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Snakebite Management in India
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Snakebite Management in India

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  • 1. Dr. Rajeev 1
  • 2. What the snakes do? m   fro    are They don’t bite! ites s. Only eb nak  specie ous  They bite! ll s  of a omous  venom mate 70% ‐ven Some of them can not inject venom!  by o ites y enven n o  b n  of Some of them may inject but they… ll 50% s actua atient. ○ fail to do so! ie p the  spec Chamber empty No time to succeed ○ Don’t want to do so Some of them inject but half heartedly or don’t deliver the lethal dose due to insufficient stock. Few of them find themselves in “INDO-PAK final” and succeed to perform like ‘Veeru’. Problem starts here… As the venom is in! and that’s in sufficient quantity… What the venom does?
  • 3. lem ob pr of e oup . Th gr t the ortality ngs st m mo he sa ain he hig ar. rem ith t /ye dia 000 es w In are . 0, tri ~5 ry c bite oun te: ima c a r th r ake fP y o eat sn ea an D at m o not tr gre ls d A pita hos 5
  • 4. The controversy India is one of the world’s leading producers of snake venom antiserum . mortality does not rest in snake venom antiserum shortage. 6
  • 5. THE FATE Patients are referred… to distant, better equipped hospitals… and thus make journeys without the cover of snake venom antiserum (ASV)… REFRRED… DEFFRREED… REFFERRRRRRRED… D… ! 7
  • 6. Crucial factors in decresing mortality Availability of treatment, particularly close to the scene of the bite. (access) Confidence in (DOCTORS) being able to treat the patient. (knowledge) Equipments. Medicines. Referral facilities. Please note: delayed access &/or treatment increases the cost of treatment and decreases chances of survival. 8
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  • 10. A death en route (DEnR) case (ID: 1949356/ 17.06.08) investigation revealed the pitfall. A  case of snake bite was taken up by Dediapada ambulance on the way to a remote village.  Relatives were coming towards the ambulance with the patient on a motorcycle. When the  EMT took up the case he was out of the coverage area. The patient was having the early  signs of neurotoxic envenomation (ptosis, agitation etc.) but hemodynamically stable. A  tourniquet was applied by relatives on the limb proximal to the site of bite. Frank edema  and bluish discoloration of skin distal to the tourniquet applied was there. The EMT was not  aware of the possibility of sudden deterioration after removal of the applied tourniquet  (JIMA JUNE 2007). The patient was looking so healthy that the EMT did not find the need of  providing oxygen. He removed the tourniquet in the ambulance & the patient deteriorated  suddenly. The patient became breathless & cyanosed. EMT started CPR. He was in coverage  area but was not able to contact ERCP as his hands were not free & he had not applied the “HANDSFREE”. Oxygen/OPA/NPA/Ambus’ were Not Used. The doctor of CHC Dediapada declared the patient “DEAD”. It all happened within 30 minutes. A patient having earliest  signs of neurotoxic envenomation died within 30 minutes...can you believe? 12
  • 11. 13
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  • 15. Administer ASV only if you are sure that there is un neutralized, unbound venom in the blood or tissue fluid 17
  • 16. SNAKE BITE: EVIDENCE OF SYSTEMIC ENVENOMATION causing neurological causing haemostatic impairment (neost. disturbances i.e., test.pptx ) i.e., all cobras, members of the viper kraits and rarely Russell’s family. viper. a 20WBCT indicating the signs will be visual, initially involving muscles incoagulable blood or enervated by the cranial evidence of spontaneous nerves. bleeding from gums. ptosis, ophthalmoplegia, difficulty in swallowing 18
  • 17. Nerve.mpg
  • 18. SNAKE BITE: LOCAL SWELLING 20
  • 19. SNAKE BITE: LOCAL SWELLING 21
  • 20. SNAKE BITE: LOCAL SWELLING 22
  • 21. SNAKE BITE: Those who do not show manifestation 23
  • 22. 24
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  • 29. In the case of neurotoxic envenoming, once the snake venom antiserum has been administered, the next step is to administer a neostigmine test to establish if the victim reacts to anticholinesterase. 31
  • 30. Neurological Assessment Objective measures of neurological impairment as single breath count, length of time upward gaze can be maintained, Assessment of imminent respiratory failure Ability to raise their head. 32
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