case presentation of snake bite

2. Cleopatra VII

3. introduction
 70 % of snakes in Palestine are non venomous .
 Males are bitten almost twice as often as females.
 Most common snake her in Palestine is Vipera
palaestinae.
 No available data about number of snake bites her in
Palestine.
 Test dose of ASV is not essential because even if victim
is sensitive to ASV, does not preclude its use.

5. Case
A 55 year old male, came to the ER on 1772013 at 1
pm
Presenting complaints:
 Snake bite in the morning at 9 am.
 Bleeding from the site of bite till now

6.  Present history: According to the patient he was
alright before he was suddenly bitten while he was
walking in the garden . The escaped snake was about
20 cm
long & brownish in color. The patient,
went home & only bandaged the wound. In a few
hours the pain got intense & the bleeding didn’t stop
from the wound. There was difficulty in walking
associated with the pain & he felt numbness in the
left leg.
There are no associated features of hematomesis,
melena, epistaxis or vomiting , haemoptisis .
There was no history of bleeding disorders among the
family.

8.  Past medical/surgical:
Angiography & angioplasty: 5yrs ago.
 Personal hx: appetite-N, micturation-N
bowels-N, sleep-disturbed.
 Drug hx: none.
 Family hx: not significant.

9. Physical examination
 Patient looks ill, but conscious in time/place/person.
 Vitals: Bp-110/63, pulse-96 bpm, R/R: 21/min O2 sat :
96 temp : 37.1
General impression: swelling on left leg from the foot to
the knee.

11. Examination
 CNS- sensory was bilaterally equal, but slightly





decreased at the lateral side of the left foot and leg .
Tone, power & reflexes were bilaterally equal & normal.
Abdomen- firm, non tender, relax, no vissibel venes .
Cvs- s1 + s2, no murmurs
Resp- Normal vesicular breathing, no additional sounds
No skin rash

12. Chest X- ray
 It was normal

13. Investigations
 Hb-9.1
 Plt-110,000
 WBCs : 9.5
 MCV : 86
 RDW : 11.6

14. Investigations
Coagulation profile:
 PT-48
(control 9-13)
 INR-4.53
 APTT-98
Biochemistry:
 Urea: 22 (10-50)
 Creatinine: 0.68
 Albumin: 4.17 (3.8-4.4)
Electrolytes:
 Potassium : 2.28
 Calcium : 8.17
 Magnesium: 1.92
 Sodium: 141
 Chloride: 100
(2.7-4.5)
(8.1-10.4)
(1.58-2.55)
(136-140)
(98-104)

15. Investigations
LFTs:
 Bilirubin Total: 2.08 (<1.3)
 Bilirubin direct: 0.47 (<0.3)
 ALT: 21
(upto 40)
 Alk Phosphate: 62 (39-117)

16. Diagnosis
 Most likely snake bite complicated by DIC .

17. Treatment
 O2 by nasal cannulae
 500 cc normal saline
 100 mg hydrocortison
 Anti tetanus serum ( ATS ) 2 cc
 given 10U of anti venom
 120 ml of FFP.

18. Treatment
 Then transferred to Nablus to Rafidia hospital , there
he was admitted to ICU and the after 3 hours he died .

19. Take home massage
 Any prolonged bleeding or any abnormal
bleeding following a snake bite it is DIC .

20. Thanks to
 Darwish Nazal Governmental hospital.
 Qulqilia UNRWA hospital .