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.