I should be blunt – I started as an intern some months back and was drowned in the sea of patients. There it is, I said it – the reason I have been missing from doc2doc for 6 months. But one thing is for sure, it is entirely different being a student and being a doctor.

One of the cases which I saw plenty during my posting in the general medical ward were snake bites. During a typical day in late summer/beginning of the monsoons atleast 1 in 10 patients being admitted was a case of snake bite. Most of the cases that I saw were from vasculotoxic snakes, only a handful were bites from neurotoxic snakes. The diagnosis and management of snake bite is pretty straight-forward – the only hurdle was the time delay with which the patients presented. There is still significant superstitions regarding snake bite and we had patients presenting with renal failure after being treated by quacks.

This dead snake was brought by a patient

However there are some questions to which I haven’t found any satisfactory answer – may be you guys can figure something out –

• In the 20 min Whole Blood Clotting Time (WBCT) test, why 20 min has been taken as a limit?
• Say a patient presents within 30 mins of a suspected vasculotoxic snake bite – the first 20 min WBCT is negative – do we need a second WBCT tested? If yes, then when? Same question with neurotoxic snake bite – how long should we observe a patient for the onset of neurological signs/symptoms?

Resource for snake bite in SE Asia region –

• Guidelines for the management of snake-bites (PDF)