Arshad Naseem, Shaheen Moin.
Snake Bite with multi system involvement.
Pak Armed Forces Med J Jan ;51(2):187-9.

On 21st August 2000 at about 2230 hours, a patient of 25 years of age was brought to MRC (medical reception center) of C.M.H Murree Hills with three hours history of snake bite on dorsal aspect of right foot. The snake was black coloured measuring about two feet in length was killed at home and mutilated to the extent that it was unidentifiable. Patient was given traditional first aid at home i.e.-, incision was given at the site of bite followed by mouth suction. He complained of pain at the site of bite, increasing effort to keep both his eyes open, difficulty in swallowing of saliva and generalized weakness. There was no history of nausea, vomiting, bleeding gums, chest pain, breathlessness, numbness of right foot or leg. Clinically he was an asthenic, anxious and irritable patient having bilateral symmetrical complete ptosis. Vital signs were normal and PEFR (peak expiratory flow rate) was 300L/min. Pupils were dilated but reactive to light and all eye movements were normal. The gag reflex and palatal movements were sluggish while all tendon reflexes were normal. The muscle power in all the limbs was of grade 4/5 while he was unable to lift his head of the pillow against resistance. There was no sensory deficit. Rest of his clinical examination was unremarkable. He was kept in intensive care unit and nursing staff was advised to monitor his respiratory rate, PEFR, and oxygen saturation to look for respiratory embarrassment. His initial coagulation profile (CT, PT, PTTK) showed- blood failed to clot; while BT, platelet count and serum fibrinogen levels were all normal.

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