The medical offi cer who is treating the cases of snake bite should take meticulous
care to look in to the patient’s status and provide fi rst aid as well as supportive measures
before referring the case to higher centre / speciaslist. The details are furnished in
Table 15 below.
Table No. 15: Referral aspects for snakebite
Who needs?
Patient requiring
• Respiratory support
• Deteriorating
neurologic
manifestations
• Surgical
intervention-Necrosis
/ Fasciotomy
• Spontaneous
persistent bleeding
• Co-morbid diseases
• Acute impending
kidney failure
When to refer?
Refer the patient
after stabilising the
case and after giving
injection ASV (Refer
to Annexure VIII and
IX)
Where to refer?
Refer to higher institution
having
• Ventilator
• Dialysis facilities
• Measures to provide
further supportive
treatment.
Referral Criteria for Haemotoxic envenomation
Once the ASV is fi nished and the adverse reaction dealt with the patient should be
automatically referred to a higher centre with facilities for blood analysis to determine
any systemic bleeding or renal impairment. The 6 hours rule ensures that a six hours
window is now available in which to transport the patient.
Referral Criteria for Neurotoxic envenomation
If after one hour from the end of the fi rst dose of ASV, the patient’s symptoms have
worsened i.e., paralysis has descended further, a second full dose of ASV is given over
one hour. ASV is then completed for this patient. If after 2 hours the patient has not
shown worsening symptoms, but has not improved consider this case for referral to a
higher centre
Instructions while referring
• Inform the need for referral to the patient and / care giver [family member or
the accompanying attendant]
• Give prior intimation to the receiving center using available communication
facilities
• Arrange for an ambulance
• Transfer in a vehicle to Secondary Care Hospital or Tertiary Care Hospital
where mechanical ventilator and dialysis facilities are available
Continue life supporting measures
• Provide airway support with the help of an accompanying staff
• Send the referral note with details of treatment given
• Instruct one staff to accompany the patient during transportation if required.
• Hand over the referral form with details regarding treatment given
• Mention the clinical status clearly in the referral form at the time of referral.