PS03P
MASSIVE SKIN NECROSIS FOLLOWING COBRA BITE

Introduction: Local necrosis which needed debridement or amputation is common complication of a snake bite. On the other hand, large area of necrosis which need frequent debridement and skin graft is very uncommon. Case Report: We present a case of 11 years old boy with an extensive back necrosis following a snake bite at his right shoulder. The incident happened while the boy is playing in paddy fields with his friends. He complained of pain at bitten subsequently become sleepy and drowsy. However he denied any shortness of breath. He was brought to the hospital and immediately anti‐tetanus toxoid and polyvalent (Antivenom) was given. He was noted to have respiratory distress subsequent morning and was ventilated promptly. Three days later he was referred to our team for extensive back necrosis. Clinical examination revealed normotensive blood pressure with stable pulse rate. Three was low grade fever noted and a snake bite mark at the right shoulder with extensive skin necrosis, estimated about 15% of body surface area. Multiple episodes of wound debridement was done on day 5, day 9 and day 13. Split skin graft was applied over the back and shoulder and he was discharged well on day 35. During follow up, a minimal area which is not cover by good skin however parents refused for another split skin graft. Conclusion: Immediate treatment of cobra bite is very crucial in order to save patient's life. Early and extensive debridement of any skin necrosis should be emphasized to warrant patient's survival.