SNAKE BITE AND COMPLICATIONS.

27 year old presents with snake bite. No neurotoxic symptoms seen Fang marks present on the dorsal aspect of Left foot. Pain+ Edema+ Creat:0.7 PT:13.3 INR: 1 aPTT: 37.2 K+: 3.49 Na+: 140 ASV given. Analgesics given . Now, the patient returned with swollen foot with tolerable pain. Adviced Trypsin + Chymotrypsin. Signoflam. Probable Compartment syndrome? Thrombus? How to proceed ?

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Snake bite mark seen on the dorsum of the foot and with local swelling There are two types of toxicity of poisonous snake haemitoxic that causes haemolysis of blood manifested by bleeding from different system of the body and neurotoxic. Preliminary all investigation done all within normal limit. As it is not known wheather snake is poisonous or not If not poisonous nothing to do if poisonous watch for toxic sign , still now no neurotoxic sign but there may be delayed sign and watch for any haematuria or any bleeding as ecchymosis Apart from systemic complication local complication like local necrotic fasciatis may be there due to toxicity of poison. If at all takes proper care should be taken Rpt all investigation including LFT and kidney function test.

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Lower limb oedema after snake bite . D/D 1.Deep vein Thrombosis 2.Infective cellulitis with compartment syndrome 3.Lymphatic obstruction and lymphangitis It should not be taken lightly . It can lead to serious pulmonary embolism. OR compartment syndrome. Management- 1.Get a colour doppler study of lower limb vessels to look for DVT or lymphatic status 2 A MRI scan to look for any signs of compartment syndrome. 3.Start with pareentersl antibiotics like Piperacillin 4 gm + tazobactum 500 mg × 6 hourly 4.Tab chymoral forte × 6 hourly 5.Elevation of limb 6.Further treatment depends upon the investigations report

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Local lympho edema or exudative fluids collection due to snake poison. BT-CT normal so no Haematological complications Rx Continue ASV Inj TT Diclofenac inj q 12 hrly Chymoral forte TDS Glycerin + magnesium sulfate dressing Limb elevation to 45-60 degrees Needle aspiration of serous / hemorrhagic fluid Linezolide 300 ml q12 hrly Will recover in 3-5 days

Gross swelling of lower limb can be because of lymphatic blockage or blocked venous drainage His symptoms and signs are predominantly inflammatory, it is suggestive of vasculotoxic snake venom - probably krait or viper bite Sonography to look for venous thrombosis - of thrombosis found treatment of same Limb elevation Antibiotic Wait and watch

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Gross swelling may be due to lymphatic blockage or blocked venous drainage or return. Continue treatment. Elevate limb. Iv infusion line with inj ceftam 1gm iv slowly bd and inj MVI iv slowly. Maintain electrolytes imbalance and maintain IO Chart. Reassurance and counciling required. Regular monitoring and constant evaluation required.

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SUGGESTIVE OF POST SNAKE. BITE CELLULITIS LYMPHEDEMA ADVISABLE 1. BLOOD. AND. URINE.....C / S 2. COLOR. DOPPLER. STUDY 3. ECG....... 4. USG.....CHEST. AND. ABDOMEN 5. TAZOBACTUM+. PIPERACILLIN ...I/ V..... INFUSION 6. N. S. A. I. D

POST SNAKE BITES COMPLICATIONS.. ? CELLULITIS.. NEED'S.. MANAGEMENT AS PER REQUIREMENT..WITH .. EXPERTS OPINION..

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Not ejected Betul toxins nor serious Hemotoxin Local necrosis should be monitored If further development, admit the patient in hospital.

*Kindly Check for distal limb pulse mam. *Pulselessness & pain on passive stretching is more suggestive of compartment syndrome

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