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Makunda Christian Leprosy and general Hospital
“Clinical study on snake bite syndrome, species correlation and ASV dose requirement” Dr. Ann Miriam Makunda Christian Leprosy and general Hospital Bazaricherra P.O, Karimganj Dist., Assam – GPS coordinates: 24*25'55.78"N 92*19'51.33"E
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Location GPS coordinates: 24*25'55.78"N 92*19'51.33"E
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Brief Hospital Statistics 2011-12 Total OP: 91,242 Total IP: 9471
Brief statistics of Karimganj District Population: 12 Lakhs Deaths due to snake bites : 0* Oujha : 2 *According to NRHM data
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Bazaricherra Gram panchayat
LOWAIRPOA BLOCK Population : 1 Lakh Bazaricherra Gram panchayat Population : 12 thousand A survey was done and it was noticed that there were only 2 deaths by snake bites in the last 15 years.
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Common Poisonous snakes in Makunda
Red-necked keelback Rhabdophis subminiatus Banded krait Bungarus fasciatus
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Other venomous snakes identified by the local people
White lipped pit-viper Greater black Krait Monocled Cobra
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Oujha
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Probable cause of Cellulitis
Treatment by Oujha – Cutting of snake bitten area by using a blade and applying local herbal medicine
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Dead snakes brought – Nil
Snake bites last year = 10 Venomous bites = 1 Non – venomous bites = 9 Mainly Hemotoxic = 1 Dead snakes brought – Nil
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Patients requiring mechanical ventilation – Nil
OUTCOMES Patients requiring mechanical ventilation – Nil Patients requiring hemodialysis – Nil Deaths - Nil
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Whole blood transfusion
FACILITIES AVAILABLE Bleeding time Clotting time Whole blood transfusion Hemodialysis facilities – Machine available (Not in use) Mechanical ventilators – yes High Dependency area
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Blood investigations done
Hemogram Serum Creatinine Blood Sugar BT / CT Platelet count ECG
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INDICATION FOR ASV ADMINISTRATION Prolonged BT/ CT
Adrenaline given when there is sign of anaphylaxis Initial dose of ASV 8 – 10 vials Duration of administration 4 – 6 hours Test used for monitoring response - Whole Blood Clotting Time Time of measurement of coagulation parameters – 3 times in a day
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ADMINISTRATION OF REPEAT DOSE OF ASV Not given so far
ADMINISTRATION OF CONTINUOUS LOW DOSE OF ASV
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CEILING DOSE No experience USE OF NEOSTIGMINE
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INDICATION FOR ANTIBIOTIC THERAPY Cellulitis COMMON ANTIBIOTICS USED
Ampicillin and Ampicloxacillin
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PATIENTS ADMITTED IN High Dependency area PATIENTS REFERRED FOR No referrals so far
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COMPANY OF ASV PURCHASE Haffkine STOCK OF ASV 10 Vials
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Why are snake bites so un-common in Makunda?
Thickly populated location Venomous snakes present Dense forests Frequent floods
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THANK YOU
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