Abstract
Introduction: Most of the snake bite deaths reported were due to delay in giving antivenom or non-availability of species specific antivenom and the relatives of deceased allege against doctors that proper care is not given. Forensic pathologist is expected not only to give cause of death but also give opinions about potential negligence in such cases. Case report: A middle aged woman died while being transported from a local hospital to a tertiary care hospital following a snake bite. She was brought to the hospital with symptoms suggestive of neurotoxin poisoning and anti-snake venom was given at the local hospital. The patient developed shortness of breath and she was transferred to a tertiary-care hospital for further ventilator support, but the patient was pronounced dead on the way after 2 hours of the bite. Bite mark with two fangs was found on left upper part of the breast. Inflammatory signs were found around the bite mark with necrosis and blister formation. Autopsy revealed no hematological manifestations. Conclusions: The COD was envenomation of neurotoxin due to cobra bite. The allegation of medical negligence may be challenged, because death could occur rapidly within 30 minutes to two hours in cobra bites and delay in transport may also have played a vital role especially being a rural area. Role of non-availability of species specific antivenom and efficacy of common anti snake venom should be further studied before giving opinions regarding potential negligence.
Highlights
IntroductionThere are 2400 species of snakes distributed around the world, of them 10% are venomous [1]
Most of the snake bite deaths reported were due to delay in giving antivenom or non-availability of species specific antivenom and the relatives of deceased allege against doctors that proper care is not given
A middle-aged woman died while being transported from local hospital to tertiary care hospital following snake bite
Summary
There are 2400 species of snakes distributed around the world, of them 10% are venomous [1]. Sri Lanka has only 93 species of land and marine snakes of which five (5) are deadly venomous, two (2) are moderately venomous. Snake bites are a common problem in Sri Lanka among people living in rural and agricultural areas. A middle-aged woman died while being transported from local hospital to tertiary care hospital following snake bite. Clinicians had tried to intubate, but failed and was managed with ambu bag and mask ventilation. She was transferred to a tertiary-care hospital for further ventilator support and management but died before admission after 2 hours of the snakebite. Relatives alleged that proper management was not provided even they brought the victim early to the hospital, such as failed intubation. At the end of the examination, the COD was envenomation due to cobra bite
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