Aims

  • Mass Awareness programs for prevention of snake bite
  • To Achieve 100% survival after snake bite by Early hospitalization & prompt Treatment for victims.
  • Training/workshop program for Doctors & paramedical staff.
  • Research

Snake Bite Management, Research Toxicology Training Center

Introduction

THE SNAKEBITE PROBLEM- A ‘DISEASE’ OF POVERTY
Snakebite affects the lives of around 4.5 million people worldwide every year; seriously injuring 2.7
million men, women and children, and claiming some 125,000 lives. Globally the greatest burden is
experienced in the tropical world; where many nations remain under developed or suffer from poor
governance, political and/or social, conflict, resource scarcity, high disease burdens, or food insecurity. The
available evidence shows that it is in the world’s poorest economies that the burden of snakebite mortality
is the greatest, and survival is no guarantee of a full recovery, with many thousands of victims being left
permanently disabled and emotionally destroyed by their injuries.

No Disease. Incidence Deaths
1 Snakebite envenoming 2682000 100000
2 Chaga’s disease 217000 14000
3 Cholera 178000 4000
4 Dengue Hemorrhagic fever 73000 19000
5 Leishmaniasis 1691000 51000
6 Japanese encephalitis 44000 14000
7 Schistosomiasis 5733000 15000
8 Yellow fever 2100 100

The World Health Organization added snakebite to the list of Neglected Tropical Diseases in 2009,
but made no provision to seek global funding to do anything about the problem. Like all endeavors, global
health is highly politicized, and it wasn’t long before snakebite was downgraded by WHO under a subdefinition:
“Other ‘neglected’ conditions“. This belies the extent of the problem – snakebite is a global
catastrophe affecting millions of the world’s poorest, and least empowered people. A 1998 WHO analysis of
global snakebite envenoming incidence and mortality provided figures that can be used to place snakebite
in comparison to other tropical illnesses:
Part of the explanation for why snakebite towers over many of these other diseases in terms of
numbers, perhaps lies in the fact that of all of the other neglected tropical diseases shown have been
subject to substantial control programs by the international community, while snakebite remains largely
unfunded and ignored among global public health priorities. The Global Snakebite Initiative was born out
of the desire by a group of international snakebite researchers to shift attention from simply reporting the
problems, to actively do something to solve them.

Project

 

0% morality & 0% Renal Failure in Russell’s viper patients in Rural Set Up

This poster is presented at IST World Congress – Oxford University UK. 2014

Cobra bite observations

  • Site of bite:-Rt leg:-16,lt leg:-18,Rt hand:-14,Lt hand:-7.
  • Total no. of cases:- 55 (M-33,F- 22).
  • Time of bite:- Maximum bites during day time and working hours.
  • Average time of bite and admission:-Min:-15mins,Max:-2 to 3hrs.
  • Seasonal Variation –June, July, Sept.
  • Direct Admissions :- 30(55%),Referred :-25(45%) .
  • Age group :- Max bites in working age group 20 to 50 yrs (5 ys-82 yrs)
  • 3 snake Rescuers bitten by cobra while wrong handling.
  • Last few years in our dist. 16 snake rescuers died due snake bite
  • 11 Cobra were brought killed by victims & 4 were brought live
  • 25 % patients of cobra bite required Ventilator .
  • ventilator  requirement from 3 to 12 hours. Recurrence of  symptoms in one patient.
  • Local Necrosis -20(36 %),Skin Grafting – 6(11%).
  • No mortality.

Common Krait :- Total no of pts :- 53

  • M 31, F 22
  • Krait brought killed :-12 (22.64%).No history of snakebite- diagnosis clinically
    • Site of bite:-LL :- 9(17%), RL:- 8(15%), Lt hand:-16(30%),
    • Rt hand:-9(17%), Pinna of ear:-1(2%),
    • Bite mark not seen:-11(22%).Multiple bites:-2(4%)
    • Time of bite: in the early morning. Age-4 mths to 70 yrs
    • Time of development of symptoms:- 1 hrs-8 hrs
    • Bite mark may or may not seen, no swelling, Pain in abdomen, vomiting,

    Ptosis,  Dyspnoea, Dysarthria, Paralysis, Coma.

     One patient had hemetemesis

    • Direct admission :-32(60%) cases & Referred from PHCS:-21(40%) cases.
    • Time between bite and admission :-2-3 hrs. Mini:- half hr. Max:- 7-8 hrs.
    • Ventilator: 25 (47.17%) , NIV:- 6, Tracheostomy-1.
    • Unusual presentations – only pain in abd in children, Coma, convulsions, pulm oedema, stroke,  High suspicion of having snake bite is required

Russell's Viper Bite

  • Total no. of Pts :- 93 ( M 51, F 42).
  • Snake brought killed :- 27 (29%).
  • Site of bite:-LL leg:- 25, RL:- 28 Lt hand:- 25, Rt hand:-15,
  • Dry bite :- 3, Max bite in June, July, August.
  • Rare sites of bite:- neck, chest, abdomen, Multiple bites -2.
  • Time of bite:- Maximum bites in afternoon and evening.
  • Age group:- (3-76 yrs) Max in 20-50 yrs, working age group.
  • Severe local pain, Generalized swelling, Tenderness, Coagulopathy, Shock.
  • Neurotoxicity :- 6. ptosis, flaccid paralysis.
  • Ventilator :-6 (6.4%). NIV :- M :- 3, F :- 2.
  • Server necrosis :- 2 skin grafting :-1.
  • Hemetemesis M :- 2, F :- 3, 5.3%.
  • Nephrotoxicity :- 6. Managed medically,-3 Haemodialysis- 3 pts
  • Average ASVS -20-30 vials max-45 ASVS.
  • No fasciotomy, Skin grafting 1.
  • 100 % survival.
Saw Scaled Viper Bite Date and Time of Bite 06/05/21@11: 30 Am
DOA : 07/05/21@ 9 :30 pm Age : 67
WBCI prolonged, Thrombocytopenia and Swelling up to upper arm, ecchymosis.
Required more vails of ASVs.
35 years male was admitted with H/O Cobra bite during sleep (Sleeping on the Floor) Date of Bite on 06/05/21@ 01: 30 Am
DoA : 06/05/21 @ 2:15 Am.
Had cardiorespiratory arrest immediately after admission H/O vomiting Treated with CPR for one n half hour, NIV, Inj Ateopine, Inj Neostigmine, Inj Efcorlin, Inj Sodabicarb Emm Endotracheal intubation done kept On a ventilator for 24 hrs, Inj ASVs 21 vials given. Extubated Fully conscious well oriented. Local swelling treated with Antibiotics.

65 yrs old lady with RV bite brought immediately half hour after bite in shock BP 80 systolic , excessive sweating and cold peripheries , gum bleeding , severe local swelling , WBCT not clotted 45 minutes , total ASVS 25 shock management . Fully recovered no local necrosis

RV bite victim survived, limb is also saved extensive Necrosis debridement 3 times and skin grafting . required 3 months for full recovery

On the International Snake Bite awareness day Sandesh Dumbre 15 yrs boy with H/O common Krait bite was extubated. He had Krait bite on 9/9/19 @ 3 am while sleeping on the floor .Initially thought it was ant bite .started getting vomiting ,pain in abdomen and loose motions admitted @10 am with bradycardia ,hypotension, gasping . Was kept on ventilator for 9 days .Unconscious for 4 days .slowly recovered. Extubated today feeling happy with parents

4 month, Female baby, had a snake bite while sleeping in cradle (Zoli). Bite on forehead, brought Semiconscious Ventilated ASV – 5, Recovered completely.

  • 60 yrs Female , H/O bite – at 1.30am during sleep .
  • Bite Twice admitted 4.20 am (3 hrs) .
  • c/o vomiting, abd pain ,semiconscious.
  • Pulse 122 / min. BP – 170/110 mm of Hg
  • Severe ptosis, DJ Absent ,SPO2 80
  • Kept on ventilator immediately .
  • On day 3 minimal response to pain.
  • Extubated after 8 days Recovered fully.

Name – Sulabai Waman Dhole, Age – 65yrs

Adress– At/Post – Shiroli, Tal.-  Junnar, Dist. – Pune

DOA  – 3/7/13, DOD – 10/7/13

Activity – Sitting on door steps of entrance of house had Cobra Bite on gluteal region  left side, during rainy season (July).

Total ASV given 17, managed by nasal o2 ,Ventilator not required

Local Septic wound with severe necrosis.

Required  debridement

Name – Bhor Skhubai  Haribhau

Age – 35 Sex – Female

Address – At/ Post  Walti, Tal – Ambegaon, Dist – Pune.

DOA –14/9/09

DOD – 21/9/09

Local Manifestation –  Necrosis.

ASV – 18

Russell’s Viper Bite – Mr. Dongre. DOA – 1 May 13

History of snake bite while feeding cattle, Below left nipple, severe pain, swelling, erythema, hypotension.

ØName   – Vasant  parshuram  Thorve, 65 yrs.

Address   – At/Post – Shiroli Br., Tal – Junnar, Dist – Pune.

DOA   – 26/2/14, DOD – 16/3/14

H/o snake bite on ankle of the right foot while watering the plants.

Total ASV 15 Ampuls

Local wound necrosis, debridement done

WBCT   – Incomplete up to 25 min

Name  : Miss. Sujata Dongre

Age  :19 years

Sex   : Female

Summary  : H/O Russell’s viper Bite.  Bite on the left side foot.   Patient was admitted 2 Hours after bite.

Date   : 17/7/2009

WBCT   : Incomplete up to 45 min.

Patient also had hematuria & upper  G.I.Bleeding.

35yrs F, RV Bite at Lt foot Hypotension, thrombocytopenia, decreased urine output severe local swelling with pain, swelling increase up to left Breast, ASVs, shock management , Blood and platelet transfusion, Debridement of foot medially and laterally for extensive Necrosis, required skin grafting . Snake found on the place of bite after 3 months ( RV)

22 yrs male patient admitted on H/O Russell’s viper bite on 5 May 2021 at 11 pm H/O pain, swelling, vomiting, nausea
WBCT did not clot more than 1Hr. Hematuria started with 10 vails ASVs Developed anaphylaxis so ASVs given very slowly. Thrombocytopenia swelling increased up to the thigh.

32 yrs M Patient
Snake Bite on left foot calf @06.50 pm on 20- 11-2018.

Complaint of pain, swelling increase upto right thigh, ant. abd.al wall. Ecchymosis ++ , WBCT not clotted 1 Hr.,
Oliguria Urine Output 100ml first 24 Hrs. , S. Increased Vr from 1.22 to 6.55. BUL 130 treated with ASVs, immediate fluid challenge Inj Lasix Antibiotics required 5 HD
Recovered fully.

40 Yrs young tribal man had common krait bite while sleeping on the floor at 2 am . brought to hospital with Neurotoxic symptoms Dyspnoea,dysarthria, Dysphonia, excessive salivation.. Started ASVs 10 Viail immediately. 1 hr after had sudden cardio respiratory arrest. Revived successfully with CPR, Endotracheal intubation & other medical management was kept on ventilatilator for 27 hours. fully recovered without any neurodeficit. relativers were taking him to mantrik. Thanks to volunteer who brought them to hospital

50 yrs. old, female had rat bite while cleaning house, Recovered completely

45 yrs male having  R V Bite at  Rt foot

WBCT -not clotted 45min

Difficulty in Breathing, Ptosis Refereed from cottage Hospital Junnar

Signs of Neurotoxicity

Inj ASV 20 vials

Name – Hande kalawati Baban, Age – 70 ,Female

Address – At/Post Umbraj Tal Junnar Dist Pune

DOA – 18/8/07 Time – 3.30pm, DOD – 20/8/07

History of snake bite at 3pm O/E breathlessness, difficulty in swallowing, vomiting, excessive sweating, restless and cold, difficulty in opening eyes, Pulse-124/m, irregular, BP-170/94, CNS- drowsy, ptosis, dysphonia.

Emergency endotracheal intubation done and kept

on ventilator.

Hb – 10.40gm%, WBC – 10900, BUN – 27,

S.Cr. – 1.26, B.T. – 2..05, CT – 4.55

ECG – Multiple ventricular ectopics

Local Exam – Swelling, blisters, necrosis. ASV – 7

Name – Santosh Shivaji Wani, 35yr., Male, Susarbag, Tal – Junnar.

Date of Bite – 13 Jul 14, Time – 6.30am

DOA – 13 Jul 14, Time – 9.45 am

HOB – While walking on out side the house.

Site Of Bite – Right leg middle toe.

Fang Mark present, swelling present, clot at the fang mark, blurred vision, giddiness.

Treatment –

ASV – 8, Inj. Effcorlin 200mg, Dexa 8mg and antibiotics.

Observation –

HB – 14.90, BUL – 25.0, S.Cr. – 0.84, WBC – 11,300, BT – 1.55, WBCT – 4.50, Na – 145.0, K – 4.30. 

  • Name : Sakure Sachin Maruti.
  • Age : 25 yrs. Male.
  • Address : Renewadi, Manchar.
  • Activity at time of bite : Driving Tractor.
  • DOA : 4 May 12 Time : 4:30pm
  • DOD : 12 May 12 Time : 5:30pm
  • Local Manifestation : Swelling, fangs mark at dorsum of right hand.
  • Systemic Involvement : Pulse – 70, BP – 130/80
  • Investigation : HB – 10.8, WBCT – Prolonged, WBC – 10100, Urea – 25
  • Treatment : ASV – 27
  • Janabai Ashok Doke, 50yrs. Female
  • DOBite – 23 June 14 Time – 6.45 pm
  • DOA – 23 June 14 Time – 7.20pm
  • Site of Bite on left leg medial side of thigh, Farming
  • Pulse – 135mmhg, BP – 60/40
  • Peripheries cold
  • Fang marks present, swelling present, ecchymosis present, respiratory depression present, SPO2 90, WBCT – 8min.
  • Treatment given
  • NIV, ASV, 10 Vials – 1hr.,
  • Released tourniquet – BP – 40 systolic
  • Injection – effcorline 400mg, Dopamine 400microg, Adrenaline 0.3mg repeated thrice, haemaccel IV 2 bottles, dexa 8mg, IV fluids.
  • I/U output – 3000/1300 ml in 12 hrs.
  • Investigations –
  • Heamogram – 23 June 14
  • HB – 11.80, WBC – 6100, BT – 2.10, CT – 8.20, sugar – 92mg%, BUL – 27.00, S. Cr. – 0.91, S. E. – Na – 141, K. – 3.4
  • 24 June 14 – HB – 11.60, WBC – 14,400, BT – 2.15, CT – 5.35, sugar – 97mg%, BUL – 26.00, S. Cr. – 1.12, S. E. – Na – 139, K. – 3.8
  • I/U output – 2000/1800 ml in 12 hrs.

60 yrs female patient was admitted with H/O snake Bite Lt Hand while removing Hirda from tree . Snake Brought Killed confirmed as Saw Scaled Viper . H/O Hemetemesis twice WBCT Nt clotted more than 25 mins .treated with ASVs 30 vials .Anaphylactic reaction to ASVs. Total 15 ASVs.

Real inauguration
Recently we have upgraded our ICU with life saving equipment like advanced ventilator etc received from Dr Minoo Mehta trust Pune. Same were inaugurated at the hands of respected Dr S S Jadhav & Dr Bhushan Mangaonkar immediately after inauguration we have received 55yrs female with H/O snake bite she was Pulse less ,Respiration stopped comatose cold immediately I Started CPR & Dr Mrs Pallavi Raut, 10 Drs , Dr Rajesh Patil ,Dr Sanjay Ghadge, Dr Jadhav,(Ranjani), Dr Shashank Phapale president JTMPA , Dr Ganesh Naikodi , Dr Sushil Bagul, Dr Sanjay Dumbare, Dr Purushottam Borhade (otur) who came for inaugural function joint us in the CPR & Resuscitation Dr Mrs Pallavi Raut incubated the patients was taken on venti. Other drs helped to infuse emergency medicines we have pushed 20 Asv Inj in 10min as a bolus
We are able to feel the pulse after 45min of aggressive management
Required respiratory support for 12hrs (No Neck holding for long time )
Additional 5 vials ASVS given she is fully conscious well oriented at present only on antibiotics awaiting debridement (and skin grafting) for severe local necrosis.
Thus we are able to save life of young working lady due to availability of advanced ventilator immediately after inauguration.

Patient of cobra bite with 7 months pregnancy brought gasping and in respiratory failure treated successfully with ventilator and other medical management. Delivered normally male child after two months.

40yrs  M, RV Bite at both Hand

Referred from  R H Junnar, severe burning pain with rapidly progressive Swelling  of both hands, WBCT Clotted 20min,

Hypotension, Drowsy, Breathlessnes

Inj ASV – 30 Vials

Debridement of  Lt Hand done, WBC (D1)-12900 Increased to 22400 (D5)

NAME – Arun Lohot

DOA – 28 Sept. 2013

DOD – 14 Nov. 2013

Cobra bite 2 ASV given at Ghodegaon PHC. Then brought unconscious taken on ventilator for 1 day total ASV given 22

Local wound severe necrosis at right foot, debridement  done twice.

Skin grafting done.

Healed completely.

Name: Mr. Rambhau Maruti Bhor

Age: 45 years, Male, Khamundi (Junnar)

Summary  : Patient was admitted with H/o common krait Bite in bed during deep Sleep, painless bite to left Side mid arm, noticed some wetness on LT arm 2 hours after of bite. H/o pain in abdomen, vomiting, excessive salivation, total paralysis.

Treatment  : Required artificial Ventilation of four hours After admission. Kept on Ventilator for five days.

Needed          : tracheostomy.

Total Hospitalization – 16 Days.

  • Name – Reddy Saikumar, 5 yrs old boy
  • Activity – Russell Viper snake bite while playing in the field
  • Date – 4th May 2009 Time of bite – 7 pm
  • DOA – 4th May 2009 Time – 8 pm admitted in shock.
  • Symptoms – Vasculotoxic signs & symptoms, severe tachycardia , dyspnoea, swelling at site of bite whole RT foot extending up to lower abdomen in two days , severe scrotal & Penis swelling
  • Investigation – Blood investigations shows prolonged clotting time more than 1 hr.
  • Platelets count 90,000.
  • HB – Initially 9.5 drops up to 6 mg%. Pt had severe gangrene of right foot on 5th day.
  • Treated shock management, inj A S V, corticosteroids, Higher Antibiotics, iv fluids.
  • Antibiotics

65 yrs old lady with RV bite brought immediately half hour after bite in shock BP 80 systolic , excessive sweating and cold peripheries , gum bleeding , severe local swelling , WBCT not clotted 45 minutes , total ASVS 25 shock management . Fully recovered no local necrosis

48 Yrs Male Pt H/O Snake Bite 25/1/18 7pm Took some Ayurvedic treatment and came to us on 27/1/18 at 4.30pm .(46hours after Bite )
H/O Hematuria , Gum Bleeding oliguria ,WBCT Not clotted More than 45 Min , Thrombocytopemia , RFT Normal Treated with ASVS 20 Vails , Hydration
Severe Anaphylaxis to ASVS treated with Inj Effcorline, Inj Adrenaline
Recovered in 3 Days No Local Swelling

Do it R.I.G.H.T.

  • Reassure the patient. 70% of all snakebites are from non-venomous species. Only 50% of bites by venomous species actually envenomate the patient
  • Immobilize in the same way as a fractured limb. Use bandages or cloth to hold the splints, not to block the blood supply or apply pressure. Do not apply any compression in the form of tight ligatures, they don’t work and can be dangerous!
  • Get to Hospital Immediately. Traditional remedies have NO PROVEN benefit in treating snakebite.
  • Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital.

Do not do any of the following

  • Do not use a tourniquet.
  • Do not cut into the snake bite.
  • Do not use a cold compress on the bite.
  • Do not give the victim any medications unless directed by a doctor.
  • Do not raise the area of the bite above the victim’s heart.
  • Do not attempt to suck the venom out by mouth.
  • Do not use a pump suction device. While these devices were formerly recommended for pumping out snake venom, it is now believed that they are more likely to do harm than good.

FIRST AID FOR SNAKE BITE

Immediately: If others are present, have someone phone for medical assistance. If unable to phone, send someone for help. Reassure the patient and encourage them to remain calm and still.

As soon as possible, apply a broad pressure bandage from below bite site. Start first with a bandage around the bite site, then apply another bandage, upward on affected limb (Starting at toes, bandaging upward as far as possible). Leave fingers or toes unbandaged to allow victim’s circulation to be checked. Do not remove pants/trousers, just bandage over top of clothing.
2. Bandage firmly as for a sprained ankle, but not so tight that circulation is prevented. Continue to bandage upward from the lower portion to bitten limb.
3. Apply the bandage as far up the limb as possible to compress the lymphatic vessels.
4. It is vital to now apply a splint. Bind a stick or suitable rigid item over the initial bandage to splint the limb. Secure the splint to the bandaged limb by using another bandage, (if another bandage is not available, use clothing strips or similar to bind.) It is very important to keep the bitten limb still.
5. Bind the splint firmly, to as much of the limb as possible, to prevent muscles, limb and joint movement. This will help restrict venom movement. Seek urgent medical assistance now that first aid has been applied.
APPLYING A PRESSURE – IMMOBILIZATION BANDAGE TO HAND OR FOREARM
As soon as possible, apply a broad pressure bandage around the bite site, then apply another bandage from the fingers of the affected arm, bandage upward as far as possible bandage the arm with the elbow in a bent position, to ensure the victim is comfortable with their arm in a sling. Leave the tips of the fingers unbandaged to allow the victim’s circulation to be checked.
Bind a splint along the forearm.
Use a Sling to further prevent limb movement.
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R P ( Nanasaheb )Sabnis $mrutidin programme at
Gunjalwadi Highschool Along with Principal Mr Narsode sir , kanade sir ,Nalawade sir ,Dr Vikasji Dere

Mission – ZSBD . Snake Bite Awareness Lecture at Balasaheb Jadhav Collage Ale for Staff Academy & Science Graduate Students. Thanks to Principle Dr Subhash Wadekar, Prof Wakchoure Pro. Sangita Bharti, Prof Jaisingh Gadekar, Prof. Gulve Arun , Dr Mrs Pallavi Raut.

Awareness programmes regarding Snake Bite at 1) Sahyadri School Inglun 2) New English School Khamgaon 3)Yedeshwar Vidhyalaya Yedgaon 4) Kulswamini Khanderaya Highschool Hivre Tarfe Ngaon 5)Ekanah Govind Dev Prashala.Bori Salwadi

Mission ZSBD Zero Snake Bite Death .
Lect Delivered @MASTACON 2019 n MULTICON 2019 Pune on Snake Bite Management. IMA members from all over Mah attended and appreciated our mission and promised to get actively involved

Thank you Dr Prof Manjunathan kini , Dr Sekar seshagiri for giving me apportunity to share my experience of snake bite Management in NGBT 2018 conf @ Jaipur.

ZSBD (Zero Snake Bite Death) Lecture taken on Snake bite management for Dehuroad doctors association (DDA)
Thanks To , Dr. Sachin Patil ,Dr. Hitendra Ahirrao ,Dr. Kishor Naikare ,Dr.Vaishnavi Naikare , Dr. Chavat and all members of DDA

Zero Snake Bite Death
Lect @ Ayurved & Research medical college Nigdi Pimpri Pune . Thanks Dr Phdake ,Dr Anuja ,Dr Khairnar ,Dr swapna more than 200 medical students and staff nurses attended the lecture .

International Toxinology Short Course

IST - World Congress Oxford UK 2014

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