Newer Lights in Management of Snake Bite Cellulitis, Surgical Vs. Medical.

Abstract

Incidences of Snake bite are inseparable from human life, especially in rural areas because the reptiles live both in domestic and in wild. Snake bite is of great public health interest not only because it volves huge financial Commitment from the government but also due to its morbidity and mortalityAs for the medical fraternity is concern the responsibility lies in reducing the morbidity , mortality as well as reducing the xpenses. This can be achieved by using appropriate dose of ASV in appropriate time and early fasciotomy for the needy patients at the right time There are many guidelines available for medical management were as no proper guidelines available for managing the snakebite induced cellulitis and compartmental syndrome we have attempted to propose a few guide lines for the management of the same Material And Methods: This is a prospective observational study in a tertiary medical care hospital in the western part of Tamil Nadu between Jan 2013 to Dec 2015 with 1224 patients all are presented with history of snake bite and signs of envenomation Inclusion Criteria: All the patients with features of envenomation,Patients with features of impending gangrene. Exclusion: patients with co-morbidity like diabetes and hypertension Patients on aspirin, and bleeding diathesis Study Period: all patients admitted between Jan 2013 to Dec 2015 Aim Of The Study: The aim of the study is to study and compare the outcome of intensive medical management with ASV and medicines including analgesic verses surgical are useful in reducing the morbidity due to snake bite induced cellulites. The presently available polyvalent ASV, one effective against bites due to common neurotoxic and hemotoxic snakes. Theoretically, it would appear that patients with more severe envenomation need higher doses of ASV for effective neutralization of circulating snake venom but practically it is not many of the times we need surgical intervention but there are no universal acceptable guidelines available hence on this study will help to form a guide lines Results: Intensive treatment with ASV and appropriate management of cellulitis with appropriate antibiotics will reduce the morbidity, but early bullae formation, discoloration, compartmental syndrome, gangrene even in presence of abnormal coagulation profile can be effectively managed with surgical decompression with transfusion of FFP.with medical management Conclusions: Fasciotomy should be done at the earliest in fingers and toes,after aggressive ASV Fasciotomy for proximal parts of the limbs should be done once we see a bleb. When the fasciotomy has to cross a joint follow z pattern while incising. Trunk fasciotomy can be postponed until gangrenous changes are evident