Snake Bite Management

A 35-year-old woman from Madhya Pradesh is brought to the hospital 6 hours after a cobra bite to her right hand. She has local swelling up to the elbow, but her vital signs are stable and she is fully conscious. Neurological examination is normal. Investigations: PT 14 seconds (control 12 seconds), aPTT 36 seconds (control 32 seconds), fibrinogen 250 mg/dL, platelet count 2.5 lakh/μL. 20-minute whole blood clotting test shows normal clot formation. What is the most appropriate next step in management?

A 28-year-old farmer from rural Maharashtra presents to the emergency department 4 hours after a snake bite to his left foot while working in the field. On examination, he has local swelling extending up to the knee, with fang marks visible. His vital signs are stable. Blood investigations show: PT 18 seconds (control 12 seconds), aPTT 45 seconds (control 32 seconds), fibrinogen 80 mg/dL (normal 200–400), platelet count 1.2 lakh/μL. 20-minute whole blood clotting test shows no clot formation. What is the most appropriate immediate management?

Which of the following antivenoms is indicated for the management of viper bite in India?