Makunda Christian Leprosy and general Hospital “Clinical study on snake bite syndrome, species correlation and ASV dose requirement” Dr. Ann Miriam Makunda Christian Leprosy and general Hospital Bazaricherra P.O, Karimganj Dist., Assam – 788727 GPS coordinates: 24*25'55.78"N 92*19'51.33"E

Location GPS coordinates: 24*25'55.78"N 92*19'51.33"E

Brief Hospital Statistics 2011-12 Total OP: 91,242 Total IP: 9471 Brief statistics of Karimganj District Population: 12 Lakhs Deaths due to snake bites : 0* Oujha : 2 *According to NRHM data

Bazaricherra Gram panchayat LOWAIRPOA BLOCK Population : 1 Lakh Bazaricherra Gram panchayat Population : 12 thousand A survey was done and it was noticed that there were only 2 deaths by snake bites in the last 15 years.

Common Poisonous snakes in Makunda Red-necked keelback Rhabdophis subminiatus Banded krait Bungarus fasciatus

Other venomous snakes identified by the local people White lipped pit-viper Greater black Krait Monocled Cobra

Oujha

Probable cause of Cellulitis Treatment by Oujha – Cutting of snake bitten area by using a blade and applying local herbal medicine

Dead snakes brought – Nil Snake bites last year = 10 Venomous bites = 1 Non – venomous bites = 9 Mainly Hemotoxic = 1 Dead snakes brought – Nil

Patients requiring mechanical ventilation – Nil OUTCOMES Patients requiring mechanical ventilation – Nil Patients requiring hemodialysis – Nil Deaths - Nil

Whole blood transfusion FACILITIES AVAILABLE Bleeding time Clotting time Whole blood transfusion Hemodialysis facilities – Machine available (Not in use) Mechanical ventilators – yes High Dependency area

Blood investigations done Hemogram Serum Creatinine Blood Sugar BT / CT Platelet count ECG

INDICATION FOR ASV ADMINISTRATION Prolonged BT/ CT Adrenaline given when there is sign of anaphylaxis Initial dose of ASV 8 – 10 vials Duration of administration 4 – 6 hours Test used for monitoring response - Whole Blood Clotting Time Time of measurement of coagulation parameters – 3 times in a day

ADMINISTRATION OF REPEAT DOSE OF ASV Not given so far ADMINISTRATION OF CONTINUOUS LOW DOSE OF ASV

CEILING DOSE No experience USE OF NEOSTIGMINE

INDICATION FOR ANTIBIOTIC THERAPY Cellulitis COMMON ANTIBIOTICS USED Ampicillin and Ampicloxacillin

PATIENTS ADMITTED IN High Dependency area PATIENTS REFERRED FOR No referrals so far

COMPANY OF ASV PURCHASE Haffkine STOCK OF ASV 10 Vials

Why are snake bites so un-common in Makunda? Thickly populated location Venomous snakes present Dense forests Frequent floods

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