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Nursing management of snake bite SlideShare

SNAKE BITE MANAGEMENT. Snake bite is one of the major public health problems in the tropics. It is also emerging as an occupational disease of agricultural workers. In view of their strong beliefs and many associated myths, people resort to magico -religious treatment for snake bite thus, causing delay in seeking proper treatment Document the amount of pain at the site of the bite and the time of pain onset compared with time of the bite (especially important). With envenomation, the onset of pain is usually immediate. (Note: With coral snake bites, there may be little evidence of local reaction at the bite site.) 3 powerpoint on nursing management of burn

SNAKE BITE MANAGEMENT - SlideShar

Snake bites aren't terribly common in the U.S. — and they aren't usually fatal. But according to the World Health Organization, between 4.5 and 5.4 million snake bites occur each year and 1.8 to 2.7 million of those cause illnesses. It's estimated that at least 81,000 to 138,000 people die each year from snake bites Management of snake bite Many snake bites do not result in envenoming. The rate of envenoming varies depending on the species of snake. Whether envenoming has occurred cannot be immediately determined when the patient presents. This means all suspected snake bites must be triaged as a medical emergency and observed for snake bite management powerpoint lectures Today I am uploading two lectures about snake identification ,envenomation clinical features ,first aid and treatment based on INDIAN Scenario.These slides are prepared by Dr.mukund A Prabhu -junior resident and Dr.muhammed faizal -intern ,both are from my prestigious college -calicut medical college Although surgeons are often involved in the management of snake envenomation in the United States, it is essential to recognize that snakebites are a medical, not surgical, condition. Excision of the bite site was once recommended, but it is now understood that this is a disfiguring procedure that does not confer any survival benefit

Initial management includes basic resuscitation and assessment of the patient. Once airway, breathing and circulation have been assessed and stabilised, the diagnosis can be made and specific management undertaken. All cases of suspected snake bite should be observed for sufficient time to exclude delayed envenoming Paul V, Pratibha S, Prahaald KA, et al. High-Dose Anti- Snake Venom Versus Low- Dose Anti Snake Venom in the treatment of Poisonous Snake Bites- A Critical Study. J Assoc Physicians India 2004; 52:14-17. Indian National snake bite Protocol 2008; Guideline for management of snake bite in south east Asia countries by David Warre Snake bite is uncommon in Victoria and envenomation (systemic poisoning from the bite) is rare. The bite site may be evidenced by fang marks, one or multiple scratches. The bite site may be painful, swollen or bruised, but usually is not for snakes in Victoria. There are no sea snakes in Victoria, however land-based snakes can swim

Management of Poisonous Snakebite

Nursing management of Burns - slideshare

Emergency nurses in particular should be aware of the first aid techniques appropriate for Australian snake bite, as well as the recognition and management of envenomation. This article will outline the steps required and rationale for applying first aid techniques considered to be effective in retarding spread and circulation of snake venom Immobilize the bitten limb with a splint or sling. Any cloth or bandage may be used for this, as done for fracture limb. Any form of movement causing muscle contraction like walking, undressing will increase absorption and spread of venom by squeezing veins and lymphatics. Pressure immobilization (PIB) is believed to delay in spread of venom to. World's Best PowerPoint Templates - CrystalGraphics offers more PowerPoint templates than anyone else in the world, with over 4 million to choose from. Winner of the Standing Ovation Award for Best PowerPoint Templates from Presentations Magazine. They'll give your presentations a professional, memorable appearance - the kind of sophisticated look that today's audiences expect This is your NCLEX reviewer and practice questions for leadership and management in nursing. In this nursing test bank, test your knowledge of the concepts behind nursing leadership and management with these 80 practice questions.. Leadership & Management in Nursing Test Bank. Leadership is the ability to direct or motivate an individual or group to achieve set goals Most often it is a seasonal occurrence in the range of spring, summer to autumn months (March - October) and most often it is the Vipera berus. Case reports point to the care and management of patients after snake venom poisoning. Key words: Vipera berus, envenomation, snakebite severity score, haemorrhagic swelling, antiseru

(q ) Death due to Snake Bite or Animal Bite (r ) Fire Arm injuries (s) Drug overdose (t ) Drug abuse (u ) Dead brought to the Accident and Emergency Dept / MI Room (Found dead) and deaths occurring within 24 hours of hospitalization without establishment of a diagnosis 8. General Guidelines for dealing with Medicolegal case Management . Drooling of saliva, a challenging condition, is better managed with a multidisciplinary team approach. The team includes primary care physician, speech therapist, occupational therapist, dentist, orthodontist, otolaryngologist, paediatrician and neurologist. After initial assessment, a management plan can be made with the patient 2. Conduct / facilitate awareness workshops on snakes and snake bites. 3. Promote ethical and legal rescue and handling of snakes & an online database of snake rescuers across the country. 4. Build a network of snake bite treatment experts across the country. 5. Provide email / on phone assistance to people on various snake related issues. 6 Options for Acute Care (POAC) group to explore the development of a clinical collaborative pathway for the management of women suffering with SVNP, which could be safely managed in the community, either at home or in a POAC setting. This would meet the healthcare needs of these women in a timely fashion and provide care closer to home. Thi

Treatment. Termination of the exposure including removing all soiled clothing. Gently cleanse with soap and water to hydrolyze organophosphate solutions. Airway control and adequate oxygenation. Intubation may be necessary in cases of respiratory distress due to laryngospasm, bronchospasm, bronchorrhea, or seizures We are open for safe in-person care. Learn more: Mayo Clinic facts about coronavirus disease 2019 (COVID-19) Our COVID-19 patient and visitor guidelines, plus trusted health information Latest on COVID-19 vaccination by site: Arizona patient vaccination updates Arizona, Florida patient vaccination updates Florida, Rochester patient vaccination updates Rochester and Mayo Clinic Health System.

Handing over a patient. An SBAR approach is a good system to ensure you give all the details in a systemic way. Think about what the person you are speaking to will want to know, have the notes, drug chart and observation sheets available so that you can answer any appropriate questions. Explain your name, role and division 2. Dialysis-Peritoneal dialysis is very popular nowadays and used in the treatment of methanol poisoning and in Snake bite. Haemodialysis is more superior technique but requires highly sophisticated unit for care. Peritoneal dialysis and haemodialysis have limited use in the treatment of intoxication with chemicals. 3 Otherwise, treat their spider bite like you would most insect bites and stings: Wash the area of the bite with soap and water. Place a cold compress or ice pack on the area for about 10 minutes to. The 5 Types of Shock and Their Causes 1. Anaphylactic Shock. Anaphylactic Shock refers to a severe and life-threatening allergic reaction. It can occur as a result of eating particular foods, taking certain medications, or an insect bite Snake bites treatment should be handled immediately and with great care. Prompt treatment may help promote recovery by minimizing symptoms. Since it is very difficult to distinguish if the bite is from a poisonous snake or not, immediate first aid should always be applied to all snake bites.However, to be extra safe, ensure that you treat the bite as a venomous bite

3. Unfortunately, sea snake bites have little or no pain, and no edema (or only with a mild local reaction) at the site of bite. (On the contrary, fish stings are painful). 4. According to many studies, most (about 2/3rd) of the snake bites in Malaysia are due to the Malaysian pit viper bites Snake Bite. Sanjivani Vati is a primary medicine for snake bite. It has antivenin properties, which reduces the risk and symptoms of snake poison. In the case of snake bite, it should be given in a dosage of 3 tablets (375 mg) and 2 times a day. Sanjeevani Vati Dosage . The classical ayurvedic dosage of Sanjivani Vati is as follows Dr. Shyam Sundar President Elect API (2021-22) 6 SK Gupta Nagar, Lanka, Varanasi 221005, UP Mobile: 9453048500 E : drshyamsundar@hotmail.co

Snake Bite and Scorpion Stings,(Kurdistan)

Rhabdomyolysis is a potentially life-threatening syndrome resulting from the breakdown of skeletal muscle fibers with leakage of muscle contents into the circulation. The most common causes are. Shemesh IY, Kristal C, Langerman L, Bourvin A. Preliminary evaluation of Vipera palaestinae snake bite treatment in accordance to the severity of the clinical syndrome. Toxicon 1998; 36:867. Jurkovich GJ, Luterman A, McCullar K, et al. Complications of Crotalidae antivenin therapy. J Trauma 1988; 28:1032. Vozianova ZhI, Chepilko KI A head injury is any injury that results in trauma to the skull or brain.The terms traumatic brain injury and head injury are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of injuries, there are many causes—including accidents, falls, physical assault, or traffic accidents—that can cause head injuries medicalppt.blogspot.com contains more than thousand Presentations and lecture notes in most fields of medicine. If you are going to prepare a seminar you can compare with multiple similar presentations given here, some times if you are busy you can use these slides as such without any modification or with slight modification 24 hours emergency services: appropriate management of injuries and accident, First Aid, Stabilisation of the condition of the patient before referral, Dog bite/snake bite/scorpion bite cases, and other emergency conditions Referral services In-patient services (6 beds) 3.2. Maternal and Child Health Care including family planning

DISASTER MANAGEMENT :ROLE OF TEACHER DR. PUNAM BANSAL ASSISTANT PROFESSOR GCE 20-D/CHD TALK DELIVERED TO COLLEGE NSS STUDENTS ON 27.9.2013 DEFINITIONS OF DISASTER A disaster can be defined as any occurrence that cause damage, ecological disruption, loss of human life, deterioration of health and health services on a scale, sufficient to warrant an extraordinary response from outside the. You think the bite may have damaged a bone, tendons, or nerves, because you can't bend or straighten the body part or you've lost feeling in it. The wound is red, swollen, or oozing fluid 14. Hansdak SG, Lallar KS, Pokharel P, Shyangwa P, Karki P, Koirala S. A clinico-epidemiological study of snake bite in Nepal. [priory.com] The epidemiology, clinical course, and management of snakebites in the North American Snakebite Registry. J Med Toxicol. 2017;13(4):309-320

  1. General Principles of Poisoning. Poisoning is contact with a substance that results in toxicity. Symptoms vary, but certain common syndromes may suggest particular classes of poisons. Diagnosis is primarily clinical, but for some poisonings, blood and urine tests can help
  2. FRACTURE AND. DISLOCATION Nucki N Hidajat, dr, MS, SpBO (K), FICS Department Orthopaedi & Traumatology Faculty of Medicine, Padjadjaran University Dr Hasan Sadikin Hospital - Bandung. Orthopaedic tree orthos paedos. introduction. 1741, Nicolas Andry Orthopaedia, the Art of Preventing and Correcting Deformities in Children The present scope of orthopaedics: Include all ages Consist of art and.
  3. Introduction, Characteristics, Importance and Components of Primary Health Care. Primary health care is an essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at the cost that the community and the country can afford to maintain.
  4. ated clothing and thoroughly wash the skin with soap and water. If possible perform pulse oximetry and give supplemental oxygen if indicated. Intubation and mechanical ventilation may be.

WHO Snakebite

  1. istering diphtheria antitoxin derived from horse serum, 1895. The Historical Medical Library of The College of Physicians of Philadelphia. This article assumes familiarity with the terms antibody, antigen, immunity, and pathogen. See the Glossary for definitions
  2. - Older siblings, day care - Exposure to certain foods, farm animals - Exposure to antibiotics during infancy • Cytokine milieu Adapted from Bach, JF. N Engl J Med 347:911, 2002. Upham & Holt. Curr Opin Allergy Clin Immunol 5:167, 2005 Also: Papadopoulos and Kalobatsou. Curr Op Allergy Clin Immunol 7:91-95, 200
  3. Poisoning Self-Care at Home If you or someone you know has swallowed or breathed a poison and you or they have signs or symptoms, such as nausea, vomiting, pain, trouble breathing, seizure, confusion, or abnormal skin color, you must call either an ambulance or the U.S. National Poison Control Center at 1-800-222-1222 for guidance
  4. ated Intravascular Coagulation. Disse
  5. Snake bites/venom; Epidemiology. Anemia is an extremely common disease affecting up to one-third of the global population. In many cases, it is mild and asymptomatic and requires no management. The prevalence increases with age and is more common in women of reproductive age, pregnant women, and the elderly
  6. imum of 2 talks a day! Voi, Mtito, Lewa, Nanyuki, Timau, Nairobi, Soysambu, Gilgil, Naivasha, Limuru here we come. SMS 0718 290 324 or email snakes@bio-ken.com for more info
  7. Anemia is described as a reduction in the proportion of the red blood cells. Anemia is not a diagnosis, but a presentation of an underlying condition. Whether or not a patient becomes symptomatic depends on the etiology of anemia, the acuity of onset, and the presence of other comorbidities, especially the presence of cardiovascular disease. Most patients experience some symptoms related to.

AIDS Pathophysiology. Acquired immune deficiency syndrome (AIDS) is caused by the HIV or human immunodeficiency virus. The infection causes progressive destruction of the cell-mediated immune (CMI. An antidote is a substance that can counteract a form of poisoning. The term antidote is a Greek word meaning given against. This post will help you familiarize yourself with the common antidotes that are used in the hospital setting. The following are antidotes that should be familiarized by the nurse to respond to this emergency situation quickly หากผล lab ออกมาแล้วเราแก้ไขให้ลด K ในคนไข้เลยย่อมเป็นผลเสี Mary McKenna Guanci, MS RN CNRN, is a clinical nurse specialist in the Neuroscience Intensive Care Unit at Massachusetts General Hospital, Boston, MA. Comments 3090D553-9492-4563-8681-AD288FA52AC

Snake Bite: Symptoms, Causes, Diagnosis & Treatmen

Poisoning snake2012+MCQs. 1. SNAKE BITES/scorpion stings Snake bite is common life-threatening in many countries. Farmers, hunters, rice-pickers are at particular risk Prompt medical treatment is vital. 3-5 million victims /year, 50 000 deaths , 400 000 amputations. 40% of bites do not produce signs of envenoming. It is difficult to predict which bites will produce symptoms or the clinical. If you are 100% certain that the snake is nonvenomous, wash the area with soap and water and stay home. You'll be fine. Infection following a bite from any snake - venomous or nonvenomous - if exceptionally uncommon, and it is not appropriate to start empiric antibiotics. Similarly, the likelihood of getting tetanus from a snakebite in. a snake bite, a heart attack, being hit). A social threat occurs when you believe you will be rejected, humiliated, embarrassed, or put down. A mental threat occurs when something makes you worry that you are going crazy or losing your mind. The perception of the threats varies from person to person. Some people, because of thei

Snake Bite Management Powerpoint Lecture

1 Introduction. The global burden of snake bites is often underestimated. Swaroop and Grab were the first to definitively highlight this burden in 1954. Snake bite was added to the World Health Organization (WHO) neglected list of tropical diseases in 2009. An estimated 5.5 million people are bitten by snakes per year resulting in 400,000 amputations and between 20,000 and 125,000 deaths annually Objective: To investigate the prevalence of snakebites and associated epidemiologic factors in Khorram-shahr County, Iran, between 2013 and 2017. Methods: This was a cross-sectional descriptive-analytical study. Information was collected and recorded via questionnaires. Snakebite data included gender, age, occurrence regions, bite site, time of being bitten, month and season Snake Bite: How to Easily Halt the Spread of Snake Venom Snake venom is poisonous, a new way that can neutralize the deadly snake venom in a cheap and effective way was discovered, reveals study.

In Ethiopian traditional practice, the roots of Verbena or Atuch, are soaked in water and drunk to expel roundworm, help with snake bite, and relieve stomach ache and diarhoea. A 'herb of all trades', Verbena is found to have antimicrobial properties and is traditionally used for treating tropical ulcers Encountering Snakes While Horseback Riding. Irving Langer is a successful real estate executive who has spent nearly five decades with E&M Associates in Brooklyn, New York. When he is not overseeing company operations and strategy as president of the company, Irving Langer enjoys a variety of outdoor interests, such as boating and horseback riding

Snakebite Treatment & Management: Severity of Envenomation

Neuropathy (often called peripheral neuropathy) is damage to one or more nerves outside of your central nervous system -- your brain and spinal cord. It results in numbness, tingling, muscle weakness and pain usually starting in the hands and feet By Ruchika Gupta . Snake CBSE class 10 English Poem Summary, Explanation, Difficult words, Question Answers. CBSE class 10 English Poem 6 Snake Poem Summary - and detailed explanation of the poem along with meanings of difficult words and literary devices used in the poem. Summary is followed by explanation of the Poem Snake.All the exercises and Question and Answers given at the back of the. Tribal communities utilize ethno medicinal plants for the treatment of diseases and disorders like diarrhea, dysentery, fever, headache, skin diseases, boils and blisters, rheumatism and gout, piles jaundice, ophthalmic diseases, toothache, bone fracture, snake bite, helminthic or worm infection, cuts and wounds, cough, cold, asthma, leprosy etc Snake Bite Management: A Scoping Review of the Literature. Ncbi.nlm.nih.gov DA: 20 PA: 25 MOZ Rank: 60. Once a snake bite occurs, the first level of management is in the field.1,6,7This is followed by triage and provision of acute care in a hospital setting with the goal of limiting the local and systemic effects of envenomation.3Although envenomation is well studied in regards to field.

Snake bite: a current approach to management - Australian

Management of snake bite 93 Management of Acute Poisoning 94 Structured Approach to the seriously injured child 96 Metabolic abnormalities 98 Principle of safe transfer and retrievals 99 Venesection with broken needles 101 Intraosseous access 102 Peripheral intravenous access 104 On going care Admit to and area with appropriate staffing and. Introduction to Community Med-----Public Health Dr.Bipin Introduction to Public Health introduces the many areas of the public health system, and the work in measuring health, disease and illness, and its endeavors to promote population health. Recommended Reading Parks Text Book of Preventive and Social Medicine by K Park Public Health and Community Medicine by Ilyas and Ansari (Pakistani. Manisha says : Food For Muscle. Carbohydrates and fat are essential to acquire strength while protein is a major source for maintaining a lean and muscular body. Food ingredients we consume are the primary sources of calories (i.e. protein and carbohydrate has 4cal/gm, and fat consume 9cal/gm) which are helpful food for muscle gain Reassure the patient. Raise the patient's legs (unless they have fractures or a snake bite) above the level of the heart, with head flat on the floor. Treat any wound or burn and immobilise fractures. Loosen tight clothing around neck, chest and waist. Maintain the patient's body warmth with a blanket or similar

Management of Snake Bite in India - JAP

The Red Cross urges people to follow these steps to help prevent, treat and respond to poisoning: If you suspect a poisoning emergency, call the National Poison Control Center toll-free at (800) 222-1222. Post this and other emergency phone numbers by all of your telephones. Keep all chemicals and medicines locked up and out of sight Diagnosis and therapeutic management of various emergencies of toxicities, sting bites and burns of farm and companion animals. Monitoring critical ill patient, application of emergency care procedures for resuscitation of critically ill patient Suggested Reading Kirk RW.1995. Handbook of Veterinary Procedures and EmergencyTreatment. 6th Ed. WB. Dear Participants, I circulated module 6A Part I (Cardiovascular disease in CKD) last week. This week is Part II (Hypertension in CKD) followed by Part III (Sudden Cardiac Death in CKD). I will prepare Dyslipidemia in CKD as a separate module later. Hypertension is more common in individuals with CKD compared to those without, and prevalence increases with each progressive stag

Nursing Tests. HESI; Deborah has 4 years of teaching experience and a master's degree in program development & management. View bio. Some people bite their finger nails, and in order to. • Emergency care includes: Immediate treat-ment of accidental injury and victims of criminal acts, treatment of snake bites, treatment of victims of natural calamities. • Reproductive health includes: - Right to reproductive health without gender discrimination is ensured to every person. - Right to highest possible maternal an Compartment syndrome is a painful condition, with muscle pressure reaching dangerous levels. Acute compartment syndrome is a medical emergency, usually caused by trauma, like a car accident or broken bone. Chronic (or exertional) compartment syndrome is caused by intense, repetitive exercise and usually stops with rest or changes in routine A mock drill is a method of practising how a building would be evacuated in the event of a fire or other emergency. Usually, the building's existing fire alarm system is activated and the building is evacuated as if the emergency had occurred. Drills provide virtually the only means, short of an actual incident, of measuring the state of readiness and of testing the effectiveness of an.

The neuromuscular system is composed of the nerve root, the peripheral nerve, the neuromuscular junction and the muscle. Signs specific to each portion of the nervous system will be presented to help aid in the neurolocalization process. Signs of forebrain disease include a change in the content of the patient's consciousness SIPOC. SIPOC. ประโยชน์ของการวิเคราะห์กระบวนการทำงานโดยใช้ SIPOC. ทำให้เราสามารถย้อนกลับไป ปรับปรุงกระบวนการ หรือ re-design ได้. มีคำศัพท์ 2 คำ. Remove jewellery and clothing in contact with burn source. Cool affected area as soon as possible (within 3 hours from time of burn) for 20 minutes with cool running water. If unavailable, other options include: frequently changed cold water compresses, immersion in a basin, irrigation via an open giving set

Clinical Practice Guidelines : Snakebit

First aid is the first and immediate assistance given to any person suffering from either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial intervention in a serious condition prior to professional medical help being available, such as performing cardiopulmonary resuscitation (CPR) while. The symptoms of kidney and lungs are more pronounced. Heart failure (sys. And dias.), Shock, cardiomegaly, pericardial effusion and ECG abnormalities, valvular and myocarditis. Other causes: porphyria, ingestion of beets/beet, carrot or blackberry, medication (rifampicin, antipsychotics,.

Rub vigorously for at least 20 seconds (Figure1). Rinse your hands with plenty of running water. Dry your hands with a towel or air dryer. Using personal protective gear is an important strategy to minimize the risk of blood and bodily fluid exposure. If the person is bleeding, always wear gloves and protective eyewear when giving first aid. Coagulation Disorders: Definition Coagulation disorders deal with disruption of the body's ability to control blood clotting. The most commonly known coagulation disorder is hemophilia , a condition in which patients bleed for long periods of time before clotting. There are other coagulation disorders with a variety of causes. Description.

Development of Human Resource. A group of people who are able to do work is known as human resources . A human resource development HRD concept was first introduced by Leonard Nadler in 1969 in a conference in the US.He defined HRD as those learning experience which is organized, for a specific time, and designed to bring about the possibility of behavioral change If bitten by a snake, try to identify the snake if possible—but do not risk another bite. Taking a picture of the snake with a digital camera or mobile phone may help in its identification. General treatment for snake bites includes rinsing the bite area with clean water. [2,3] DO NOT cut the bite marks or attempt to suck out the venom

Snake Bites: Types, Symptoms, and Treatment

Welcome To Longdom Publishing SL. Longdom Publishing SL is one of the leading international publishers of open access journals covering clinical, medical, biological, pharmaceutical sciences as well as engineering, management and technology oriented subjects. Our aim is to catalogue the current scholarly information sourced from across the world and broadcast to maximize its utility and impact. In the event that a horse is bitten by a venomous snake, riders should remain calm and immediately contact veterinary services. While potentially deadly, rattlesnake venom results in about five human fatalities every year from as many as 8,000 bites

International Journal of Pharmacy Teaching & Practices 2014, Vol.5, Issue 1, 905-909. Importance of Poison Information Centre and Role of a Pharmacist in Management of Poisoning Amit Sharma*, Vinay Pandit Department of Pharmacology, Laureate Institute of Pharmacy Keywords: self-poisoning, Pharmacoinformatics, Research Article Poison control, Pharmacy services Please cite this paper as Amit. ACTIVITIES. Kamrul Hassan Department of Horticulture Bangladesh Agricultural University, The status of Early Childhood Care and Education in Bangladesh, - Title: Government s steps to implement Pre-primary Education in Bangladesh Author: MAHMUDA AKHTER Last modified by: User Created Date: 10/13/2009 8:26:09 AM, Snake bites withou Stork bites, angel kisses, or salmon patches These are small pink or red patches often found on a baby's eyelids, between the eyes, upper lip, and back of the neck. The stork bite name comes from the marks on the back of the neck where, as the myth goes, a stork may have picked up the baby

The Centers for Disease Control and Prevention (CDC) offers a number of resources that public health professionals, clinicians, emergency responders, and others can use to share health and safety information in the event of a natural disaster Snake bite n management EPI What is Covid 19 X-ray findings of covid 19 patient. Epidemic aur pandemic. Cytokinesis Kia hain Kia karta hain Layers of brain from inward to outward Why tetanus vaccine given to women's in BHU setup What is ATL The basic dynamic behind this phenomenon is that the organization is made up of a network of circular causal processes: A influences B, which then influences C, which in turn influences A, i.e., the snake bites its own tail. Understanding these internal organizational dynamics is a prerequisite for leading effective change processes