1. Snake bites NAV JIVAN HOSPITAL TUMBAGARA, SATBARWA POST PALAMU DISTRICT, JHARKHAND

2. Where are we...

3. How to reach NJH... From Kolkota: 12 hours by train to DTO From Ranchi: 4 hours by road: 135 kilometers From Delhi: 12 hours by trains to DTO – rajdhani/garib rath Nearest rail-head: Daltonganj (DTO): 35 kilometers

4. HOW BUSY WE ARE... 2009-102010-112011-122012-13 (till 28 feb) GENERAL OP 11355123781432218965 EYE OP 5682520352985546 ANTENATAL 1404189026293056 DENTAL 5226088801159 INPATIENTS 4812503745105054 DELIVERIES 1040129413741449 CESARIAN 313363429442

5. Snake Bites...

6. 2012 (Jan-Dec) – Alleged snake ALLEGED SNAKE MALEFEMALETOTAL KRAIT 222345 COBRA 134 VIPER 15823 UNKNOWN 192645 OTHERS 2810 TOTAL 5968127

7. SYNDROMES DIAGNOSISMALEFEMALETOTAL NON VENOMOUS 293766 NEUROTOXIC 121729 HEMOTOXIC 8412 NEUROTOXIC AND HEMOTOXIC 101 ONLY LOCAL REACTION 9615 OTHERS 044

8. Snakes brought... 5 (out of 127) 4 alive ? ? ?

9. Mechanical Ventilation MALESFEMALESTOTAL NEUROTOXIC 121729 NEEDED MECHANICAL VENTILATION 9918

10. Haemodialysis All bites with deranged whole blood clotting time. Nearest dialysis centre – 135 kms away Transport facilities – safe only in daytime Extreme poverty

11. 4 deaths AgeAlleged snakeSyndromeCause of death 16 UnknownHaemotoxic? Anaphylaxis 12 UnknownNeurotoxic? Anaphylaxis 72 KraitHemotoxic +NeurotoxicCardiac arrest on ventilator 40 ViperHemotoxic? Myocarditis

12. Facilities we have... Can do only clotting time. Anaesthesia ventilator No blood bank. But if donor is available, we have facilities to bleed the donor and donate it immediately.

13. When do we refer... We give all patients an option to go to higher centre. 135 kms away Poor road and transportation facilities Patients on respiratory arrest... No choice Viper bites... All efforts to refer

14. Issues of concern – unknown bites MALESFEMALESTOTAL NON VENOMOUS 142337 NEUROTOXIC 224 HEMOTOXIC 314 TOTAL UNKNOWN BITES 192645