H.S.Bawaskar Bawaskar Hospital and Research center Mahad Raigad - PowerPoint PPT Presentation

H.S.Bawaskar Bawaskar Hospital and Research center Mahad Raigad maharashtra

Unknow Clinical Echis RV Krait Cobra n bite Total (69) 20 (29%) 25 (36%) 14 (20) 2 (3%) 8 (12%) 25- Age in years 20-70(40) 13-68(41)` 10-50(28) 56,13 65(42) Male 11(55%) 22(88%) 10 (72%) 2 5(63%) Female 9 3 4 - 3 Time of bite 13 11 - 1 6 AM PM 7 14 - 1 2 Mid-6AM - - 14 - - Site of bite Neck-4 9 left hand 6 1 1 Upper thumb-2, extremities ear-2 upper arm-2 not seen-4 Lower 11(55%) 19(76%) 1 7( 88%) extremities 1.5-20(5) 0.5-6(3) 1-8(5) 0.5 and 1 0.5-3(1.5) Time between bite to hospital

Month Echis RV Krait Cobra Unknown bite March - - - 1 - April - 2 - - May - 1 - - 1 June - 1 2 2 July 22 9 10 2 1 - (38%) August 12 3 2 4 - 3 (17%) Sept 11 3 2 4 - 2 (16%) Octo 8(12%) 5 1 2 - - November - 4 - - Month wise distribution cases December - 2 - - -`

Cobra Clinical Echis RV Krait 2 Pain at the site 19` 25 - of bite 2 Edema at bite 19 25 - site and extension - 20WBCT 19 25 - - External bleeding 8 21 - - Renal failure 1 2 - - Pain in abdomen - 6 11 Neuroparalysis - - 13 2 Hypertension - - 3 - Hypotension - 3 - -

Management . Treatmnet ECHIS RV KRAIT COBRA ASV in ML 30 150- 200 200 250(200) Reaction 3 5 2 - Ventilator - - 4 1 disability - 2 - - Death - 1 2(1brought - dead) Hypertension Pul.oedema

Confirmatory Diagnosis (Clinical Syndrome) Photograph Total Non- Russell Russell's Viper Viper Russell's Viper 47 1 48 Non-Russell's 15 9 24 Viper Total 62 10 72 Confirmatory Diagnosis (Clinical Identification of Syndrome) Total preserved Non- Russell specimen Russell's Viper Viper Russell's Viper 49 0 47 Non-Russell Viper 13 10 25 Total 62 10 72

Confirmatory Diagnosis (Clinical Syndrome) Photograph Total Non-Echis Echis carinatus carinatus Echis carinatus 20 2 22 Non-Echis 9 9 18 carinatus Total 29 11 40 Confirmatory Diagnosis (Clinical Identification of Syndrome) Total preserved Non-Echis specimen Echis carinatus carinatus Echis carinatus 21 4 25 Non-Echis 8 7 15 carinatus Total 29 11 40

Photograph Photograph- Specimen- Specimen- – Russel ’ s Echis Echis Russel ’ s Viper Viper carinatus carinatus Sensitivity 75.8% 68.9% 75.8% 68.9% Specificity 90.0% 81.8% 100% 63.6% Positive Predictive 97.9% 90.9% 100% 83.3% Value Negative Predictive 37.5% 50.0% 40.0% 43.7% Value Diagnostic 77.7% 72.5% 79.1% 67.5% Accuracy Likelihood ratio of 7.5 3.8 'undefined' 1.9 a Positive Test Likelihood ratio of 0.26 0.37 0.24 0.48 a Negative Test

DEAD MORNING Woke from floor bed at 2AM with abdominal pain and vomiting Morning ptosis unable to talk and swallow and life the neck

THANKS ASV

20 Minute whole blood clotting test (20WBCT)

CP K 38 4

Victim Identified the culprit by color and big triangular head Patient identify snake by color and tringular big head Bamboo viper

Bamboo pit viper No Lymphadnopathy

RATIONAL USE OF MODERN GADGET

THANK YOU SIR