Envenoming by the Common Krait (Bungarus caeruleus) and Asian Cobra (Naja naja): Clinical Manifestations and Their Management in a Rural Setting Himmatrao.

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Presentation transcript:

Envenoming by the Common Krait (Bungarus caeruleus) and Asian Cobra (Naja naja): Clinical Manifestations and Their Management in a Rural Setting Himmatrao Saluba Bawaskar, MD, Pramodini Himmatrao Bawaskar, MBBS Wilderness & Environmental Medicine Volume 15, Issue 4, Pages 257-266 (December 2004) DOI: 10.1580/1080-6032(2004)015[0257:EBTCKB]2.0.CO;2 Copyright © 2004 Wilderness Medical Society Terms and Conditions

Figure 1 Wattle-and-daub house. A krait can easily find its way into a wattle-and-daub house to hunt for rats, mice, and lizards. Villagers often sleep on the floor of these houses. Wilderness & Environmental Medicine 2004 15, 257-266DOI: (10.1580/1080-6032(2004)015[0257:EBTCKB]2.0.CO;2) Copyright © 2004 Wilderness Medical Society Terms and Conditions

Figure 2 A bullock cart is often the only source of transportation to carry a person to a primary health center during night hours. Wilderness & Environmental Medicine 2004 15, 257-266DOI: (10.1580/1080-6032(2004)015[0257:EBTCKB]2.0.CO;2) Copyright © 2004 Wilderness Medical Society Terms and Conditions

Figure 3 Case 1. A, Killed cobra that was brought in by a relative of the bitten subject. B, Local edema with ecchymosis over the left foot (the site of the bite). Wilderness & Environmental Medicine 2004 15, 257-266DOI: (10.1580/1080-6032(2004)015[0257:EBTCKB]2.0.CO;2) Copyright © 2004 Wilderness Medical Society Terms and Conditions

Figure 4 Case 2. A, Two hours after cobra bite: fang marks with blood over right index finger, edema over dorsum of hand. B, Forty-eight hours after cobra bite: local necrosis. C, One week after cobra bite: sloughing of wound with skin necrosis, poor granulation, and unhealthy edges of wound. Wilderness & Environmental Medicine 2004 15, 257-266DOI: (10.1580/1080-6032(2004)015[0257:EBTCKB]2.0.CO;2) Copyright © 2004 Wilderness Medical Society Terms and Conditions

Figure 5 Killed krait (3.5 feet long) brought in by relative of subject in case 5 (see the Table. Wilderness & Environmental Medicine 2004 15, 257-266DOI: (10.1580/1080-6032(2004)015[0257:EBTCKB]2.0.CO;2) Copyright © 2004 Wilderness Medical Society Terms and Conditions

Figure 6 Subject in case 5—response to antivenom and neostigamine (given at T0). A, T0 (2.5hours after bite): semiconscious, bilateral complete ptosis. B, T0+20minutes: partial ptosis, conscious, unable to protrude tongue. C, T0+60minutes: ptosis reduced, able to protrude tongue. D, T0+12hours: ptosis reduced, wide opening of mouth. E, T0+24hours: ptosis reduced >50%; cornea is uncovered, able to open the mouth widely and fully protrude the tongue. F, T0+30hours: ptosis reduced, only 20% of cornea is covered, improvement in expression. G, T0+36hours: 10% of cornea is covered, otherwise completely recovered. Wilderness & Environmental Medicine 2004 15, 257-266DOI: (10.1580/1080-6032(2004)015[0257:EBTCKB]2.0.CO;2) Copyright © 2004 Wilderness Medical Society Terms and Conditions