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Child s Unbelievable Snakebite Survival Story

Child s Unbelievable Snakebite Survival Story


15 year old Child came with alleged history of snake bite on the lower limb foot, which was tied with tourniquet , patient was disoriented and agitated /irritable with abnormal movements of both upper and lower limbs ,flangs marks was seen on left foot with barely any swelling .The child had 1episode of seizures during admission for which AED was started. WBCT was done , which was 45minutes.Patient had significant hematuria for 48 hours. Patient was admitted to ICU started with inj .ASV under strict monitoring ,, IV fluids, antacids,antiemetics, antibiotics ,antipyretics, antihistamins and other supportive care was given. Every 6th hourly WBCT was done , which was prolonged , so ASV was repeated three times ( total 30 vials required). Child was monitored for renal shut down / AKI , but due to timely management hematuria resolved after 48 hours and renal parameters was normal later on. After 5 days child was successfully discharged home .





NOTE :


India is a country known to the western population as a country of snake charmersand snake over centuries. Despite generation after generations some families in our country who play with snakes(snake charmers), we fail to protect the community from snake bite which requires atleast education of the common people, how to protect themselves from snake bite as well as what to do after the bite has occurred.






First Aid Treatment Protocol :

“CARRY NO R . I . G . H . T. ”

It consists of the following:

CARRY : Do not allow victim to walk even for a short distance; just carry him in any form, specially when bite is at leg.

NO - Tourniquate , No- Electrotherapy , No- Cutting, No- Pressure immobilization

R : reassurance , I : immobilization , GH : go to hospital immediately , T : tell symptoms


DIAGNOSIS : 20 Minute Whole Biood Clotting Test (20WBCT)

A few mililiter of fresh venous blood is placed in a new, clean and dry, glass vessel and left at ambient temperature for 20 minutes. Leave glass vessel undisturbed for 20 min. If the blood is still liquid then the patient has incoagulable blood.


Table 1: Clinical features


FEATURE

COBRA

KRAIT

RUSSEL VIPER

SAW SCALED VIPER

HUMPED NOSE VIPER

LOCAL PAIN

YES

NO

YES

YES

YES

PTOSIS/ NEOROLOGICAL SIGN

YES

YES

NO

NO

NO

HEMOSTATIC ABNORMALITY

NO

MAY OCCUR

YES

YES

YES

RENAL COMPLICATION

NO

NO

YES

NO

YES

RESPONSE TO NEOSTIGMINE

YES

+/-

NO

NO

NO

RESPONSE TO ASV

YES

YES

YES

YES

NO



ASV Administration Criteria:

Evidence of coagulopathy / neurotoxicity / cardiotoxic evidence/ local swelling/ pain abdomen and persistent vomiting


ASV administration :

Total required dose will be between 10 vials to 30 vials usually, as each vial neutralizes 6mg of Russells Viper venom. Not all victims will require 10 vials as some may be injected with less than 63mg. However, starting with 10 vials ensures that there is sufficient neutralizingpower to neutralize the average amount of venom injected and during the next 12 hours to neutralize any remaining free flowing venom, even in the large study from south India, the amount of ASV exceeded 50 vials in some patients. So decision of the treating physician is of utmost importance, because the guidelines may not be useful for all patients. No Asv test dose must be administered Test doses have been shown to have no predictive value in detecting anaphylactic or late serum reactions and should not be used (Warren et al 1999). These reactions are not IgE mediated but Complement activated, They may also presensitize the patient and thereby create greater risk.


REGARDS

DEPARTMENT OF PAEDIATRICS

VAMSHODAYA HOSPITAL

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