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Factors affecting the outcome of snake envenomation
Globally 421 000 envenomings and 20 000 deaths occur each year due to snake bites with the highest numbers in South Asia, Southeast Asia and sub Saharan Africa. Use of a tourniquet and prompt administration of antivenom are factors that impact on outcome. Sankar and colleagues evaluate the clinical outcome and factors affecting it in a cohort referred to a tertiary centre in India (n=110, all had confirmed snake bites). Most of the bites occurred at night. The species of snake was identified in 81 (saw scaled viper, Russell's viper, Krait and Cobra). All were treated according to the WHO guidelines (2005). Common complications included respiratory failure (n=35) and renal failure (n=25) with 21 requiring dialysis. 14/110 died and 13/110 suffered major sequelae (skin graft, amputation). 44 had allergic reactions to the snake antivenom. Poor prognostic factors included younger age at presentation, anaemia (Hb<10 g/dL) at admission and distance walked after the bite (>1 km). The authors emphasise the need for early referral and prompt treatment, presumably as part of an accessible network, in order to better treat and improve the outcome of these common and potentially fatal bites. See page 596
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