1. Statistics about snake bite syndromes and outcomes CMC Vellore 11.3.13

2. Data Data from November 2011 – 2012 Data from November 2011 – 2012 Total cases – 48 Total cases – 48 Clinical syndromes Clinical syndromes Non venomous – 3 (6%) Non venomous – 3 (6%) Venomous Venomous –Neurotoxic:14 (29%) –Heamatotoxic:7 (14%) –Combined: 24 (50%)

3. Management strategies Premedication:no adrenaline prior to ASV Premedication:no adrenaline prior to ASV Supportive medications: Supportive medications: Neostigmine – 3 (6%) Neostigmine – 3 (6%) Antibiotic Antibiotic Amoxycillin clavulunate Amoxycillin clavulunate Cellulitis Cellulitis

4. ASV dosing Indications Indications Neurotoxic: progressing neuromuscular paralysis Neurotoxic: progressing neuromuscular paralysis Heamatotoxic: deranged bleeding parameters and clinical bleeding. Heamatotoxic: deranged bleeding parameters and clinical bleeding. ASV dose ASV dose Neurotoxic: 10 vials Neurotoxic: 10 vials Heamatotoxic – 8 – 26 vials Heamatotoxic – 8 – 26 vials

5. Adverse reactions to ASV Minor – itching and utricaria Minor – itching and utricaria –5 (10.4%) Major – anaphylaxis Major – anaphylaxis –2 (4.1%)

6. Outcomes Mechanical ventilation: 11 (22.9%) Mechanical ventilation: 11 (22.9%) Heamodialysis : 6 (12.5%) Heamodialysis : 6 (12.5%) Deaths : 0 Deaths : 0

7. Snakes identified In 3 situations In 3 situations –6%