Snake Bite: Soft Pointers for Early Diagnosis

Excerpt

A 10-y-male child, slept well, and complained of throat pain and fever in the morning. He was managed as a case of acute pharyngitis by a local practitioner. By evening, he developed neck swelling and was admitted in the emergency department. On examination, he was lethargic, febrile (temperature 37.7 °C) with stable vitals. Right neck swelling was present which was diffuse and nontender. On examination, Glasgow coma scale was 15/15. Pupils were symmetrical, reacting normally and mild ptosis was present (Fig. 1a). Broken neck sign was also seen (Fig. 1b). Other systemic examination was normal. There were no fang marks. However, in view of broken neck sign and ptosis, a possibility of snake bite (neurotoxic) was kept and antisnake venom was planned. However, the patient developed respiratory failure before the antisnake venom could be started, for which, he was intubated and ventilated. Antisnake venom was simultaneously started; 20 min whole blood clotting time was normal. Complete blood count showed Hemoglobin 13 g/dL and peripheral smear was normal. There was no evidence of hemolysis. After administration of 10 vials of antisnake venom and 2 d of ventilation, the child improved and was discharged.

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