Dr. Rajeev
         1
What the snakes do?
                                                                            m 
                       ...
lem
          ob
        pr                            of
      e                           oup .
  Th                    ...
The controversy

India is one of the world’s leading producers
of snake venom antiserum .

mortality does not rest in snak...
THE FATE

Patients are referred… to distant, better equipped
 hospitals… and thus make journeys without the
     cover of ...
Crucial factors in decresing mortality


    Availability of treatment, particularly close
    to the scene of the bite. (...
9
10
11
A death en route (DEnR) case (ID: 1949356/ 17.06.08) investigation revealed the pitfall. A 
case of snake bite was taken u...
13
14
15
16
Administer ASV
             only if
         you are sure
          that there is
un neutralized, unbound venom
          ...
SNAKE BITE: EVIDENCE OF SYSTEMIC ENVENOMATION


                             causing neurological
  causing haemostatic
  ...
Nerve.mpg
SNAKE BITE: LOCAL   SWELLING




                               20
SNAKE BITE: LOCAL SWELLING




                             21
SNAKE BITE: LOCAL SWELLING




                             22
SNAKE BITE: Those   who do not show manifestation




                                                    23
24
25
26
27
28
29
30
In the case of neurotoxic envenoming,
 once the snake venom antiserum has
 been administered, the next step is to
    admi...
Neurological Assessment
Objective measures of neurological
impairment
 as single breath count,
 length of time upward gaze...
34
35
Snakebite Management in India
Snakebite Management in India
Snakebite Management in India
Snakebite Management in India
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Snakebite Management in India

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Snakebite Management in India

  1. 1. Dr. Rajeev 1
  2. 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. 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. 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. 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. 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
  7. 7. 9
  8. 8. 10
  9. 9. 11
  10. 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. 11. 13
  12. 12. 14
  13. 13. 15
  14. 14. 16
  15. 15. Administer ASV only if you are sure that there is un neutralized, unbound venom in the blood or tissue fluid 17
  16. 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. 17. Nerve.mpg
  18. 18. SNAKE BITE: LOCAL SWELLING 20
  19. 19. SNAKE BITE: LOCAL SWELLING 21
  20. 20. SNAKE BITE: LOCAL SWELLING 22
  21. 21. SNAKE BITE: Those who do not show manifestation 23
  22. 22. 24
  23. 23. 25
  24. 24. 26
  25. 25. 27
  26. 26. 28
  27. 27. 29
  28. 28. 30
  29. 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. 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
  31. 31. 34
  32. 32. 35

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