1. SNAKEBITE PROTOCOL DEVELOPMENT WORKSHOP CMC, VELLORE 11.03.2013
A National survey of Snake bites in India (venomous and non-venomous), syndrome-snake species correlations, outcomes and ASV dose requirements
SNAKEBITE PROTOCOL DEVELOPMENT WORKSHOP
CMC, VELLORE

2. GOAL OF THE STUDY
To map the heterogeneity of snakebite syndromes, species of snakes, management practices in different centres and the clinical outcome
To create a National network of hospitals and centres for coordinating snakebite research

3. OBJECTIVES
To describe the clinical profile of snake envenomation presenting in geographically representative regions in India
To identify snake species and sub-species from the different geographical regions causing bites
To analyze the correlation between the clinical syndrome of snake envenomation and the snake species
To assess the management practices and outcomes in various regions and anti-snake venom dose requirements according to snakebite syndrome and different snakebite protocols used in different centres.

4. methodology

5. STUY DESIGN Multicentric study Observational Descriptive study
Over a period of 2 years

6. CLINICAL COLLABORATING CENTRES
Centres are selected depending on the case load and commitment to the study

7. HERPETOLOGY & VENOM DETECTION
Mr.Romulus Wittakar
Mr. Gerry Martin
Dr. Anita Malhotra
Mr.Vishal Santra
External Consultants
Dr.David Laloo
Dr.Faiz
Dr.Arirani
Venom Detection
Dr.Ashish K Mukerjee
Dr.Oommen
Dr.Dhananjaya
Dr. Sridevi
Dr.Amudhavalli
Mr.Radhakrishnan
Dr.Jayaraman

8. STUDY FLOW CHART Suspected Snakebite Admission Treatment Discharge
Informed consent
Venomous bite
Admission
Treatment
Discharge
Non-venomous bite
Observation
Documentation
Using proforma at admission and daily till discharge

9. DOCUMENTATION The study proforma: Details of bite Snake identification
Clinical syndrome
Laboratory evaluation
Complications
Treatment
ASV dose requirement
Mechanical ventilation
Neostigmine
Transfusions
Antibiotics
Outcomes

10. SUGGESTED LIST OF ESSENTIAL INVESTIGATIONS
Admission
WBCT or PT,PTT
CBC
Blood picture
Creatinine
Electrolytes
Follow up
Haemotoxic- WBCT or PT,PTT every 6 hours till normal
Renal failure- creatinine daily till normal

11. Management
The management of the cases and the dosage of ASV will be according to the discretion of the treating physician and the institutional snakebite management protocol

12. DEAD SNAKE STORAGE PROTOCOL
Dead snake available
Photograph will be taken
Stored in formalin - dilution of 40% formalin solution with water in 1:5 dilution
Part or whole snake can be preserved in 70% ethanol for DNA analysis

13. Samples required for venom detection studies
Bite site swab
Serum
Urine

14. Thank you

16. Some valuable comments from participants
Legal and social implications in killing snakes
High quality photographs /videos of snakes to be available in all centres
Idea of closed face-book for dead snake identification
Previous ASV administration
Multicentric study with lot of challenges. Proper co-ordination is vital
Cell-phone photo should be encouraged
Suggestion regarding electronic data entry
Collection of swabs should be encouraged

17. Valuable comments from participants
Increase sample size to improve identification
Use of 10%formalin (4% formaldehyde) for storage
Long term storage in formalin can spoil the specimen and so I week formalin followed by 1 day in water to leach out the formalin, then transfer to 80% ethanol
A small amount of tissue should be collected separately BEFORE formalin fixing in 80% pure ethanol for DNA analysis
Photographs should be taken before formalin fixing