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SNAKEBITE PROTOCOL DEVELOPMENT WORKSHOP CMC, VELLORE 11.03.2013

A National survey of Snake bites in India (venomous and non-venomous ), syndrome-snake species correlations, outcomes and ASV dose requirements. SNAKEBITE PROTOCOL DEVELOPMENT WORKSHOP CMC, VELLORE 11.03.2013. GOAL OF THE STUDY.

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SNAKEBITE PROTOCOL DEVELOPMENT WORKSHOP CMC, VELLORE 11.03.2013

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  1. A National survey of Snake bites in India (venomous and non-venomous), syndrome-snake species correlations, outcomes and ASV dose requirements SNAKEBITE PROTOCOL DEVELOPMENT WORKSHOP CMC, VELLORE 11.03.2013

  2. 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

  3. 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.

  4. methodology

  5. STUY DESIGN • Multicentric study • Observational • Descriptive study • Over a period of 2 years

  6. CLINICAL COLLABORATING CENTRES Centres are selected depending on the case load and commitment to the study

  7. HERPETOLOGY & VENOM DETECTION Herpetology • Mr.RomulusWittakar • Mr. Gerry Martin • Dr. Anita Malhotra • Mr.VishalSantra • External Consultants • Dr.DavidLaloo • Dr.Faiz • Dr.Arirani Venom Detection • Dr.Ashish K Mukerjee • Dr.Oommen • Dr.Dhananjaya • Dr. Sridevi • Dr.Amudhavalli • Mr.Radhakrishnan • Dr.Jayaraman

  8. STUDY FLOW CHART Suspected Snakebite Informed consent Documentation Using proforma at admission and daily till discharge

  9. DOCUMENTATION The study proforma: • Details of bite • Snake identification • Clinical syndrome • Laboratory evaluation • Complications Treatment ASV dose requirement Mechanical ventilation Neostigmine Transfusions Antibiotics Outcomes

  10. 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

  11. 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

  12. DEAD SNAKE STORAGE PROTOCOL

  13. Samples required for venom detection studies • Bite site swab • Serum • Urine

  14. Thank you

  15. 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

  16. 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

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