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Definitions

Definitions. Snakebite Syndromes definition Severity Treatment variables Clinical outcomes. SNAKE BITE-Definition. Patient presenting with snake bite -snake seen -snake brought Unknown bite with characteristic clinical envenomation responding to ASV therapy.

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Definitions

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  1. Definitions • Snakebite • Syndromes definition • Severity • Treatment variables • Clinical outcomes

  2. SNAKE BITE-Definition • Patient presenting with snake bite -snake seen -snake brought • Unknown bite with characteristic clinical envenomation responding to ASV therapy

  3. Listing of Syndromes • No envenomation • Local swelling only • Haemotoxicity with / without local swelling • Neurotoxicity only • Neurotoxicity with Local swelling • Haemotoxicity + Neurotoxicity with / without local swelling • Haemotoxicity + Neurotoxicity +renal failure with / without local swelling • Neurotoxicity + myoglobinuria   • Neurotoxicity + renal failure + muscle pain+ no local swelling + no Haemotoxicity + bite in the  sea

  4. Definition of envenomation terms • Non-venemous bite No signs of envenomation after 24 hour observation • Haemotoxicity Hemorrhagic manifestations or Whole blood clotting time › 20 minutes or Deranged PT/PTT • Neurotoxicity- (any of the below) Ptosis or Opthalmopegia Limb muscle weakness grade 4 or less Respiratory paralysis-paradoxical breathing / Type 2 respiratory failure/need for intubation

  5. Definition of Renal failure- RIFLE/AKIN criteria • Renal failure- AKIN using RIFLES criteria Estimated baseline creatinine to be calculated using GFR calculation Using MDRD formula

  6. Local envenomation • Local swelling in the absence of a tourniquet • Enlarged tender lymph node draining the bitten limb • Necrosis, blistering • Necrotising fascitis • Compartment syndrome –absent pulses

  7. Severity grading of snake bite complications • Coagulopathy 1. CT/PT/PTT abnormal- no clinical bleeding 2. CT/PT/PTT abnormal- clinical bleeding • Paralysis 1. Paralysis not requiring mechanical ventilation 2. Paralysis requiring mechanical ventilation/intubation and face mask ventilation

  8. Severity grading of snake bite complications • Renal failure 1. Renal failure not requiring dialysis 2. Renal failure requiring dialysis • Local complication 1. Local complication not requiring surgical intervention 2. Local complication requiring surgical intervention • Shock 1. Present 2. Absent

  9. Treatment variables • Local measures-tourniquet ,pressure immobilisation • Antibiotics • Anti-snake venom dose Total dose administered to patient including dose administered in outside hospital(preparation-company) • Adrenaline/hydrocortisone • Neostigmine • Ventilation /bagging • Dialysis • Transfusion • ICU care • Referral to higher centre

  10. Treatment outcomes • Haemotoxicity Time to normalisation of CT or PT/PTT • Neurotoxicty Time to regaining normal power (except ptosis) Time to extubation • Dose of anti-snake venom • Duration of ICU care • Duration of hospitalisation • Allergic reactions Minor-itching,urticaria,wheals Major-angioedema,anaphylactic shock,death • Mortality

  11. Final Analysis • Proportion of venomous and non-venomous bites • Proportion of different syndromes • Severity grading of syndromes • Syndrome- species correlation (where snakes are identified) • Mean anti-snake venom dose according to (a) syndrome; (b) severity; (c) protocol variations; (d) ASV preparations; (e) geographic location

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