Professional Documents
Culture Documents
BITE
Background
The
Big
Four
in
India
Investigations
Management
DO
NO
HARM
FIRST
What
not
to
do:
incisions,
sucking
the
wound,
tourniquets,
ice
application,
do
not
try
to
catch
the
snake
Most
of
the
traditional
first
aid
is
ineffective
(Reassure,
Immobilize
the
limb
with
crepe
bandage
and
get
to
the
hospital
ASAP)
ABC
Analgesia:
Acetaminophen/Tramadol
(Avoid
NSAIDs)
Tetanus
Prophylaxis
(only
in
the
absence
of
coagulopathy)
Antibiotics
(Augmentin):
Controversial
unless
suction/incision
is
done
ASV
ASV
(the
earlier,
the
better;
Use
judiciously
when
benefits
>
harm,
not
for
all)
No
test
dose
recommended
Indications:
Systemic
envenoming
Haemostatic
abnormalities:
Spontaneous
systemic
bleeding,
coagulopathy
(see
20WBCT,
PT)
or
thrombocytopenia
(<100
x
109/litre
or
100
000/cu
mm)
Neurotoxic
signs:
ptosis,
external
ophthalmoplegia,
paralysis
etc
Cardiovascular
abnormalities:
hypotension,
shock,
cardiac
arrhythmia,
abnormal
ECG.
Acute
kidney
injury:
oliguria/anuria,
rising
blood
creatinine/
urea
Take
Home
For
further
reading:
1. Mortality
Predictors
of
Snake
Bite
Envenomation
in
Southern
IndiaA
Ten-Year
Retrospective
Audit
of
533
Patients.
Suresh
David,
Sarah
Matathia,
and
Solomon
Christopher,
J Med Toxicol. Jun 2012; 8(2): 118
123.
2. http://apps.searo.who.int/PDS_DOCS/B4508.pdf
3. http://www.asiatox.org/9th%20apamt/OP/NATIONAL%20SNAKEBITE
%20MANAGEMENT%20PROTOCOL%202008%20_INDIA_.pdf
4. http://www.apiindia.org/medicine_update_2013/chap94.pdf
5. http://www.apiindia.org/pdf/medicine_update_2010/critical_care_emer
gency_medicine_03.pdf
6. Snake
Bite
in
South
Asia:
A
Review
Emilie
Alirol
mail,
Sanjib
Kumar
Sharma,
Himmatrao
Saluba
Bawaskar,
Ulrich
Kuch,
Franois
Chappuis
7. Emergency
treatment
of
a
snake
bite:
Pearls
from
literature,
Syed
Moied
Ahmed,
Mohib
Ahmed,
Abu
Nadeem,
Jyotsna
Mahajan,
Adarash
Choudhary,
and
Jyotishka
Pal
J
Emerg
Trauma
Shock.
2008
Jul-Dec;
1(2):
97105.
Questions/Comments:
Lakshay
Chanana
FEM
(Vellore),
MCEM
(UK)
Department
of
Emergency
Medicine
Apollo
Health
City,
Hyderabad
drlakshay_em@yahoo.com
EM
Academy
@
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