Prognostic Indicators in Snake bite: Management and Outcome Study of Snake Bite Cases in a zonal hospital in Jammu & Kashmir,India

Bhasker S; Sawhney A; Chatterjee T; Gupta T; Manjunath

Volume : VI, Issue : VI, June - 2017

Prognostic Indicators in Snake bite: Management and Outcome Study of Snake Bite Cases in a zonal hospital in Jammu & Kashmir,India

Bhasker S, Sawhney A, Chatterjee T, Gupta T, Manjunath

Abstract :

Background : Snake envenomation is a neglected environmental and occupational hazard in our country which is infested with snakes ranging from 12,000 feet altitude above sea level of the Himalayas down to Cape Comorin with an estimated total of 50,000 national snakebite deaths in the Million Death Study. These cases are managed presently as per the WHO Guidelines . There are no validated regional protocols available for management of snakebite as per the region specific snakes Methods : The objective of this study was to study the prognostic factors in management of snakebite. This was a single centre, prospective observational study of 80 patient of venomous snakebite. We also compared a regional protocol being followed in our centre with the WHO protocol of ASV administration. Results : Our study has thrown interesting facts .There were 2 deaths in the WHO regime group ( Case Fatality Ratio 2.5 ). Upper extremities were the most observed bitten part of body (60%). Majority of snakebites occurred between 1900 hrs to 0600 hrs (70%). The most common complication observed was Sepsis (60%) followed by Cellulitis (30%) and Acute Kidney Injury(AKI , 22.5%). Effective immobilization at peripheral MI Rooms lead to early (in less than 8 hrs) correction of coagulopathy in 70.8% case (p <.001 ) . A Bite to needle time less than 4 hrs was associated with lesser complications (55.6% vs 100 %) and faster resolution of coagulopathy(66.7% vs 30.8%) which was highly statistically significant.The Accelerated regime fared better in our study as compared to the WHO Regime in terms of no mortality , correction of coagulopathy in less than 8 hrs ( 100% cases , p < .001 ) , lesser complications and short duration of hospitalization. Conclusion : Immobilization and the prompt transport of the snake bite victims to the hospital, along with the prompt administration of ASV with a target Bite to Needle time less than 4 hrs, remains the mainstay to reduce the morbidity and the mortality which are associated with snake bites. It will be prudent to carry out a larger clinical study prospectively to identify inadequacies in the management of snakebite and study the effectiveness of Accelerated Regime