SNAKEBITE PROTOCOL DEVELOPMENT WORKSHOP CMC, VELLORE 11.03.2013 A NATIONAL SURVEY OF SNAKE BITES IN...
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Transcript of SNAKEBITE PROTOCOL DEVELOPMENT WORKSHOP CMC, VELLORE 11.03.2013 A NATIONAL SURVEY OF SNAKE BITES IN...
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S N A K E B I T E P R O T O C O L D E V E LO P M E N T W O R K S H O P
C M C , V E L LO R E1 1 . 0 3 . 2 0 1 3
A NATIONAL SURVEY OF SNAKE BITES IN INDIA (VENOMOUS AND NON-VENOMOUS), SYNDROME-
SNAKE SPECIES CORRELATIONS, OUTCOMES AND ASV DOSE
REQUIREMENTS
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GOAL OF THE STUDY
• To map the heterogeneity of snakebite
syndromes, species of snakes, management
practices in different centres and the clinical
outcome
• To create a National network of hospitals and
centres for coordinating snakebite research
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OBJECTIVES
• To describe the clinical profile of snake envenomation presenting in geographically representative regions in India
• To identify snake species and sub-species from the different geographical regions causing bites
• To analyze the correlation between the clinical syndrome of snake envenomation and the snake species
• To assess the management practices and outcomes in various regions and anti-snake venom dose requirements according to snakebite syndrome and different snakebite protocols used in different centres.
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METHODOLOGY
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STUY DESIGN
• Multicentric study
• Observational
• Descriptive study
• Over a period of 2 years
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CLINICAL COLLABORATING CENTRES
Centres are selected depending on the case load and commitment to the study
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HERPETOLOGY & VENOM DETECTION
Herpetology• Mr.Romulus Wittakar• Mr. Gerry Martin• Dr. Anita Malhotra• Mr.Vishal Santra• External Consultants• Dr.David Laloo• Dr.Faiz• Dr.Arirani
Venom Detection• Dr.Ashish K
Mukerjee• Dr.Oommen• Dr.Dhananjaya • Dr. Sridevi• Dr.Amudhavalli• Mr.Radhakrishnan• Dr.Jayaraman
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Informed consent
Venomous bite
Admission
Treatment
Discharge
Non-venomous bite
Observation
Discharge
Suspected Snakebite
DocumentationUsing proforma at admission and daily till discharge
STUDY FLOW CHART
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DOCUMENTATION
The study proforma:• Details of bite• Snake
identification• Clinical syndrome• Laboratory
evaluation• Complications
TreatmentASV dose requirementMechanical ventilationNeostigmineTransfusionsAntibiotics
Outcomes
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SUGGESTED LIST OF ESSENTIAL INVESTIGATIONS
Follow up
• Haemotoxic- WBCT
or PT,PTT every 6
hours till normal
• Renal failure-
creatinine daily till
normal
Admission
• WBCT or PT,PTT
• CBC
• Blood picture
• Creatinine
• Electrolytes
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MANAGEMENT
The management of the cases and the
dosage of ASV will be according to the
discretion of the treating physician and
the institutional snakebite
management protocol
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DEAD SNAKE STORAGE PROTOCOL
Dead snake available
Photograph will be taken
Stored in formalin - dilution of 40% formalin solution with water in 1:5 dilution
Part or whole snake can be preserved in 70% ethanol for DNA analysis
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SAMPLES REQUIRED FOR VENOM DETECTION STUDIES
• Bite site swab
• Serum
• Urine
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THANK YOU
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SOME VALUABLE COMMENTS FROM PARTICIPANTS
• Legal and social implications in killing snakes
• High quality photographs /videos of snakes to be available in all
centres
• Idea of closed face-book for dead snake identification
• Previous ASV administration
• Multicentric study with lot of challenges. Proper co-ordination is vital
• Cell-phone photo should be encouraged
• Suggestion regarding electronic data entry
• Collection of swabs should be encouraged
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VALUABLE COMMENTS FROM PARTICIPANTS
• Increase sample size to improve identification
• Use of 10%formalin (4% formaldehyde) for storage
• Long term storage in formalin can spoil the specimen
and so I week formalin followed by 1 day in water to
leach out the formalin, then transfer to 80% ethanol
• A small amount of tissue should be collected separately
BEFORE formalin fixing in 80% pure ethanol for DNA
analysis
• Photographs should be taken before formalin fixing