presentation 2013-04-03 dr suresh

7/28/2019 Presentation 2013-04-03 DR SURESH

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SNAKE BITE

Dr.B.Sureshkumar


2/15

Presented with Snake bite to L/s ankle 1hour back

Snake identified as Viper

PMHxMental retarded pt

Examination

BP-110/70 mmHg PR- 80/min

Lungsclear Abdomensoft

No ptosis, No opthalmoplegia, No bleeding manifestations

LocalNo swelling, No fang marks.

Mr. Mohan

30 years


3/15

IX

Whole blood clotting time < 20min on admission Rx

IM tetanus toxoid 0.5mg stat

WBCT in 2hours

KUO for ptosis, Bleeding manifestations

Monitor UOP, BP, RR

After 2 Hours of Admission. Pt developed Ptosis

WBCT >20min RxIV Anti-venom Serum 10 vials given


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Day 2

8 hours later

WBCT > 20min

B/L ptosis

BP-75/60 mmHg Hyperthermia+

Ix-

CBS171 mg/dl

Rx-

IV AVS 5 vials stat (2nd

Dose)

IV Dopamine 5g/Kg/min started and

titrated according to BP

IV Cloxacillin 500mg

6hrly IV Hydrocortisone

400mg stat


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Day 3

Loose stools

Bp- 100/70 mmHg

80/50mmHg ECGST in Inferior

leads

Fever+

S. Cr1.6

Rx

IV Metronidazole 500mg

8hrly

IV Ciprofloxacin 400mgBD

IV Dobutamine 10

g/Kg/min


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Day 4

BP100/70mmHg

HR110/ Min

RespB/L crepts

SpO2


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At TH-Batticaloa

Pt went into respiratory failure and Intubated.


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Signs and Symptoms of

Envenomation.

Symptoms:

Local pain at bite site80%

Pain in regional lymph nodes55%

Vomiting26%

Bleeding from distant sites24%

Drowsiness14%

Epigastric pain8% Lower back pain7%

Dizziness/impaired consciousness2%


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Signs

Local

Local swelling 68%

Tender, enlarged lymphnodes 54%

Bleeding at bite site 31%

Local blistering andnecrosis 2%

Systemic envenomation

Spontaneous

systemic

bleeding46%Hypotension35%

Conjunctival

edema24%

Bleeding from

gums20%

Bleeding from

venipuncture

sites15%

Hematemesis11%


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Urinary Symptoms and Renal

Failure

Hematuria 72%

BUN range 14 - 68%

Proteinuria (>1 gm/liter) 55% RBC casts55%

Oliguria 44%

Renal-angle tenderness 39%


11/15

Indication for Anti venom.

Incoagulable blood with 20 mins of WBCT.

Systemic envenomation.

Spontaneous bleeding. Neurotoxicity (Russels viper).

Impaired LOC.


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WBCT

Few ml of blood in clean glass tube.

Leave it for 20 mins undisturbed.

Do it before and after the administration AVS. Can be repeated in 6 hours time until become

normal (< 20 min) WBCT.


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AVS Administration

1 Vial AVS dissolve in 10 ml of water for

injection.

Add 100 ml of N/S.

Total 200 ml over one hour infusion.

Watch for reaction.

Children also should be given same dose.


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RESPONSE TO AVS

Hypotension & Bradycardia will improve in

10-20 mins.

Spontaneous systemic bleeding stops in 15

30 mins.

CNS effects will improve in 30 mins

Blood coagualability is restored about 6 hours.


15/15

THANK YOU

presentation 2013-04-03 dr suresh

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