Mechanical ventilation in snake bite

ABSTRACT

A reversible neuromuscular blockade occurring after envenomation by a neurotoxic snake may lead to respiratory and bulbar paralysis. We present our experience in managing such a case in which all modalities of treatment including anti-snake venom [polyvalent antiserum], anticholinesterases and assisted ventilation were used. An 18 years old boy was admitted in Intensive Care Unit of Pakistan Ordinance Factories Hospital Wah Cantt with two hours history of snake bite on the dorsal aspect of left thumb. At the time of admission he was conscious with normal muscle power and breathing. The bleeding profile did not reveal any abnormality. Three hours later he developed blurring of vision, slurred speech and muscle weakness followed by difficulty in breathing and became tachypnoeic and cyanosed. He was immediately intubated and placed on ventilator after initial ventilatory support with Ambu bag. Polyvalent anti-snake venom, neostigmine and atropine were administered. Meticulous nursing care was provided with continuous monitoring of haemodynamic and respiratory variables. The clinical condition started improving on 4[th] day with spontaneous opening of eyes but on 6[th] day he developed pneumonia which was aggressively treated with antibiotics. Respiratory effort appeared on 9th day and gradually increased to adequate level on 14[th] day. He was removed from ventilator on 15[th] day. We suggest that mechanical ventilation is a helpful modality in case of respiratory failure occurring due to snake envenomation and its timely institution results in better prognosis