“Clinical study on snake bite syndrome, species correlation and ASV dose requirement”

Dr. Ann MiriamMakunda Christian Leprosy and general Hospital

Bazaricherra P.O,Karimganj Dist.,Assam – 788727

GPS coordinates:24*25'55.78"N92*19'51.33"E

Location

GPS coordinates:24*25'55.78"N92*19'51.33"E

Brief Hospital Statistics 2011-12

Total OP: 91,242Total IP: 9471

Brief statistics of Karimganj DistrictPopulation: 12 Lakhs

Deaths due to snake bites : 0*Oujha : 2

*According to NRHM data

LOWAIRPOA BLOCKPopulation : 1 Lakh

Bazaricherra Gram panchayatPopulation : 12 thousand

A survey was done and it was noticed that there were only 2 deaths by snake bites in the last 15

years.

Common Poisonous snakes in Makunda

Red-necked keelbackRhabdophis subminiatus

Banded kraitBungarus fasciatus

Other venomous snakes identified by the local people

• White lipped pit-viper• Greater black Krait• Monocled Cobra

Oujha

Probable cause of CellulitisTreatment by Oujha – Cutting of snake bitten area by using a blade and applying local herbal medicine

Snake bites last year = 10Venomous bites = 1

Non – venomous bites = 9Mainly Hemotoxic = 1

Dead snakes brought – Nil

OUTCOMES

Patients requiring mechanical ventilation – NilPatients requiring hemodialysis – Nil

Deaths - Nil

FACILITIES AVAILABLE

Bleeding timeClotting time

Whole blood transfusionHemodialysis facilities – Machine available (Not in use)

Mechanical ventilators – yesHigh Dependency area

Blood investigations doneHemogram

Serum CreatinineBlood Sugar

BT / CTPlatelet count

ECG

INDICATION FOR ASV ADMINISTRATION

Prolonged BT/ CTAdrenaline given when there is sign of anaphylaxis

Initial dose of ASV 8 – 10 vialsDuration of administration 4 – 6 hoursTest used for monitoring response -

Whole Blood Clotting TimeTime of measurement of coagulation parameters –

3 times in a day

ADMINISTRATION OF REPEAT DOSE OF ASV

Not given so far

ADMINISTRATION OF CONTINUOUS LOW DOSE OF ASV

Not given so far

CEILING DOSE

No experience

USE OF NEOSTIGMINE

No experience

INDICATION FOR ANTIBIOTIC THERAPY

Cellulitis

COMMON ANTIBIOTICS USED

Ampicillin and Ampicloxacillin

PATIENTS ADMITTED IN

High Dependency area

PATIENTS REFERRED FOR

No referrals so far

COMPANY OF ASV PURCHASE

Haffkine

STOCK OF ASV

10 Vials

Why are snake bites so un-common in Makunda?• Thickly populated location• Venomous snakes present• Dense forests• Frequent floods

THANK YOU