Surviving a snake bite

Morning rounds were about halfway through, and we had just finished up coming up with a plan to treat a little three year old boy with an obstructed airway who was struggling to breathe.  Rather than moving on to the next patient with a huge infected scalp wound, I was quickly summoned to the ER by our hospital security man.  There was a 32 year old woman lying there on a stretcher, unconscious.  Her breathing was shallow and she looked quite pale.  We got a quick history from her family.  She had been walking outside at dawn, less than 3 hours prior to arriving, and was bitten by a snake.  She didn’t see it, but based on the quick onset and spectrum of her symptoms, there’s a good chance it was a black krait.

This is not a snake you want as a pet.  Their venom is extremely toxic, and if antivenom is not administered quickly, its bite will eventually lead to coma, paralysis of the diaphragm, and death due to suffocation.  Snake bites are a common occurence in Nepal, with an estimated 20,000 bites occurring per year (with about 1,000 of those leading to death).  Our patient was critically ill by the time she got to us.  We gave her antivenom and steroids immediately and started oxygen.  After offering a prayer on her behalf and explaining her tenuous situation to her family,  we moved her to the ward and continued to administer the antivenom in an IV drip.

By the end of the day she was perking up.  This was surprising considering the state she came in earlier that morning. We’ve had other snake bite victims who’ve taken days to wake up.  By that night, she wanted to eat, and by the next morning she was already asking to go home.  We had to explain to her to slow down a bit, and reminded her that 24 hours earlier she was on death’s doorstep and at that point still had antivenom running into her vein.

By the second morning, there was no holding her back.  She was back to her bubbly self and was basically begging to go home, and we shut off the antivenom drip and watched her for several hours prior to letting her go.

It was a great feeling for all of us watching her stroll out the door, heading home to take care of her one month old baby.  Hopefully no more early morning hikes through knee high grass in flip flops are on the agenda!