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 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 2  |  Issue : 3  |  Page : 48-49

Snake bites in Rural India - A surgical view point


1 Department of Medicine and Surgery, Kakatiya Medical College, Warangal, Telangana, India
2 Department of Medicine and Surgery, Sri Guru Ram Das Institute of Medical Science and Research, Amritsar, Punjab, India
3 Department of Medicine and Surgery, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India
4 Department of Medicine and Surgery, Dr. NTR University of Health Sciences, Vijayawada, Andhra Pradesh, India

Date of Submission27-Jun-2021
Date of Decision10-Sep-2021
Date of Acceptance12-Sep-2021
Date of Web Publication28-Dec-2021

Correspondence Address:
Tarun Kumar Suvvari
17-2-49/2, Vengala Rao Colony, Amadalavalasa, Srikakulam, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jssrp.jssrp_14_21

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How to cite this article:
Srivastava D, Singh S, Simhachalam Kutikuppala L V, Suvvari TK. Snake bites in Rural India - A surgical view point. J Surg Spec Rural Pract 2021;2:48-9

How to cite this URL:
Srivastava D, Singh S, Simhachalam Kutikuppala L V, Suvvari TK. Snake bites in Rural India - A surgical view point. J Surg Spec Rural Pract [serial online] 2021 [cited 2022 May 29];2:48-9. Available from: https://jssrp.org/text.asp?2021/2/3/48/334043



Dear Sir,

Snakebite is a neglected disease that leads to 16,000 deaths annually in the country. Poor infrastructure and lack of access to antivenom allow snake bites to have high morbidity and mortality. In 2019, the World Health Organization (WHO) planned to decrease the global burden by 50% before 2030, of which a systematic study is a part, to detect the extent of surgical problems being faced in relation to the snake bites.[1]

Management of snakebite is difficult as we cannot differentiate symptoms between snakebite with or without envenomation. Transport to the nearest healthcare facility has become the first choice and is preferred over first aid. After the patient has been bitten, his vitals should be assessed as soon as possible. The bitten limb should be at the heart level with him lying on the ground. The limb can be raised if any swelling and/or erythema are present and they do not accompany any systemic symptoms. The use of a tourniquet is quite controversial; some studies say that it may be of some help, but recent studies suggest that if not done properly, it can perturb the blood flow to the affected tissue and lead to edema and other local effects of the venom. Compression of the wound is not recommended. Studies have also shown that any incision and suction are not beneficial and no longer recommended as it can lead to worsening of the overall quality of patient's treatment. Scrubbing and applying any chemicals are not recommended. Antivenom is the mainstay of management and is made of purified IgG antibodies. These can be stored in the refrigerator. If any adverse reactions are detected, then antivenom should be discontinued and corticosteroids and antihistamines should be given. Epinephrine is indicated in severe bronchospasm, hypotension, and angioedema. Studies show that when antivenom is given within 4 h of the bite with early intervention, the risk of requiring surgical intervention decreases. Antivenom is given until clinical improvement of the patient is seen. The initial infusion of antivenom should occur at a rate of 2 ml/min or diluted bolus with 5–10 ml/kg of isotonic saline administered at a fixed rate over 1–2 h. Intravenous fluids should be given to patients upon reaching the hospital. The next step is to irrigate the wound and inspection wound. Symptoms should be monitored periodically every 2–3 h. Fasciotomy is indicated when compartment syndrome is present.[1],[2]

Snakebite envenomation (SBE) is a serious problem even reported by the WHO. Symptoms of envenomation include pain, generalized weakness, numbness, and other symptoms depending on type of snake and its venom. However, if these symptoms progress to infectious lesions, tissue necrosis, fasciitis which may be necrotic in nature, ischemic lesions, and even compartment which however rare can happen, then surgical intervention can become necessary. However, somehow surgical complications are becoming an increasing risk for mortality and morbidity among rural population affecting the workforce in the agricultural domain of our country. It is common in rural population also because of the farms being the most common place for snakes to be present and farmers to get a snakebite.[2],[3]

Predominance to lower limb was found, but upper limbs seemed to get affected due to patient holding on to grass and getting exposed to snakes then. Currently, snakebite is also getting fairly common among pediatric age groups. Many local complications such as compartment syndrome, tissue necrosis all threatening limb survival, and even sometimes systemic complications arise. Surgical interventions for these are not outlined that well which poses difficulty in managing patients.[2],[3]

Talking about compartment syndrome, however rare but can cause further necrosis and loss of limb because of ischemic complications. Compartment syndrome is to be dealt timely, and a fasciotomy is the surgical treatment to prevent all the injury related to snake bite.[4]

The governments, scientific communities, and nongovernmental organizations should increase the money spent and funding toward improving the awareness about the snakes and SBE among the rural communities, which can in turn decrease the treatment costs, when people receive prompt and adequate treatment.

Educating and empowering the rural communities regarding the snakebites and the threats of SBE and thus alleviating the hindered SBE management, leading the way toward a comprehensive decrease in the treatment expenses, morbidity, mortality and other socioeconomic implications resulting from SBE.

Acknowledgment

Sincere thanks to Squad Medicine and Research for their support and guidance.

Financial support and sponsorship

Sincere thanks to Squad Medicine and Research for their support and guidance.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Russell JJ, Schoenbrunner A, Janis JE. Snake bite management: A scoping review of the literature. Plast Reconstr Surg Glob Open 2021;9:e3506.  Back to cited text no. 1
    
2.
Bhaumik S, Beri D, Lassi ZS, Jagnoor J. Interventions for the management of snakebite envenoming: An overview of systematic reviews. PLoS Negl Trop Dis 2020;14:e0008727.  Back to cited text no. 2
    
3.
Hernandez MC, Traynor M, Bruce JL, Bekker W, Laing GL, Aho JM, et al. Surgical considerations for pediatric snake bites in low and middle-income countries. World J Surg 2019;43:1636-43.  Back to cited text no. 3
    
4.
Chattopadhyay A, Patra RD, Shenoy V, Kumar V, Nagendhar Y. Surgical implications of snakebites. Indian J Pediatr 2004;71:397-9.  Back to cited text no. 4
    




 

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