Indian Journal of Trauma and Emergency Pediatrics

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 Paracetamol is one of the most commonly used drug world wide. It is the deethylated active metabolite of phenacetin. Paracetamol (acetaminophen) was discovered in Germany at the end of the 19th century and has come into common clinical use since 1950.1 Paracetamol is contained in many preparations, in many forms either alone or in combination with other drugs (usually opiates) for analgesia and in other mixtures its analgesic and antipyretic properties and is available as both over-the-counter and as prescription-only medications. Because of its wide availability paired with comparably high toxicity, (compared to ibuprofen and aspirin) there is a much higher potential for overdose especially in children.

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 Although neurotoxic snakebite mortality is exceeded by that from viperine species it remains a significant contributor to total figures. The rapidity of onset of life threatening respiratory compromise in a developing world context with little access to mechanical ventilation contributes to poor outcomes, particularly amongst children. The majority of hospitals in the developing world are primary care centers, with limited facilities, and yet are close to the scene of the bite. Most of the textbooks used in medical education are written from a tertiary hospital perspective with the assumption that access to a mechanical ventilator is available. Consequently guidelines for primary care hospitals are inapplicable and result in most patients being transferred to other hospitals in sub-optimal conditions. This paper examines neurotoxic snakebite and recommends management techniques, use of anti snake venom and support drugs and the various methods of airway support that can be sourced or improvised in a primary care setting.

Key Words: Snake Bites, Neurotoxicity, Airway Management, Developing World, India

First Aid is a crucial element in ensuring the optimum outcome from a venomous snakebite and correct application is a significant determinant of the condition in which a child victim will present at hospital for treatment. Unfortunately the field is still dominated by traditional myths and unscientific and impractical modern ones. It is therefore vital that doctors both know and disseminate the correct first aid methods., The Indian National Snakebite Protocol outlines a modern approach based on the mnemonic Do it R.I.G.H.T., Reassure, Immobilise, Get to Hospital, Tell tale signs. These actions all support the prime objective of first aid in snakebite, to minimise both the speed at which venom will spread from the bite site and attach to receptor sites and any delay in getting the victim to a hospital. The use of tourniquets, cutting the wound and application or consumption of herbal remedies have been proven to be ineffective in treating the acute stage of snakebite and can also be intrinsically dangerous in such an emergency.,  Doctors are ideally placed to dispel myths,collect and disseminate accurate information about snakebite first aid and major risk activities in their area, supported by eye-catching posters for display in schools and hospitals. 

Key Words. Snake Bites, Intensive Care Units, Pediatric, Pediatrics, Developing World, India, First Aid