ABSTRACT
Background: Kumaon region of Uttarakhand has a wide array of snakes. According to national health profile 2016 report on state wise cases and death due to snake bite was 167 and 1 respectively in Uttarakhand 2015 (Jan- December).This led to enquire this statistical disparity in spite of high prevalence of snake bite cases. Aim: To asses treatment outcome of Snake bite victim in tertiary care setting. Material And methods: Outcome was assessed in terms of clinical status at the time of discharge and duration of hospitalization. Results: Dose range of anti snake venom (ASV) for all snake bite victim was 10 -20 vials. 86.36%% case recovered and 13.6% died. Conclusion:Timely appropriate dose of anti snake venom administration has led to better outcome for which transportation of snake bite victim to appropriate health facility with in golden hour is imperative.
ABSTRACT
Background: Rural Bengal has one of the highest snakebite prevalence in India. This prospective observational study was initiated with the motive to analyse the effects and adherence to implementation of the new national snakebite protocol 2016.Methods: Data were collected from the patients admitted with snake bite on a pre-designed and pre tested case study form and analysed with the help of descriptive statistics.Results: A total of 75 patients arrived in the hospital during the study period out which 53 were male (most in the age group of 31-40 years) and majority of them were farmers (26.6%) or housewives (25%). Maximum of them were bitten in the lower limbs (54.6%) and peak time of bite was between 6 am-12 pm (40%). Most of them reached the hospital late, i.e., beyond 2 hours (70.6%). It was found that there were 26 neurotoxic, 16 hemotoxic and 1 neuro-hemotoxic cases and the rest were non-venomous cases. Fifty-one of them received ASV and 4 died. There was 80% adherence in the indication of ASV administration, 73.3% in the ASV dose, 32% in the monitoring after ASV administration, 94.66% in the monitoring 20 WBCT, 100% in adherence to haemodialysis as indicated.Conclusions: The results showed good adherence in all the parameters. Protocol guided treatment has also resulted in rational use of ASV. So, from this study, it was concluded that protocol guided treatment is effective in snakebite management, but its continuous revision and amendments should be considered in future.
ABSTRACT
Background: Dhule district in Maharashtra (India) has snake bite as a common medical emergency. There are 168 villages in Dhule district and its majority of the population is engaged in farming and snakebite is a major occupational hazard particularly during the harvesting season. The available data on the epidemiology of snake bite from the here is sparse. Poisonous and nonpoisonous snake bites accounts approximately 30 admissions per month which increase to 35-40 admissions in rainy season in Civil Hospital. Methods: Fifty patients with severe neuroparalytic snake envenomation, resulting in acute type II respiratory failure, admitted to medical ICU for mechanical ventilation during one year period, were studied. Ventilatory requirements, amount of antisnake venom (ASV) infused, period of neurological recovery and hospital survival were evaluated. Results: 60% of patients affected were in the age group of 21-40 years. Maximum numbers of bites were during April to September (84%). All patients had severe manifestations such as ptosis, ophthalmoplegia, neck muscle weakness, limb and respiratory muscle weakness. 200 ml ASV was administered to all, along with atropine and neostigmine. Mechanical ventilation was required for a median duration of 26.60 hours. All victims in the study group survived with complete neurological recovery except one mortality for a patient who had suffered irreversible hypoxic cerebral injury prior to arrival in hospital and needed ventilatory support for 9.58 days. Conclusions: Timely institution of ventilatory support and fixed dose of 200 ml of ASV along with anticholinesterase treatment was sufficient to reverse neuroparalysis in severe elapid bites.
ABSTRACT
BACKGROUND: ASV is a closed-loop ventilation system that guarantees a user-set minimum per-minute volume in intubated patients, whether paralyzed or with spontaneous breathing. Here, we tested the effects of ASV onrespiratory mechanics and compared them with volume-controlled ventilation (VCV). METHODS: Thirteen patients meeting the criteria for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) were enrolled. All patients were paralyzed to eliminate spontaneous breathing. We started with VCV (VCV1), then used ASV followed by VCV modes (VCV2), maintaining minute volume as much as that of VCV1. RESULTS: During ASV, compared with VCV1, the inspiratory and expiratory tidal volumes and expiratory resistance increased. Conversely, the total respiratory rate and maximum pressure decreased. No changes in the arterial blood gases, heart rate, or mean systemic pressure were noted during the trial. CONCLUSIONS: In ALI/ARDS patients, although no differences were observed in the arterial blood gas analysis between the two modes, ASV provided better respiratory mechanics in terms of peak airway pressure and tidal volume than VCV.