Background: Neuro-paralysis leading to type II respiratory failure is the most important cause of morbidity and mortality in victims bitten by venomous snakes of Elapidae family. In-hospital cardiac arrests are secondary to presumed acute respiratory compromise and an excellent outcome can occur after well-choreographed, high quality cardio-pulmonary resuscitation. Compartment syndrome is characterized by an increase in intra-compartmental pressure with subsequent neurovascular compromise and tissue necrosis. Hence early necrectomy and debridement are indicated in such instances. Case Report: We herewith report a case of snake bite with cardiac arrest following severe neurotoxic envenomation, was managed successfully in our critical care. In our case, the presentation was late, resulting in a substantial delay in anti-venom therapy. The resultant delay contributed to a significant morbidity and prolonged hospital admission. Conclusion: The case report illustrates some practical difficulties faced by clinicians pertaining to complications. Institution of appropriate therapy without delay results in better outcome, including in a rural critical care setting.
Abstract:Supervasmol 33 ® is a popular emulsion-based permanent hair dye, containing mainly paraphenylenediamine (PPD) and has been emerging as one of the important causes of intentional self-harm in the developing world. The effect of PPD when ingested is serious and includes cervicofacial edema, mucosal injury, respiratory distress, rhabdomyolysis, acute renal failure and myocardial injury. We herewith report a case of hair dye poisoning in which patient developed cardiac arrest and was managed successfully in our critical care. In conclusion, early recognition and treatment is vital with special emphasis on airway management. In case of cardiac arrest, to follow ACLS guidelines for CPR and strictly adhere to post-arrest bundle care, which may ensure optimal neurological outcomes. Finally, appropriate therapy without delay results in better outcome, including in a rural critical care setting.
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