Case History/examination
Md. Milon, 35 years old, married bakery worker, hailing from Thakurgaon, came to the Emergency Department of the General Hospital, Nilphamari on 9th October (Monday), 2023 at 9:30 AM, complaining of a bite by an unidentified snake to his right foot near the little toe. at 3.00 am on 9th October when he was sleeping in a tin shed house nearly 07 hours ago from the time of examination. At that time, he woke up from sleep and saw that there was bleeding from the bite site, but he did not see anything in the room. After about half an hour of biting, he develops pain in the bitten site as well as severe headache, and bodyache. He was treated by a local traditional healer (Ojha) with scratching of the bitten site. As there was no improvement with this treatment, he ligated the right leg with rope in three areas and visited Thakurgaon district hospital. In the Emergency department of Thakurgaon District Hospital, ligature by rope was removed and two firm tourniquets were given with roller bandages. After that, he was referred to Nilphamari District Hospital due to a lack of antivenom.
On examination, the patient was altered conscious; pulse 88/min, regular, blood pressure 120/80 mmHg, respiratory rate 25breath/min, oxygen saturation 98% in room air, bilateral partial ptosis, broken neck sign was present, pupils are normal reacting to light and the chest was clear on auscultation, simplified snakebite severity score was grade 3. The local examination of her right foot showed no swelling, bruise, redness, hotness, or tenderness and no other local features of envenomation. After clinical examination, blood samples were taken for a bedside 20 min whole blood clot test, and it was negative.