Tuesday, 10 July 2012

             Snake bite

Snake bite is an acute life threatening medical emergency often faced by farmers and farm
labourers. Early diagnosis of envenoming by venomous snake and its rational and accurate
management may save life. Rural Indian victims of snake bite are reported earlier due to easily
available transport including auto and jeeps and constructed approachable roads to the majority of
villages. Irrespective of early reporting, the fatality in venomous snake envenoming is due to nonavailability
of medical officers at primary health Center (PHC), inadequate facilities including antisnake
venom (ASV), and resuscitation trolley: working laryngoscope, endo tracheal tubes, Ambu
bag, ventilator and other emergency medicine. Many times the medical officer is a freshly passed
graduate and has not seen and treated the venomous snake bites before. This adds to the morbidity
and mortality. Because of expensive ASV and it not being easily available to private hospitals,
many doctors avoid admitting the case due to threat of anaphylaxis. Moreover the poor rural
population cannot afford expensive ASV and treatment at private hospitals. Snake bite should be
declared as an occupational hazard. ASV should be available free of cost to victims admitted to
private hospitals. ASV is always in short supply. To avoid the crisis of ASV supply, peripheral
doctors should be trained regarding management of snake bite and indications of ASV. Availability
of snake venom antigen detection kit (ELISA Mono-specific) is a must. Antivenin producers in
India should be encouraged to prepare antivenom from venom obtained from snakes caught from
relevant areas of the country.


Venomous snake bite is an important public health hazard in tropical and subtropical countries. In rural areas snake bite poisoning is a leading cause of premature death of young earning
member of the family. In India 35,000-50,000 lives are lost per year due to venomous snake bite. More than 2000 deaths per year are reported from Maharashtra. This is the tip of the iceberg as
the majority of snake bite deaths go unreported as many villagers go to traditional healers like
mantriks and tantriks. Moreover snake bite is not a notified disease in medical fraternity. It is
surprising that, snake bite poisoning is seldom mentioned as a priority for health research in a
developing country like India. The grant allocated for snake bite is many times less than the grant
allocated to amoebic dysentery (with a negligible fatality as compared to snake bite). Unfortunately
public health authorities, nationally and internationally, have given little attention to this grave, life
threatening medical problem, relegating snake bite envenoming to the category of a major neglected
disease of the 21st century. There should be more encouragement from government and other
funding agencies for conducting research. Moreover there are very few medical scientists taking
interest or carrying out research in this field.
Most of the venomous species of snakes are “sit and wait” predators wherein they lie camouflaged
lying in wait for their potential victim and they strike when the prey comes within their striking
distance. The snake usually then lets go allowing the venom to take effect after which they follow
their prey by following its scent trail. So after a human strike, it is very likely that the snake will be
found in the 30 foot radius and it should be remembered that they are no less dangerous after the
first strike. So victim should be moved away from the area.

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