Venomous snake bites affect at least 400,000 people and claim approximately 20,000 lives each year, mainly in the rural
tropics. Paralysis is a common mechanism of death for those bitten by cobras, kraits, mambas, and a number of Australian
snakes. Because it is an ancient scourge and a modern problem, superstition continues to sabotage evidence-based approaches to
snakebite. A major challenge is the fractured state of communication and research among major stakeholders. Neurologists can
contribute tremendously to urgent and achievable goals for the benefit of victims of snakebite worldwide. We propose 4 related,
a. National and global surveys of herpetologists, neurologists, emergency and critical care workers about the local therapies
and available resources (e.g., antivenoms, neuromuscular pharmaceuticals, and ventilators) for snakebite-paralyzed victims in
b. use of noninvasive tests (such as diaphragm ultrasound and NIF scoring) to assess muscle function and respiratory capacity
of bitten and treated victims
c. use of simple neurologic testing modalities (such as physical exam, EMG and nerve conduction testing) to describe the timing
and severity of snakebite paralysis, and response to antivenom and other therapies
d. high-quality trials of low-cost neuromuscular medications which could revive neuromuscular junction function in patients
affected by paralytic venoms and be taken orally or intra-nasally.
In 2006 the WHO added snakebites to a list of Neglected Tropical Diseases which need urgent, multidisciplinary attention.
Intelligent collaborations are urgently needed to ameliorate this ongoing epidemic.
Dr. Rais Vohra completed emergency medicine residency at UT Southwestern Medical Center, and then Fellowship in Medical Toxicology at UC San
Diego. He is currently Associate Medical Director of the California Poison Control System?s Fresno-Madera Division, and the Director of Toxicology
and Attending Physician in Emergency Medicine at the UCSF-Fresno Medical Center in Fresno, CA
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