Discussion
Snakebite continues to be an undervalued factor contributing to
unintentional fatalities in Bangladesh. The annual mortality rate
resulting from snake bites in rural Bangladesh is 6041(2). Numerous
misconceptions and fallacies surrounding snake bites contribute to a
postponement in the admission to the emergency department of the
affected individuals. Neurotoxic snake bites are strongly linked to a
high mortality rate caused by rapid respiratory failure, particularly in
rural regions (9).
The neurotoxic snake bite case resulted in the occurrence of type II
(hypercapnic) respiratory failure. The occurrence of severe
neuromuscular paralysis and poor ventilation was attributed to the
impact of the snake’s toxin, which targeted the neuromuscular junction
(10,11).
A patient who has been bitten by a snake necessitates immediate
emergency care, administration of antivenom, and appropriate respiratory
support with mechanical ventilation. These interventions have the
potential to enhance the patient’s prognosis and reduce fatality rates
(12). This patient came to our hospital with severe neurotoxic features
and impending respiratory failure. We managed the patient with
supportive measures, antivenom, and bedside ventilation maintained by
Ambu bag and then transferred to the ICU with Ambu bag which was 55 km
away from our hospital. After 4 days of mechanical ventilation support
in the ICU and 5 days of medical management in the ward, the patient was
survived and discharged from the hospital without any complications.
The timely identification, prompt delivery to medical facilities, and
effective therapy of neurotoxic snake bites are crucial factors in
attaining favorable outcomes. The recommended treatment protocols for
venomous snake bite patients include antivenom and anti-acetylcholine
esterase (causative therapy), prophylactic infections of the bitten limb
(additional therapy), and ventilator support (supporting therapy). These
interventions are essential in preventing respiratory failure and saving
the life of the patient (13). Implementing ventilatory care can be
straightforward and has proven to be lifesaving (14). In case of a
venomous snake bite where severe neurotoxic features including
respiratory muscle paralysis occurred, immediate initiation of
mechanical ventilation even at the bedside for respiratory support along
with other management can save many lives.