:44Or in elepidic group.
33:45We go for single breath count test.
33:48What is single breath count test?
33:50As the name suggests.
33:51In single breath.
33:52How many counting we can do.
33:55Single breath.
33:551, 2, 3, 4, 5, 6, 7, 8, 9, 9, 9, 9, 9, 9, 9, 9, 9, 9, 9.
33:57So, Dr. Sab.
33:58Count the numbers in single breath.
34:02And Dr. Sab.
34:02This is done.
34:05Every 15 minutes.
34:07Every 15 minutes.
34:09And my dear friend.
34:10If it decreases.
34:13If it decreases.
34:14That suggests.
34:16That your respiratory muscle paralysis is taking place.
34:20Or you can say.
34:21Your respiratory failure is taking place.
34:23you can go for the treatment protocol of this very very important neurotoxic snack my different
34:30this is known as single breathe count test if the counting is dropping in every single breathe and
34:38you are you have to repeat it in every 15 minutes that is known as single breathe count test now
34:43the next is vasculotoxic sir i already told you v for vasculotoxic v for viper viper toxicity
34:53is vascular toxicity it causes DIC and local and systemic bleeding local and systemic bleeding
35:03and other bleeding which are very very common it is epistaxis hematomasis hematomasis melina
35:16gum bleeding these are hemoptysis these are common bleeding which can be seen and as a complication
35:28it can produce DIC disseminated
35:31disseminated intravascular coagulopathy this is known as DIC and my dear friend this DIC
35:50as a complication it can lead renal failure it can lead renal failure and observe in the local
35:59bite site there may be pain swelling with bleeding pain swelling with bleeding this i already discussed
36:09in the local symptoms so mainly if you see the vasculotoxic symptoms are very very common
36:15in viper DIC can lead renal failure if abdominal pain and retroperitoneal bleeding this is also
36:23suggestive of viper bite this is also suggestive for viper bite and also as far as treatment is
36:32concerned if you have the symptom start with ASV anti-snake venom FFP what is FFP fresh frozen plasma
36:43fresh frozen plasma and surgical debridement
36:49surgical debridement of the necrotic lesion or of the necrosis surgical debridement is done
36:59this is very very important word for viper which is vasculotoxic
37:03for vasculotoxic we do 20 minute whole blood clotting test what we take sir we take a test tube
37:14which is clean and dry test tube and we put whole blood in this test tube and we wait for 20 minutes
37:31we wait for 20 minutes if after 20 minutes the blood is clotted that means either it is normal or it belongs
37:42to some other snake it can be cobra common career or it can be illipidi or other group
37:49illipidi or other group if it's a clotted but my dear friend if it is not clotted
37:55if it is not clotted my dear friend that's why it suggests that this is viper snack poisoning
38:05DIC or viper snack poisoning and my dear friend repeat the test every 6 hours
38:13repeat the test every 6 hours that is also very very important for this 20 minute whole blood clotting test
38:23repeat the test so repeat the test every 6 hours now sir sign and symptom of myotoxic i already told you
38:31the myotoxic is of sea snake atchis carinatus so it's very simple there will be pain and swelling
38:39that can be possible muscle necrosis is the first finding then rhabdomyolysis then myoglobinemia
38:49myoglobinuria and it can cause renal failure this is myotoxicity this is myotoxicity very very important
38:59sign and symptom of myotoxicity so ultimately it causes renal failure
39:04now said treatment for treatment the first you have to follow the right strategy what is the meaning of
39:11right strategy that is first is reassurance
39:15why reassurance my dear friend because the most common cause of death is fright
39:20to remove the fear just reassure the patient
39:25number two immobilization
39:27immobilization immobilize the patient
39:33number three and four go to
39:36the nearest hospital and number five is t tell all the symptom and history
39:46to the doctor tell all the symptom and history to the doctor the clinical symptom the site local site
39:57symptom this has to be told to the doctor so this is first you have to follow the right strategy now
40:03no there are few no my dear friend most of the people commit mistake here
40:08no suction
40:10no ligature
40:14don't go for suction
40:18choose no ligature
40:20no turniquid
40:23no coterie
40:24no electricity
40:27or electric shock used
40:29at that particular place
40:31electric coterization should not be used
40:33so these are some important no
40:35no suction
40:37no ligature
40:38no turniquid
40:39no coterie
40:39no electricity
40:40electric shock
40:41at that site of bite
40:43no sir
40:44immobilize the limb
40:47it is either by
40:50crap bandage
40:53or by
40:56sutherland
40:59rep
41:01it is either by
41:02crap bandage or sutherland rep
41:05my dear friend you have to normalize the pressure
41:08because in by this we immobilize the limb
41:12by binding with
41:14crap bandage
41:15and sutherland rep
41:17our motive is our motive is to occlude
41:24lymphatic
41:29our motive is to occlude lymphatic because
41:32the venum passes through lymphatics
41:38that's very very important and how much pressure you require upper limb pressure almost
41:4140 to 70 mm hg or almost similar pressure
41:4855 to 70 mm hg pressure in this
41:52no sir
41:53this is done in cobra bite
41:57in cobra bite
42:00not done in viper bite
42:03because in viper bite
42:05if you are applying the pressure there is already a swelling is there already bleeding is there
42:10so in viper bite it can cause compartment syndrome
42:18in viper bite it can produce compartment syndrome because of the
42:22swelling and bleeding and necrosis it can produce compartment syndrome
42:26so don't do this in viper bite
42:29so use the crap bandage
42:31and use this sutherland rep and apply the optimal pressure apply the optimal pressure
42:37very very important so now i am coming to asv
42:40first tell me the full form of asv it is
42:45anti-snack venum
42:50the root is iv
42:53rate is
42:551 to 2 ml
42:57per kilogram body weight
42:59and doses are
43:028 to
43:0310 vials we have to use root rate and doses
43:08anti-snack venum
43:10so asv root rate and doses are done
43:14doc sir asv is
43:15freeze or dried powder
43:17so we should use some diluent
43:21we should use some diluent
43:24and asv was discovered by
43:26calmati
43:27asv was discovered by calmati
43:32and there is a in india in mumbai
43:37we have a institute
43:40which is known as hopkins
43:46institute where we prepared anti-snack venum
43:50and asv mainly has venum used for four snakes
43:55these four snakes are very simple my dear friend
43:58cobra
44:00kareth that is common kareth
44:04rustle viper
44:06and
44:08so
44:10scaled viper
44:12rustle viper and so scaled viper
44:14so you can remember what are the snakes which are used
44:16cobra kareth
44:18rustle viper
44:19and so scaled viper
44:20asv
44:21four snakes are used
44:22it should be used within
44:25four to six hours of bite
44:28source my dear friend
44:31source is
44:33horse
44:37source is
44:38source
44:39is horse
44:40hyper
44:44immunized
44:46serum
44:47source is
44:48horse
44:48hyper immunized serum
44:50and also it can lead allergy
44:53or you can say anaphylaxis
44:56so whenever you are injecting asv
44:58you should be ready with the injection of
45:02adrenaline
45:05to counteract any anaphylaxis or allergy
45:08and also
45:10asv is given when you have
45:13severe local
45:16invinomation
45:19severe
45:22local
45:22invinomation
45:24symptom
45:25example
45:26pain
45:28progressive
45:32swelling
45:35with bleeding
45:38pain
45:39progressive
45:40swelling
45:41with bleeding
45:42that's very very important
45:44if your local reaction is a lot of
45:45regional lymphadenopathy
45:47you can go for
45:48pain progressive
45:49swelling with bleeding
45:51or severe
45:52systemic
45:53what are the severe
45:54systemic
45:54i already told you
45:56bleeding in systems
45:58yes bleeding in system
46:00neuro
46:01paralytic symptom
46:02i already told you the
46:03neuro paralytic symptom
46:04the ptosis and descending
46:06paralysis
46:06everything i told you
46:07and abnormal
46:09whole blood
46:10clotting
46:11time
46:12my different
46:13abnormal
46:14whole blood clotting
46:15time
46:15this i discussed
46:16here
46:17very very important
46:17abnormal
46:19whole blood clotting
46:20test
46:21if these are there
46:22you can go for
46:23asv
46:24so local
46:26local
46:26invinomation
46:27invinomation is our
46:28clinical symptom
46:29local symptom
46:29after snack bite
46:31and systemic
46:31invinomation
46:32that is systemic
46:33symptom
46:34if you have
46:34bleeding
46:35very much
46:36neuro paralytic
46:36symptom
46:37or wbct
46:38abnormal
46:39you have to go for
46:40asv
46:41now
46:42neuro paralytic
46:43if the symptoms
46:44are neuro paralytic
46:45neurotoxic symptom
46:46you will go for
46:47asv
46:48till the
46:49improvement
46:50till your
46:51symptom gets
46:52improved
46:52and my dear friend
46:53in vasculotoxic
46:54till the
46:56clotting time
46:57become normal
46:58till the
47:00clotting time
47:01become normal
47:01this is a very
47:03very important
47:03slide
47:04for asv
47:05covering four
47:06snakes
47:06cobra
47:07kareth
47:08viper
47:08russell viper
47:09and saw scale
47:10viper
47:10very very important
47:12now sir
47:14other treatment
47:14for snack bite
47:15we can use
47:16neostigmine
47:17and along with
47:19neostigmine
47:20we also use
47:21atropine
47:22the dose
47:24of neostigmine
47:25it is around
47:251.5 milligram
47:27and dose
47:29of atropine
47:30is 0.6 milligram
47:32doxa why do we
47:34use
47:35neostigmine
47:36actually sir
47:38everyone knows
47:39it is
47:39anti
47:40cholinistrate
47:43it is
47:45anti
47:46cholinistrate
47:46so it
47:47will
47:48increase
47:48acetylcholine
47:50effect
47:51it will
47:53increase
47:53the acetylcholine
47:54effect
47:54it will
47:55reverse
47:55the
47:56the
47:59symptom
47:59of
48:00respiratory
48:02failure
48:05or a
48:06symptom
48:06of
48:07neuro
48:07respiratory
48:08failure
48:08neuro
48:09paralytic
48:09symptom
48:09it will
48:10control
48:10this
48:11neostigmine
48:11is used
48:12now why
48:13do we
48:13use
48:13atropine
48:14sir
48:14atropine
48:15because it
48:16is increasing
48:16acetylcholine
48:17we are
48:19using
48:19atropine
48:21to control
48:22muscarinic
48:24effect
48:25of
48:28acetylcholine
48:29we are
48:30using
48:30to control
48:31muscarinic
48:32effect
48:32of acetylcholine
48:33we are
48:33using
48:33atropine
48:34so these
48:35are given
48:36in cobra
48:36bite
48:37neostigmine
48:38plus
48:38atropine
48:39and my
48:40dear friend
48:40just remember
48:41one more
48:41important
48:42concept
48:42the
48:43neostigmine
48:44action
48:44is on
48:46post-synaptic
48:50toxin
48:52action
48:53my dear friend
48:55the post-synaptic
48:56toxin
48:56action
48:57is an
48:57action
48:57of
48:58cobra
48:59antibiotic
49:01and tetanus
49:02toxin
49:03are given
49:03for infection
49:06and tetanus
49:07chances
49:07now sir
49:09yeh agar
49:10aisa question
49:10ajae
49:10asv
49:12neostigmine
49:13atropine
49:14plus
49:14mechanical
49:15ventilation
49:16this is
49:17indicative
49:18of cobra
49:18bite
49:19simple
49:19asv
49:21fresh
49:22frozen
49:22plasma
49:23and
49:23surgical
49:24debridement
49:25this
49:25i already
49:25told you
49:26my dear
49:26friend
49:26this
49:28is done
49:29in
49:29wiper
49:30bite
49:30asv
49:32and
49:32mechanical
49:32ventilation
49:33this
49:34is
49:34only
49:35and
49:35only
49:35done
49:36in
49:36karit
49:36not
49:38in
49:38this
49:39in
49:39cobra
49:40we
49:40use
49:40neostigmine
49:41and
49:42this
49:42atropine
49:43neostigmine
49:45and atropine
49:46a very
49:46very important
49:47neostigmine
49:49is effective
49:49in cobra
49:49only
49:50and with
49:51atropine
49:51because
49:52the
49:53neuroparalytic
49:53symptom
49:54or the
49:54respiratory
49:54failure
49:55can be
49:55reversed
49:56by
49:56neostigmine
49:57it is
49:58very
49:58very
49:58important
49:58because
49:59it is
50:00more
50:00dangerous
50:01in cobra
50:02it is
50:02more
50:02dangerous
50:03in cobra
50:04and
50:04to
50:05control
50:05the
50:05mascarinic
50:06symptom
50:07we use
50:08atropine
50:08along with
50:09the
50:09neostigmine
50:10is it clear
50:10sir
50:11so this
50:11is a
50:12very
50:12very
50:12important
50:13treatment
50:13protocol
50:14karetvenum
50:15karetvenum
50:20is having
50:21is having
50:21pre
50:24synaptic
50:26venum
50:28action
50:29and
50:29neostigmine
50:30acts only
50:31on
50:31post
50:32synaptic
50:33venum
50:34action
50:35so
50:35why
50:36neostigmine
50:37is only
50:37used in
50:38cobra
50:38the answer
50:39will be
50:39it is
50:40post
50:40synaptic
50:41action
50:42by cobra
50:43toxin
50:44cobra
50:44venum
50:44pre
50:45synaptic
50:46action
50:47is by
50:47karetvenum
50:48that's why
50:49neostigmine
50:49only
50:50acts in
50:50post
50:51synaptic
50:52action
50:52my dear
50:53friend
50:53this is
50:53all about
50:54the
50:54animal
50:54irritant
50:55poison
50:55animal
50:56irritant
50:57poison
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