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Snake bite case presntation

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case presentation of snake bite

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Snake bite case presntation

  1. 1. Cleopatra VII
  2. 2. introduction  70 % of snakes in Palestine are non venomous .  Males are bitten almost twice as often as females.  Most common snake her in Palestine is Vipera palaestinae.  No available data about number of snake bites her in Palestine.  Test dose of ASV is not essential because even if victim is sensitive to ASV, does not preclude its use.
  3. 3. Case A 55 year old male, came to the ER on 1772013 at 1 pm Presenting complaints:  Snake bite in the morning at 9 am.  Bleeding from the site of bite till now
  4. 4.  Present history: According to the patient he was alright before he was suddenly bitten while he was walking in the garden . The escaped snake was about 20 cm long & brownish in color. The patient, went home & only bandaged the wound. In a few hours the pain got intense & the bleeding didn’t stop from the wound. There was difficulty in walking associated with the pain & he felt numbness in the left leg. There are no associated features of hematomesis, melena, epistaxis or vomiting , haemoptisis . There was no history of bleeding disorders among the family.
  5. 5.  Past medical/surgical: Angiography & angioplasty: 5yrs ago.  Personal hx: appetite-N, micturation-N bowels-N, sleep-disturbed.  Drug hx: none.  Family hx: not significant.
  6. 6. Physical examination  Patient looks ill, but conscious in time/place/person.  Vitals: Bp-110/63, pulse-96 bpm, R/R: 21/min O2 sat : 96 temp : 37.1 General impression: swelling on left leg from the foot to the knee.
  7. 7. Examination  CNS- sensory was bilaterally equal, but slightly      decreased at the lateral side of the left foot and leg . Tone, power & reflexes were bilaterally equal & normal. Abdomen- firm, non tender, relax, no vissibel venes . Cvs- s1 + s2, no murmurs Resp- Normal vesicular breathing, no additional sounds No skin rash
  8. 8. Chest X- ray  It was normal
  9. 9. Investigations  Hb-9.1  Plt-110,000  WBCs : 9.5  MCV : 86  RDW : 11.6
  10. 10. Investigations Coagulation profile:  PT-48 (control 9-13)  INR-4.53  APTT-98 Biochemistry:  Urea: 22 (10-50)  Creatinine: 0.68  Albumin: 4.17 (3.8-4.4) Electrolytes:  Potassium : 2.28  Calcium : 8.17  Magnesium: 1.92  Sodium: 141  Chloride: 100 (2.7-4.5) (8.1-10.4) (1.58-2.55) (136-140) (98-104)
  11. 11. Investigations LFTs:  Bilirubin Total: 2.08 (<1.3)  Bilirubin direct: 0.47 (<0.3)  ALT: 21 (upto 40)  Alk Phosphate: 62 (39-117)
  12. 12. Diagnosis  Most likely snake bite complicated by DIC .
  13. 13. Treatment  O2 by nasal cannulae  500 cc normal saline  100 mg hydrocortison  Anti tetanus serum ( ATS ) 2 cc  given 10U of anti venom  120 ml of FFP.
  14. 14. Treatment  Then transferred to Nablus to Rafidia hospital , there he was admitted to ICU and the after 3 hours he died .
  15. 15. Take home massage  Any prolonged bleeding or any abnormal bleeding following a snake bite it is DIC .
  16. 16. Thanks to  Darwish Nazal Governmental hospital.  Qulqilia UNRWA hospital .

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