388 Where There Is No Doctor 2011 Green Pages
Thailand: Antivenoms for king cobra, banded krait,
Russell’s viper, Malayan pit vipers, and others.
Thai Red Cross Society, Bangkok, Thailand,
tel: (66) 2252-0161, fax: (66) 2252-0212,
www.redcross.or.th
Instructions for the use of snakebite antivenoms
usually come with the kit. Study them before
you need to use them. The bigger the snake, or
the smaller the person, the larger the amount
of antivenom needed. Often 2 or more vials are
necessary. To be most helpful, antivenom should be
injected as soon as possible after the bite.
Be sure to take the necessary precautions to
avoid allergic shock (see p. 70).
Antitoxins for tetanus
Tetanus Immune Globulin (human) often comes in:
vials of 250 units
Tetanus antitoxin (horse) often comes in: vials of
1,500, 20,000, 40,000, and 50,000 units
In areas where there are people who have not
been vaccinated against tetanus, the medical kit
should have an antitoxin for tetanus. There are
2 forms, one made from human serum (tetanus
immune globulin, Hyper-tet), and one made from
horse serum (tetanus antitoxin). If available, use
tetanus immune globulin, as it is less likely to
cause a severe allergic reaction.
But if you use horse serum tetanus antitoxin,
take precautions against allergic reaction: If the
person suffers from asthma or other allergies, or
has ever received any kind of antitoxin made from
horse serum, give an injection of antihistamine such
as promethazine 15 minutes before injecting the
antitoxin.
If a person who is not fully vaccinated against
tetanus has a severe wound likely to cause tetanus
(see p. 89), before he develops the signs of tetanus,
inject 250 units (1 vial) of tetanus immune globulin.
If using tetanus antitoxin, inject 1,500 to 3,000 units.
Inject babies with 750 units of tetanus antitoxin.
If a person develops the signs of tetanus,
inject 5,000 units of tetanus immune globulin, or
50,000 units of tetanus antitoxin. Give it in many
intramuscular injections in the large muscles of the
body (buttocks and thighs). Or, half the amount can
be given intravenously if someone knows how.
The signs of tetanus usually continue to get
worse in spite of treatment with antitoxin. The other
measures of treatment described on pages 183
and 184 are equally or more important. Begin
treatment at once and get medical help fast.
FOR SWALLOWED POISONS
Activated Charcoal
This comes as a powder. Follow the directions on
the bottle, or mix the indicated dosage in 1 glass of
water or juice and drink the whole glass.
Activated charcoal absorbs poisons that have
been swallowed and reduces the harm they
cause. It is most effective if used immediately after
swallowing the poison. Do not use this medicine
if the person has swallowed strong acid, lye,
gasoline, or kerosene.
Dosage of activated charcoal, within 1 hour after
swallowing poison:
adults and children 12 years and older:
50 to 100 g., 1 time only
children from 1 to 12 years:
25 g., 1 time only, or 50 g. in case of
serious poisoning
children under 1 year old:
1g./kg. 1 time only
To eliminate poison from the body after effects
of the poison have begun:
adults and children older than 1 year:
25 to 50 g. every 4 to 6 hours
children under 1 year old:
1g./kg., 1 time, followed by ½ this dose
every 2 to 4 hours. For example, if the
baby weighs 6 kg., give 6 g. of
activated charcoal for the first dose,
and 3 g. every 2 to 4 hours afterwards.
FOR SEIZURES (FITS, CONVULSIONS)
Phenobarbital and phenytoin are common
medicines used to prevent seizures of epilepsy.
Other, more expensive medicines are sometimes
available, and doctors often prescribe two or more
medicines. However, usually a single medicine
works as well or better, with fewer side effects.
Medicines to prevent seizures are best taken at
bedtime, because they often cause sleepiness.
Diazepam can be given to stop a long-lasting
epileptic seizure or a seizure during pregnancy or
child birth (eclampsia), but it is not usually taken
daily to prevent them. Magnesium sulfate can also
be given to stop eclampsia.