IDENTIFICATION AND KNOWLEDGE OF SNAKE

FIRST AID TREATMENT OF SNAKE BITE AND WE MUST KNOWLEDGE ABOUT TREATMENT PROTOCOL OF SNAKE BITE CASES IN A HOSPITAL By Soumya Sengupta (9474565047) (Courtesy Dr.Dayal Bandhu Majumdar and  his Whats app group Snake Bite Interest Group) Preface :- As per official records every year minimum of 50,000 people die due to snake bite but the unofficially this toll is more than 1,00,00. Whereas in Australia despite the largest number of poisonous snakes the death rate due to snake bite is  average 2-3 person per five year. Did we ever wondered why such a difference? The main reason behind these deaths are ignorance, seeking treatment from majic healers and quakes . Non availability of proper treatment in rural area also added to this problem. It also a most unfortunate fact that the treatment protocol of snake bite in India is most neglected syllabus of MBBS curriculum in India . The neglected rural problems may be one of the reasons for this. In the prevailing situation a WhatsApp group named as 'Snake bite interest group” under the leadership of Dr. BN Majumdar has come up as a ray of hope for the victims of snake bite. It has Specialist Doctors of more than six States of India as members who are continuously enriching the knowledge by posting the case details of various snake bite cases and also offering their guidance on treatment of snake bite over telephone. The continued and combined effort of these learned Doctor's has lead  to the formation of “Snake bite treatment protocol” which has been included in the curriculum of medical education . A chapter on snake bite management has been included in the syllabus of class-VII of West Bengal. Sheer awareness can only be helpful in avoiding death due to snake bite.  Let us discuss the poisonous and dangerous snakes and identify the  deadly killer. These are the four venomous snake species responsible for causing the most human snake bite cases leading to death. 1. Cobra(hooded snake has with neurotoxic poison) 2. Saw-scaled viper(hooded snake with neurotoxic poison) 3. Russel's Viper(Generally affect circulatory system) 4. Common Krait(Non hooded snake with neurotoxic poison) Apart from these there is one more species of poisonous snake i.e. Branded Krait but Banded kraits are shy, not typically seen, and are mainly nocturnal. When harassed, they will usually hide their heads under their coils, and do not generally attempt to bite. Hence we need not worry about it.  For prevention of snake bite :- * Keep your surroundings clean. * Before sleeping in night, the bed must be cleaned and mosquito net must be used. * Try to avoid walking outside during night. In case it is unavoidable, try to use a stich and while walking keep striking the ground with it, clapping will be of no use  because the snake does not have ears. * Flip your shoes before putting it on. * Close the rat holes of houses. Please note that any black magic will never ever save the life from snake bite. First Aid treatment of snake bite Follow the procedure of Do   R_I_G_H_T R- Reassurance Reassure the patient, because due to fear of death, a snake bite victim will always be in a state of severe stress. He/She must be convinced that with proper treatment and care lots of patient have ben saved and so will he. I – Immobilization The lower mobility will ensure less spread of poison in body. To avoid bending the affected part, tie a scale or a piece of stick using a cloth piece  over the affected part(Hand/Leg). GH – Go To Hospital Make a telephonic inquiry from nearest hospital that whether 1. A.V.S , 2. Neospegmine 3. Atropine and 4) Adrenaline  is available. Go to the hospital that stocks these medicines. Please remember that snake bite cases can eaisily be treated at Primary Health Center of a block. If possible, make the patient sit between two people on a motorcycle. To keep the patient awake engage him/her in a conversation. Please remember that time plays important role in life saving. T- Tell Doctor for Treatment On reaching the hospital, ask the doctor to treat for snake bite.  While narrating the history of case any notable changes in change in voice pattern and its time of origin should also be explained to the Doctor. RULE OF 100 Infusion of 100ml of AVS in body within 100 minutes of snake bite increases 100% chances of survival of patients. Let us know the protocol of management of a snake bite patient once it reaches hospital and how does a doctor confirm that it is a case of snake bite. ২০ WBCT (20 Minute Whole Blood Clotting Test) It is a procedure to detect the effect of venom of a snake. Tools :- (a) Syringe (b) Dried, clean and new test tube(plastic and reused clean test tube will not suffice. For accuracy both are quite essential) Procedure:-              Withdraw 2ml blood from patient and put it in a vertically placed glass test tube. Leave ti for 20 minutes(a stop watch will be a better option for measuring time). After 20 minutes slightly tilt the test tube for any coagulation(clotting). Non coagulation is the confirmation of a Russel Viper bite. Please note that No pathology is required for this test.            Other than Russel Viper(Hematotoxic) all type snake bite can be diagnosed based on the  symptoms of a patient.   Symptoms of envenomous(poisoning):- 1) Bilateral Ptosis(Main symptom in all snake bite) 2) Severe burning sensation near fang mark(In case of hooded snake) 3) Subsequently localised sewlling . 4) Bleeding from various parts of body(in case of Russel viper bite) 5) Difficulty in swoolowing. 6) Blurred vision. 7) Tongue falling back. 8) Dizziness If treatment delayed, breathing problem and later on death due to choaking. *In case of Common Krait bite(deadliest snake of Aisan region) there is no localized burning sensation, there is no fang mark sensation. Pain abdomen, joint pain, fits or feeling of weakness and ptosis is a sure symptom of Krait bite. Treatment- Once en-venomous is confirmed, the Doctor * No skin test is to be carried out(As it has been discontinued by the WHO guidelines in the year 2010). ¼ part of Injection Adrenaline subcutaneous (same dose for the patient ranging from child to elderly)(rest need to be kept to tackle Adverse Reaction). 10 vials of AVS to be put in saline and infused within less than one hour through intravenous route.Neostigmine and Atropine injection should also be given failing which the patient may die.(in case of 100% confirmed case of Russel viper bite, these two may not be necessary) * In any case without administration of 10 vials of AVS, Neostigmine and Atropine, the patient should not be transferred(Please note that during 2014, Malati Lohar , a Krait bite victim of Vishnupur infused only 05 vials of AVS and was transferred from Vishnupur District hospital to Bankura without administering Neostigmine and Atropine injection died enroute. *In few cases adverse reaction of AVS may occur which includes difficulty in breathing, severe bodyache ect. Suct reactions can be managed with 0.5ml Adrenaline injection. * In case of severe envenomous, second or third dose of AVS can be administered in hospital having facilities of treatment of Kidney ailments. In case Russels Viper bite dialiasis may be eminent.(A delay of each minute leads to damage of kidney one percent.) Delay is treatment of hooded snake bites may lead to necrosis, later on it may lead to amputation opf the affected part of the body. Let us join hand in preventing deaths due to snake bite and persuade the referral of victims to nearby Hospital and providing free of cost treatment.  Please do remember that Govt. of West Bengal has a provision of offering an ex gratia of  Rs. 1 Lakhs to the next of kins of the person who die due to snake bite. For this a certificate from the Govt. hospital is required mentionng the cause of death as snake bite. And for claiming the amount the post mortem report is not at all required(Govt. Of WB order No-1561(19)F.R/4P-3/04 dated 19.08.2008.