Asif H Osmani, Rasheed Durrani, Jamal Ara.
Morbidity resulting from delayed presentation of snake bites cases.
J Surg Pak Jan ;12(1):31-3.

Objective: To determine the frequency of morbidity in delayed presentation from snake bite and to evaluate various causes regarding delayed presentation to tertiary care center. Study Design: Case series. Place and Duration of Study: National poison control center (Medical unit 1), Jinnah Postgraduate Medical Center, Karachi, over a period of one year from 1st April– 30th september 2005 and 1st May-30th October 2006. Subject & Methods: One hundred and ten patients were admitted with the diagnosis of snake bite. All males and females of age group between 11- 80 years were included in the study with mean age being 30.9 years. Snake bite victims came from Southern Sindh including Thar, Gharo, Mir pur sakhro, Korangi, Orangi, Hub (Balochistan). All the patients were injected with polyvalent anti snake venom and tetanus toxoid regardless of time elapsed in their presentation. Results: There were one hundred and ten patients included in the study. There were 72 males and 38 females. Thirty patients came to NPCC early (within 4 hours) and were treated promptly and hence recovered. The patients who came late developed complications like wound infection, bleeding diasthesis, renal failure, septicemia and shock. There were 80 patients who came late i.e after 4 hours. Causes of delayed presentation were, 49 patients initially visited local practitioners or quacks, 14 patients did self medication first, 11 patients had transport problems and 6 patients had to cover long distances to reach to NPCC. Morbidity associated with delayed presentation were pain in 75 patients , along with it 62 patients had wound infection, 58 patients had bleeding from the wound, 30 patients had bleeding from other sites and 10 patients were hypotensive. Eight patients died due to these complications. Conclusions: There is significant time delay from snake bite onset to arrival of patient in the hospital. This study highlights the importance of time factor in snake bite management. Early treatment plays an important role in the fate of patients with snake bite. Problems of late arrival at the hospital can be overcome by organizing snake bite awareness programs regarding the importance of early treatment, quick transport and avoiding treatment from local practioners and quacks.

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