Abstract:
Introduction
Snakebites are a common problem in Sri Lanka among people living in rural-and agricultural areas. Most of the deaths reported were due to delay in giving antivenom or non-availability of species specific antivenom. Relatives of deceased allege against doctors that up front and proper care is not given on time. Forensic pathologist IS expected not only to give cause of death but also give opinions about negligence in such cases.
Case report
A middle aged woman has died while being transported from a local hospital to a tertiary hospital following a snake bite. History revealed that the snake had bitten her while she was trying to get on to a. bicycle which was parked in an abandoned old house. She was brought to the hospital with symptoms suggestive of neurotoxin poisoning and anti-snake venom was given at the local hospital. The patient developed shortness of breath and she was transferred to a tertiary-care hospital for further ventilator support, but the patient was pronounced dead on the way. The killed cobra was brought to the morgue. Bite mark with two fangs was found on left upper part of the breast. Inflammatory signs were found around bite mark with necrosis and blister formation. Autopsy revealed no hematological manifestations.
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Conclusions
At the end of the examination, the diagnosis was envenomation of neurotoxin due to cobra bite. The allegation of medical negligence may be challenged, because death could occur rapidly within 30 minutes to two hours in cobra bites and delay in transport may also have played a vital role especially being a rural area. Role of non-availability of species specific antivenom, and efficacy of common anti snake venom should be further studied before giving opinions regarding medical negligence.
