Snake bites

NAV JIVAN HOSPITALTUMBAGARA, SATBARWA POSTPALAMU DISTRICT, JHARKHAND

Where are we . . .

How to reach NJH . . .

• From Kolkota: 12 hours by train to DTO• From Ranchi: 4 hours by road: 135 kilometers• From Delhi: 12 hours by trains to DTO –

rajdhani/garib rath

• Nearest rail-head: Daltonganj (DTO): 35 kilometers

HOW BUSY WE ARE . . .

2009-10 2010-11 2011-12 2012-13 (till 28 feb)

GENERAL OP 11355 12378 14322 18965EYE OP 5682 5203 5298 5546ANTENATAL 1404 1890 2629 3056DENTAL 522 608 880 1159INPATIENTS 4812 5037 4510 5054DELIVERIES 1040 1294 1374 1449CESARIAN 313 363 429 442

Snake Bites . . .

2012 (Jan-Dec) – Alleged snake

ALLEGED SNAKE

MALE FEMALE TOTAL

KRAIT 22 23 45COBRA 1 3 4VIPER 15 8 23UNKNOWN 19 26 45OTHERS 2 8 10

TOTAL 59 68 127

SYNDROMES

DIAGNOSIS MALE FEMALE TOTALNON VENOMOUS 29 37 66NEUROTOXIC 12 17 29HEMOTOXIC 8 4 12NEUROTOXIC AND HEMOTOXIC 1 0 1ONLY LOCAL REACTION 9 6 15OTHERS 0 4 4

Snakes brought . . .

• 5 (out of 127)• 4 alive ? ? ?

Mechanical Ventilation

MALES FEMALES TOTALNEUROTOXIC

12 17 29NEEDED MECHANICAL VENTILATION 9 9 18

Haemodialysis

• All bites with deranged whole blood clotting time.

• Nearest dialysis centre – 135 kms away• Transport facilities – safe only in daytime• Extreme poverty

4 deaths

Age Alleged snake Syndrome Cause of death

16Unknown Haemotoxic ? Anaphylaxis

12Unknown Neurotoxic ? Anaphylaxis

72

Krait Hemotoxic +Neurotoxic Cardiac arrest on ventilator

40Viper Hemotoxic ? Myocarditis

Facilities we have . . .

• Can do only clotting time.• Anaesthesia ventilator• No blood bank. But if donor is available, we

have facilities to bleed the donor and donate it immediately.

When do we refer . . .

• We give all patients an option to go to higher centre.

• 135 kms away• Poor road and transportation facilities• Patients on respiratory arrest . . . No choice• Viper bites . . . All efforts to refer

Issues of concern – unknown bites

MALES FEMALES TOTALNON VENOMOUS 14 23 37NEUROTOXIC 2 2 4HEMOTOXIC 3 1 4

TOTAL UNKNOWN BITES 19 26 45