Background: Snake bite is an established important cause of morbidity and mortality among the poor and rural population across the world including India. India accounts for the highest number of ...snakebites and related mortality globally. Objective: Identification of factors favoring the mortality due to snake bite. Methodology: A descriptive cross-sectional study was conducted from April 2022 to March 2023, and deaths due to snake bites reported from different health care facilities and community were included in the study. Results: A case-fatality rate of 5.9% due to snake bite was documented in the study. The factors identified as favorable for mortality were delayed treatment, followed by suboptimal care at primary and secondary health care facilities and traditional beliefs of the community. Conclusion: Provision of emergency service as point of care delivery, focusing on provision of training to strength point of care emergency services, co-ordination and linkages with the community members can strengthen the efforts toward reducing the mortality due to snake bites.
Snakebites occur in the community, not in the Emergency Unit. As such it is important to understand the first-aid concepts and pre-hospital emergency care aspects of this neglected disease. This ...article will highlight the concepts for emergency care within the context of the current pre-hospital arena and in light of the recent South African Snakebite Symposium consensus meeting held in July 2022, where wilderness rescue, emergency medical services and other medical participants agreed through evidence review and consensus debate on the current best approaches to care of the snakebite victim outside the hospital environment.
It is quite interesting that when a venomous snake bites a person and the victim does not suffer from any signs or symptoms of envenomation. A good percentage of venomous snake bites in humans do ...occur without venom injection. This phenomenon is termed as “Dry” bite in clinical medicine. Though this was not very uncommon in toxicological practice but, our awareness of this problem has increased. In this article an effort has been made to provide an insight into the incidence, pathophysiology and patho-mechanics of this unique medical enigma.
•“Dry bite” is a definitive clinical entity in venomous snake bites.•Incidence varies with species of venomous snakes, geographical area.•Possible explanations discussed in this review article.
A 66-year-old woman had been treated with two doses of antitoxin 4 years previously for a snake bite. Recently, she was bitten again by a pit viper on her right hand and was treated with two doses of ...antitoxin. Four days later, fever, swollen and tender lymph nodes, and erythema of the whole body developed. She was diagnosed with serum sickness and was treated with steroids and antihistamines. Her symptoms gradually improved without sequelae. Even if no serum sickness occurred after a previous administration of antitoxin, it is important to explain the risk of serum sickness when administering antitoxin again.
Although sea snakes (Elapidae) are commonly encountered by fishermen, accurately authenticated envenomings by them are uncommon in clinical literature. We report an authenticated case of Shaw's ...short, or spine-bellied, sea snake (Hydrophis curtus) bite in a young fisherman from northern Sri Lanka. The patient had clinical and biochemical evidence of mild transient myotoxicity but no evidence of neuromuscular paralysis or significant renal injury. Consideration of the clinical manifestations suggests either a mild envenoming or a dry bite. The patient completely recovered without any antivenom therapy and was discharged on the fourth day. Prolonged observation may be beneficial to exclude complications of sea snake envenoming.
Envenomation syndromes following snakebites can include tissue reaction, coagulopathy, nephrotoxicity, and neurotoxicity. Cardiotoxicity is rare but usually presents with dysrhythmias. Myocardial ...infarction after envenomation has rarely been reported. We discuss a case of snake bite simulating ST-elevation myocardial infarction (STEMI). Our patient is a 49-year-old male who sustained a snake bite in his left hand. Patient had hemodynamic collapse requiring increasing pressor support; EKG and troponin results confirmed STEMI. Cardiac catheterization did not demonstrate any thrombosis, rather severe cardiomyopathy with left ventricular ejection fraction 20-25%. Even though our patient did not require any coronary intervention, an angiogram was warranted given the clinical presentation. Our case demonstrates severe cardiotoxicity following snake bite. Further research is warranted to study the mechanism behind such phenomena.
Objectives
Rattlesnake envenomations are uncommon, and the majority occur in adults. Although Crotalidae equine immune F(ab’)
2
antivenom (F(ab’)
2
AV; trade name ANAVIP) was introduced in 2018, no ...pediatric specific studies of F(ab’)
2
AV have been reported to date. The objective of this study was to evaluate the clinical performance and adverse effects of F(ab’)
2
AV in children.
Methods
A single-center, retrospective chart review was performed on patients with rattlesnake envenomation presenting to a children's hospital between October 2018 and August 2022. Inclusion criteria were age younger than 18 years and F(ab’)
2
AV use. Exclusion criteria were other antivenom use at any time and presentation beyond 24 hours postenvenomation.
Demographic characteristics, hemoglobin, platelet count, fibrinogen, international normalized ratio, number of F(ab’)
2
AV vials used, infusion-related complications, and clinical outcomes were collected.
Results
Twenty-six patients, 19 males and 7 females, with a mean age of 7.7 years (0.67 to 16 years) met inclusion criteria. Fourteen (54%) were treated with only the initial 10 vial F(ab’)
2
AV doses. Twelve patients were given additional doses with a median additional vials of 10 (4–34 vials; interquartile range, 8.75–12 vials). The median total vials given for all patients was 10 (10–44 vials; interquartile range, 10–20 vials).
Two patients developed acute infusion reactions. Both were treated by slowing the infusion rate and with medications (diphenhydramine, corticosteroids). No delayed reactions were noted. No patients required blood products or surgical interventions.
After discharge, no complications, recurrent symptoms, return visits, or readmissions were reported. Follow-up by chart review or phone was obtained for 18 patients, and no postdischarge complications were noted. Seven patients had postdischarge hematologic laboratory evaluations and all were normal.
Conclusions
Although limited by small sample size and postdischarge follow-up, F(ab’)
2
AV was well tolerated in our series of pediatric patients, consistent with prior studies of all age groups.
BACKGROUND: Poisoning is the fourth most common cause of mortality in rural India. The commonest agents in India appear to be pesticides, sedatives, chemicals, alcohol, animal plant toxins and ...household toxins. Our hospital receives an average of 20 to 25 poisoning cases every month.
AIMS: To profile all cases of poisoning those are reported to casualty department at Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research (CDSIMER); to study the types and frequency of poisoning cases admitted to the centre; to study the socio demographic associations of the poisoning cases.
MATERIALS AND METHODS: Present study is a hospital record-based retrospective observational study of acute poisoning cases registered in the medicolegal register in the casualty of CDSIMER, which is a tertiary care centre situated in rural area near Harohalli, Ramanagara District, India.
RESULTS: Males constituted 58% of the cases and 33.52% of the cases were in the age group of 21–30 years. 81.4% of the cases were able to reach hospital between 1 to 8 hours. 56% of the cases recovered and were discharged within 3 days. In 22 cases the duration of admission was more than 2 weeks as they went into complications. Organo phosphorus group of insecticide was the most common type of poison consumed constituting to 40.8% of the cases followed by Snake bite. Attempt to suicide (60.35%) was more common than accidental poisoning.
CONCLUSION: Insecticides mainly Organophosphorus compound are the most common group of poisons which causes morbidity and mortality in rural Indian population especially in young adults between 21 to 40 years. Owing to the presence of forests in the region, Snake bite becomes the second largest type of poisoning. Suicide frequently prevails in the rural areas; financial problem is the leading cause for farmers to commit suicide.
Pain-acute, chronic and debilitating-is the most feared neurotoxicity resulting from a survivable venomous snake bite. The purpose of this review is to present in a novel paradigm what we know about ...the molecular mechanisms responsible for pain after envenomation. Progressing from known pain modulating peptides and enzymes, to tissue level interactions with venom resulting in pain, to organ system level pain syndromes, to geographical level distribution of pain syndromes, the present work demonstrates that understanding the mechanisms responsible for pain is dependent on "location, location, location". It is our hope that this work can serve to inspire the molecular and epidemiologic investigations needed to better understand the neurotoxic mechanisms responsible for these snake venom mediated diverse pain syndromes and ultimately lead to agent specific treatments beyond anti-venom alone.
To explore the changes in serum enzymes in patients with a snake bite, the treatment of respiratory dysfunction, and the clinical effect of anti-snake serum treatment. Fifty snake bite patients ...admitted to the emergency medicine department were selected and rolled into a light group (n=27), heavy group (n=15), and critical group (n=8). Anti-venomous snake serum was injected intravenously. Patients with severe respiratory dysfunction were treated with mechanical ventilation. The white blood cell (WBC), C-reactive protein (CRP), interleukin-6 (IL-6), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), and creatinine (Cr) counts of the heavy group and the critical group were higher versus light group (P<0.05). The WBC, CRP, IL-6, ALT, AST, BUN, and Cr of the critical group were higher versus the heavy group (P<0.05). The prothrombin time (PT), activated partial thrombin time (APTT), and thrombin time (TT) of the heavy group and critical group were longer versus the light group (P<0.05). The PT, APTT, and TT of the critical group were longer than the heavy group (P<0.05). The fibrinogen (FIB) of the light group was higher in contrast to that in the other two groups (P<0.05), while the critical group was the lowest (P<0.05). In summary, the severity of snakebites in patients can be evaluated according to the indexes of WBC, IL-6, coagulation function, and liver and kidney function.
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