Snakes galore

The last week was quite busy. We had about 20 patients brought in with snake bite. We lost Shivam couple of days back. By God's grace, only 8 of the 20 patients had evidence of envenomation. Interestingly, nine of the 20 patients brought the culprit snake, 7 of them dead snakes and two alive ! ! !. 

Here are the snaps of the snakes brought . . . I'm glad that none of the snakes were non-venomous . . .

This is a baby cobra which bit a 30 year old lady. Thankfully, there were no signs of envenomation. 

This is a krait which bit a lady who was sleeping on the floor. Again, there was no envenomation. 

This bit a 25 year old man on his toe. Again, no envenomation

I thought this was a wolf snake. This is live. The local experts say it is a krait. The 35 year old lady who was bitten by this snake had some sore throat and dizziness for about 12 hours which settled over time. There was no ptosis. We kept the patient on observation for 36 hours and discharged her. No ASV was given. 

A cobra who bit a prominent person of a village about 40 kilometers away. Mr. Phekku, 60 years old came in about 2 hours after the bite after the customary visit to the jhad phuk. He was on mechanical ventilation for about 2 days. He is doing fine now. We gave him the maximum possible dose of 20 vials ASV. Interestingly after we told the family that the culprit snake could be in the enclosed space where he was bitten, the family hired couple of snake charmers who caught the snake live and brought it to the hospital for identification. God only knows if this was the culprit snake or one which the snake charmers got out of their kitty and show cased it. 

Another krait. Again, the victim did not have features of envenomation. 

This snake bit a 40 year old lady from a nearby village. She was brought in almost 12 hours after the bite. She had ptosis and respiratory distress. She maintaind saturation without need of intubation. Her ptosis resolved after 10 vials of ASV.

A 3 feet long cobra which bit a 50 year old man inside his flour mill. It was wrapped around one of the machine parts which he was cleaning. He came in within 15 minutes. Initially, they did not know what snake it was. Later, when we told the relatives that considering that the bite happened in a room, the snake could still be lurking inside, the searched and found it out and killed it. Interestingly, within few minutes of the snake being brought in, the patient started developing ptosis and throat discomfort. He responded well to ASV and got discharged aftr 48 hours. He needed only 10 vials of ASV.  

Another krait brought in by a patient who was bitten on the leg. Again, no features of envenomation. 

It is quite interesting that only one patient out of the six who brought in the dead krait had features of envenomation whereas two out of the three patients who brought a cobra had features of envenomation. Please note that there were 11 other patients who came with bites from unidentified snakes. 5 of them had features of envenomation and we had to give ASV. 

And, we finished about 100 vials of ASV in 3-4 days, including 50 on a single day . . . 

More, in the next posts . . . 

Dear Citizens

Someone had forwarded this message to me in my WhatsApp. I thought that it was good enough to be posted in my blog . . . Honestly speaking, I don't know that source. I thought that it was worth exploring . . . 

Suggested REFORM ACT OF 2014

1. No Tenure/No Pension: Parliamentarians collect a salary while in office, but should not receive any pay when they're out of office. 

2. Parliamentarians should purchase their own retirement plans, just as all Indians do. 

3. Parliamenarians should no longer vote themselves a pay raise. Their pay should be linked to the CPI or 3%, whichever is lower. 

4. Parliamentarians should lose their current healthcare system and participate in the same healthcare system as the Indian people.

5. Parliamentarians with tainted records, criminal charges and convictions, past or present should be summarily banned from the parliament and fighting election on any pretext or the other. 

6. Parliamentarians should equally abide by all laws they impose on the Indian people. 

7. All contracts with past and present Parliamentarians should be void effective 1/1/2015. The Indian people did not make this contract with them. Parliamentarians made all these contracts for themselves. 

8. Serving in Parliament is an honor, not a lucrative career. The founding fathers envisioned citizen legislators, so ours should serve their term, then go home and back to work. 

Neyyar Dam Trail

Snaps of a mini trail in Neyyar Dam. Quite welcome greenery . . .

Dangers of searching revisited

We had one more snake bite victim who got bitten just because she did not look at where she was putting her hand. Being a adolescent girl in a rural Indian household, she was doing her chores as part of the routine of her household. 

Arti was in charge of rolling out rotis every day morning. 

It was just another routine day which ended up being a nightmare for her and the family. For along with the wooden slab and rolling pin, which were used to flatten the lumps of wheatflour dough, was a krait which must have been attracted to the cool environment of the wood in a hot Indian summer. 

Arti put her hand into the pile of vessels which also contained the wooden slab and rolling pin. The bite was not painful. She did not develop symptoms immediately. First it was a difficulty in keeping her eyes open, which was followed by a funny sensation in the throat. 

It was dawn when she was bitten, but by the time she reached us it was late evening. Her condition was so bad that she could hardly breath. She needed mechanical ventilation. 

However, she was lucky to be weaned out within 48 hours. 

Well . . .  another warning about putting your hands into spaces without looking if there is danger lurking. 

Arti with her parents just before discharge . . . 

I was wrong

I hope the post, Krait Attack - 3 is fresh in your mind. 

Mr. Dinkar has recovered well, although he has a very badly infected bite site. 

Today, as we took rounds, Dinkar and both his sons walked in quite excited. The younger son explained that they managed to kill a large snake inside their home last night. And they attributed that snake to have bitten Mr. Dinkar. 

They had even taken snaps of the dead snake on their cell phone. 

So, Mr. Dinkar was bitten by a cobra. Dinkar says that he is postive that this was the same snake that bit him. He clarified that the white marks which he told was not like that of a krait. He told us that the white marks one can see in the snap were what he was talking about. 

So, that explains the badly infected wound. However, I don't know how to explain the fact that we had given him ten doses of Atropine/Neostigmine and he had not responded. Instead, he took 6 days on mechanical ventilation before he came around. 

I just cannot imagine Dinkar and his large family living with a large cobra inside their home. 

Dinkar's younger son heard a peculiar noise coming from the dark corner of their home as he woke up to switch off the electric motor which was pumping water into their fields. . Only after he woke up his elder brother did they realize that the noise was the hiss of an angry snake who was cornered. It was quite obvious that both the brothers realised soon that this must have been the culprit who injured their father and brought them much misery over the last month. And now, it was threatening to bite both of them. 

They had no other option but to kill the snake. They were so angry that they chopped off it's head and after taking the snaps cut it up into pieces and burnt it. 

I think Dinkar's family was lucky that nobody else was bit unlike the family in Rajasthan whose story appeared in the news recently.