A key objective of this guideline is to enable even the doctors working in Primary
\nCare Institutions as well as private practitioners treat snakebite with confi dence.
\nEvidence suggests that doctors are not willing to make use of ASV and other
\nmedications, even when equipped, due to lack of confi dence and guidelines. The
\npresent handbook on guidelines is prepared to suite their needs and outlines how they
\nshould proceed within their context and setting. The principles envisaged to treat snake
\nbite at all Health Centres \/ Hospitals irrespective of the status – Government or Private
\nare given below in Table no: 7. The initial evaluation and systemic manifestations
\nfollowing envenomation, and treatment aspects are provided in Tables 12, 13 and 14
\nrespectively.
\nTable No. 12: Initial evaluation \u2013 No Systemic Envenomation
\nASSESS
\nVital signs
\n\u2022 Pulse
\n\u2022 BP
\n\u2022 Respiration
\nSymptoms and signs
\n\u2022 Bite marks
\n\u2022 Ptosis
\n\u2022 Double vision
\n\u2022 Diffi culty in
\nswallowing
\n\u2022 Bleeding sites
\n\u2022 Reduced urine output
\n\u2022 Swelling and local
\npain
\n\u2022 Local necrosis
\n\u2022 Descending paralysis
\n\u2022 Unconsciousness
\n\u2022 Regional
\nlymphadenitis
\n\u2022 Any other symptoms
\nand signs noted down
\nCLASSIFY
\nVital signs (Adult)*
\n\u2022 Pulse rate: 60-100\/min
\n\u2022 BP 110 \/ 70 to 140\/95
\n\u2022 Respiratory rate <20\/\nmin\nSymptoms and signs\n\u2022 Local pain and\/ or\nswelling+\n\u2022 Bite mark present,\nskin broken\n\u2022 No other symptoms\nand signs present\nLaboratory test:\n20 Minutes Whole Blood\nClotting Test - blood clot\nformed\nIf above fi ndings are there\nat the time of assessment\nclassify as No systemic\nenvenomation\nTREATMENT\nTab.Paracetamol\nInj.Tetanus Toxoid IM\nRoutine antimicrobials are\nnot necessary\nMonitor Pulse, Respiration\n& BP every \u00bd hourly for 3\nhours and every 4th hourly\nfor remaining 48 hours.\nIf normal send the\npatient home\n*Vital signs for children (see age specifi c chart) are provided in Annexure II.\nIf the patient has any systemic manifestations refer to Table.13 and 14 for hemotoxic\nand neurotoxic envenomation respectively. The details of local envenomation are\nprovided in Table 4.\nTable No. 13: Haemotoxic envenomation\nASSESS \nVital signs\n\u2022 Pulse\n\u2022 BP\n\u2022 Respiration\nSymptoms and signs\n\u2022 Bite marks\n\u2022 Ptosis\n\u2022 Double vision\n\u2022 Diffi culty in\nswallowing\n\u2022 Bleeding sites\n\u2022 Reduced urine output\n\u2022 Swelling and local\npain\n\u2022 Local necrosis\n\u2022 Descending paralysis\n\u2022 Unconsciousness\n\u2022 Lymphadenitis\n\u2022 Breathing diffi culty\n\u2022 Any other, note\ndown\n\n\nCLASSIFY \nVital signs (Adult)*\nPulse rate >120 per
\nminute, feeble (a
\nresponse to hypotension)
\nRespiratory rate > 20\/min
\nHypotension <\n90\/60 mmHg\nSymptoms and signs\nSwelling and local pain\nor painful enlargement of\nnearby lymphnodes\nBleeding from the\n\u2022 Gingival sulci\n\u2022 Epistaxis\nPetechiae, purpura,\necchymoses\nHematuria\nIntracranial bleeding:\n\u2022 asymmetrical pupils\n\u2022 unconsciousness\n\u2022 convulsions\nPersistent and severe\nvomiting or abdominal\npain\nLow back pain\nNo urine output or\ndecreased urine output\nLaboratory test:\n20 Minutes Whole Blood\nClotting Test.\n\u2022 Blood clot not\nformed\nIf above fi ndings are\nthere at the time of\nexamination classify as\nHaemotoxic\nenvenomation\nTREATMENT\nTreat the patient with Anti\nSnake Venom (ASV)\n\u2022 Start IV Normal Saline with\nwide bore needle\n\u2022 Begin with one vial of ASV\nin one point of NS and start\n10-15 drops per minute for\n15 minutes & watch for\nreactions.\n\u2022 If signs and symptoms of\nanaphylactic shock (cold\nand clammy skin, rapid\npulse, dyspnoea, etc.)\ndevelop, stop the ASV drip\ntemporarily and treat the\nshock with:\nInj.Hydrocortisone 100 mg IV or\nInj.Dexamethasone 8 mg IV\nInj.Pheniramine maleate 2ml IV\nInj.Adrenaline 1:1000 (0.5ml)IM\nInj.Deriphyline 2ml IV\nOxygen administration\nIV Normal saline as life line\n\u2022 As soon as the patient\nrecovers or\n\u2022 If the patient is not having\nsigns and symptoms\nof anaphylactic shock\ncontinue the ASV drip with\nremaining seven vials \/\nampoules\n\u2022 Continue to monitor the\nvital signs at fi ve minutes\ninterval for fi rst 30 minutes\nand then at 15 minutes\ninterval for two hours\n\u2022 Stabilise the patient and\nrefer to the higher institution\nAspirin should not be used\nFluid requirements per day should be kept in mind while giving ASV. For children\nreaders are requested to see the fl uid requirement chart provided in Annexure II.\n[Table No.29]\n* Vital signs for children (see age specifi c chart) are provided in Annexure III.\n[Table no.30 to 33].\nTable No. 14: Neurotoxic envenomation\nASSESS \nFor local\nenvenomation\nrefer to Table\n4.\nFor systemic\nenvenomation\nrefer to Tables\n12 and 13\nCLASSIFY \nSymptoms and signs\n\u2022 Swelling and local pain\n\u2022 Local necrosis\n\u2022 Descending paralysis starting with\nptosis, external ophthalmoplegia\n\u2022 Numbness around the lips and\nmouth progressing to pooling of\nsecretions, diffi culty to talk and\nrespiratory failure\n\u2022 Paradoxical respiration\n\u2022 Paralysis\n\u2022 Abdominal pain\nLaboratory test:\n20 Minutes WBCT - Blood clot formed\nIf above signs & symptoms are\npresent at the time of admission\nclassify as Neurotoxic envenomation\nTREATMENT\nTreat the patient with ASV\nas mentioned in Table 13\nand add the following:\nInj.Neostigmine 1.5 mg\n(Therapeutic Test dose) as\nIM and\nInj.Atropine 0.6 mg (Test\ndose) as IV\nAfter that observe patient\nfor every fi ve minutes for\n30 minutes for signs of\nresponse\n\n\n<\/p>\n","protected":false},"excerpt":{"rendered":"
A key objective of this guideline is to enable even the doctors working in Primary Care Institutions as well as private practitioners treat snakebite with confi dence. Evidence suggests that doctors are not willing to make use of ASV and other medications, even when equipped, due to lack of confi dence and guidelines. The present […]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":21,"menu_order":6,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-47","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages\/47","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=47"}],"version-history":[{"count":0,"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages\/47\/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=47"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}