{"id":23,"date":"2010-01-20T16:15:40","date_gmt":"2010-01-20T10:45:40","guid":{"rendered":"http:\/\/www.snake-scorpion.com\/?page_id=23"},"modified":"2010-01-20T16:15:40","modified_gmt":"2010-01-20T10:45:40","slug":"1-1-general","status":"publish","type":"page","link":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/section-i-snakebite\/1-1-general\/","title":{"rendered":"1.1 General"},"content":{"rendered":"

Introduction
\nIn many parts of India, snake is worshipped and in some areas special prayers
\nare performed. In Northern India on Naga Panjami day people worship snake idol. In
\ncertain areas of Maharashtra and Goa the live snakes, rarely live cobras are brought
\nfor worship. Snake charmers carry snakes especially cobra, door to door for worship.
\nAt every house the snake\u2019s mouth is forced open and some milk is poured down in
\nits throat though milk is not snake food. It is also believed that snakes bite people
\nwho harmed them in their previous birth. When snakes are killed, people offer special
\nprayers and bury them. People also believe that snakes take revenge against those who
\nharmed them.
\nIn view of their strong beliefs and many associated myths, people resort to magicoreligious
\ntreatment for snake bite thus causing delay in seeking proper treatment. As a
\nresult, valuable time is lost in some of the deserving cases. It is poignant to note that
\nsome of the cinema and TV serial stories even now propagate non-scientifi c ideas on
\nsnakes and snakebites, and display traditional treatment. Hence, there is a need for
\nthe health department to disseminate the scientifi c aspects related to snakebites to the
\ncommunity.
\nMagnitude of the problem
\nRecently global burden of snake bite was assessed using available published data
\nand modeling technique. From that it is estimated that 4,21,000 envenomations and
\n20,000 deaths occur annually. These fi gures may be as high as 18,41,000 envenomation
\nsand 94,000 deaths.
\nSnake bites contribute to health problem in India and continue to be a major
\nmedical concern. India alone contributes to 81,000 envenomations and 11,000 deaths
\nannually. Based on the above statistics, it appears that every 10 seconds one individual
\nis envenomed and one among four dies due to snake bite. Many deaths occur before
\nthe victim reaches the hospital. Actually up-to-date national data, on the morbidity
\nand mortality due to snakebite is not available. Moreover there is no national snake
\nbite registry in India. So the available statistics is incomplete and not systematically
\ncollected. In 1972, Dr. Sawai and Dr. Homma of the Japan Snake Institute studied
\nsnakebite in about 10 hospitals in India. They reported that about 10% of snakebite
\ndeaths are among the victims who come to the hospital and about 90% die outside,
\nhaving gone for other remedies like mantra, magic, and so on. However things are
\nvery different now, after 35 years.
\nGovernment General Hospital, Chennai, from January to December 2006 has
\ntreated 281 cases of snakebites. Among them, there were 182 males and 99 females.
\nTreatment Guidelines for Snakebite and Scorpion sting
\n2 Tamil Nadu Health Systems Project, H&FW Dept, Govt of Tamil Nadu, Chennai.
\n94 were referred after treatment in different hospitals and 187 were brought to the
\nhospital directly. 274 (97.5%) survived and 7 died due to various complications of
\nsnakebite while they were in the hospital. The details on the type of snakes, clinical
\nsigns, complications, number referred, number who received supportive therapy and
\ndeath are provided below (Table no.1).<\/p>\n\n\n\n\n\n\n\n\n\n\n\n
Type of<\/span>snake<\/span><\/td>\nNumber<\/span>treated<\/span><\/td>\nLocal signs<\/span><\/td>\nNeuro Toxicity <\/span><\/td>\nHemo.<\/span>Toxicity<\/span><\/td>\nSupportive<\/span><\/td>\nNumber<\/span>Expired<\/span><\/td>\n<\/tr>\n
Mechnical<\/span>ventilation<\/span><\/td>\nHemo-<\/span>Dialysis<\/span><\/td>\nFasciotomy.<\/span><\/td>\n<\/tr>\n
Cobra<\/span><\/td>\n118<\/span><\/td>\n80<\/span><\/td>\n118<\/span><\/td>\n–<\/span><\/td>\n90<\/span><\/td>\n–<\/span><\/td>\n–<\/span><\/td>\n2<\/span><\/td>\n<\/tr>\n
Krait<\/span><\/td>\n82<\/span><\/td>\n–<\/span><\/td>\n51<\/span><\/td>\n82<\/span><\/td>\n60<\/span><\/td>\n30<\/span><\/td>\n–<\/span><\/td>\n2<\/span><\/td>\n<\/tr>\n
Russell’s<\/span>viper<\/span><\/td>\n42<\/span><\/td>\n42<\/span><\/td>\n–<\/span><\/td>\n42<\/span><\/td>\n6<\/span><\/td>\n23<\/span><\/td>\n1<\/span><\/td>\n1<\/span><\/td>\n<\/tr>\n
Hump- nosed<\/span>viper<\/span><\/td>\n4<\/span><\/td>\n4<\/span><\/td>\n–<\/span><\/td>\n4<\/span><\/td>\n–<\/span><\/td>\n4<\/span><\/td>\n–<\/span><\/td>\n1<\/span><\/td>\n<\/tr>\n
Saw scaled<\/span>viper<\/span><\/td>\n16<\/span><\/td>\n16<\/span><\/td>\n–<\/span><\/td>\n16<\/span><\/td>\n–<\/span><\/td>\n3<\/span><\/td>\n–<\/span><\/td>\n1<\/span><\/td>\n<\/tr>\n
Sea<\/span>snake<\/span><\/td>\n3<\/span><\/td>\n3<\/span><\/td>\n–<\/span><\/td>\n–<\/span><\/td>\n–<\/span><\/td>\n–<\/span><\/td>\n–<\/span><\/td>\n–<\/span><\/td>\n<\/tr>\n
Non poisonous<\/span><\/td>\n16<\/span><\/td>\n6<\/span><\/td>\n–<\/span><\/td>\n–<\/span><\/td>\n–<\/span><\/td>\n–<\/span><\/td>\n–<\/span><\/td>\n–<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

An equal or more number of snake bite cases were admitted and treated at other
\nGovernment Medical College Hospitals. Patients go to private hospitals mostly for
\nfi rst aid purposes. Very few get adequate treatment in these hospitals.
\nIn Tamil Nadu the total number of snake bite cases admitted (and expired) in the
\nsecondary care hospitals alone during 2005 – 2006 and 2006 -2007 were 19321(85)
\nand 20677(75) respectively. The total number of ASV vials used in these hospitals
\nduring the respective periods were 94481 and 96800 (Annexure I). Over all analysis
\nrevealed that the snakebites and ASV usage in West, North, East, Central, South zone
\nof Tamil Nadu were 13, 17, 20, 24 and 26% respectively.<\/p>\n

The Government is spending a huge sum of money in procuring and supplying anti
\nsnake venom. On an average, Government hospitals spend a minimum of Rs.5,000\/- per
\ncase of Snake bite and patient spends an equal amount for socio-cultural and magicoreligious
\naspects. The money lost due to loss of job and earning as well as loss of lives
\nis huge, and thus has an impact on the national economy.<\/p>\n

Deaths due to snakebite can be prevented, if some simple fi rst aid measures are undertaken by the public and \/ or by
\nthe health care providers. So, there is an urgent need to take effective steps to contain
\nthese issues.<\/p>\n

Many of the fi rst aid measures carried out at present are ineffective and dangerous.
\nThe research also concluded that the other traditional methods followed for snake
\nbite are not appropriate. It is gratifying to note that the traditional snake catchers in
\nTamil Nadu, the Irulas with their own sophisticated herbal medicine system, have now
\nunderstood the problems? They know that the snake injects venom which goes deep
\ninto the system and this can be neutralised only by injection of Anti snake venom
\n(ASV) and not by oral or locally applied remedies, no matter how famous. But this
\ninformation needs to reach other communities also.
\nHence, the need to recommend the most effective fi rst aid to the victims bitten by
\nsnakes and to recommend effective steps in the management of this problem. Poisoning
\ndue to cobra and viper groups are seen frequently in the state of Tamil Nadu. Very
\nrarely sea snakebite cases are reported. Hence, this hand book focuses on the fi rst two.
\nThough the specifi c antidote is not available for sea snake, the same general principles
\nfor other snakebites are applicable here too.
\nEpidemiology of snakebite
\nSnakebite is observed all over the country with a rural \/ urban ratio of 9:1. They
\nare more common during monsoon and post monsoon seasons. Snakebites are seen
\noften among agricultural workers and among those going to the forest. Many of the
\nsusceptible populations are poor living below poverty line, living in rural areas with
\nless access to health care. The male \/ female ratio among the victims is approximately
\n3:2. Majority are young and their age is between 25 to 44 years. Most of the bites (90
\nto 95%) are noticed on the extremities (limbs). The hospital stay varies from 2 to 30
\ndays, with the median being 4 days. The in-hospital mortality varies from 5 to 10%,
\nand the causes are acute renal failure, respiratory failure, sepsis, bleeding and others.
\nEcological aspects:
\nBy destroying forests for creating agricultural land, the prey base of the snake
\n(that is frogs and rats) has increased. The rice fi elds, which harbour millions of rats
\nattract a lot of snakes. The number of snakes per acre in a rice fi eld is abnormally
\nhigh when compared to the natural population in the forest. Humans go into the fi eld
\nevery morning and come out in the evening, just the time when snakes are active.
\nThus, the chance of an encounter between farmer and snake is very high. As more
\nareas are inhabited at the periphery of towns, even there the chances of human \/ snake
\ninteraction increase.<\/p>\n

Cobras fl ourish as long as there are rice fi elds; there they feed mainly on the mole
\nrat (varapu eli in Tamil), live and lay their eggs in the rat burrow networks. Kraits also
\nget by very well in rice fi elds because they like the plentiful small rodents such as thefi eld mouse (sundeli in Tamil) and rock mouse (kallu eli in Tamil). Kraits are also found
\nin the mounds of earth and rubble near wells. The Russell\u2019s viper lives in the rocky
\noutcrops and hedgerows of cactus and other bushes which often form the boundaries of
\nagricultural land. There, on the high ground, they have a plentiful supply of common
\ngerbil (velleli in Tamil) which are also attracted to the wealth of food humans provide
\nby their farming activities! But thanks to snakes, we are not overrun by rodents.<\/p>\n","protected":false},"excerpt":{"rendered":"

Introduction In many parts of India, snake is worshipped and in some areas special prayers are performed. In Northern India on Naga Panjami day people worship snake idol. In certain areas of Maharashtra and Goa the live snakes, rarely live cobras are brought for worship. Snake charmers carry snakes especially cobra, door to door for […]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":21,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-23","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages\/23","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/comments?post=23"}],"version-history":[{"count":0,"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages\/23\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages\/21"}],"wp:attachment":[{"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/media?parent=23"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}