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Compression bandages
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by Snakespeare on January 29, 2005
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Hello experts! :)
I am involved inputting together some information for the Australian Education Department. They're putting together a 'School Kit' of information on local venomous species - at last!
for use in all schools in NSW. For now, this is just a beginning.
So, I have a few obscure questions. Thank you for your time.
Do all doctors in rural areas carry anti venin?
Is there a test kit for identifying the snake and, if so, how long does that take?
Is it your opinion that the snake be caught and taken with the victim for ID?
Is the compression bandage technique the only acceptable treatment for initial venomous bites? (Tourniquets are right out...right?)
Is there a snake here that the compression bandage does not help? When should the compression bandage be removed, after the anti venin is administered?
Should the compression bandage be used in the same way for funnelweb spider bites?
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RE: Compression bandages
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by GREGLONGHURST on January 29, 2005
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Being from the U.S., not Down Under, I will not attempt to answer much. This much I do know..The compression bandage as first aid for elapid snakebite is recommended. Tourniquets for any type of snakebite are not.
~~Greg~~
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RE: Compression bandages
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Anonymous post on January 29, 2005
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I wouldn't just "recommend" a pressure bandage. I consider it imperative to have as first aid for elapid envenomations. The use of a pressure bandage can mean life or death for the victim.
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RE: Compression bandages
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by paleoherp on January 30, 2005
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Hi , test kits apparently take about 30 mins to accuratly identify a snake and reduces the need for administration of polyvalent anti venom but if identification is uncertin treat as if the snake was unidentified . The "pressure-immobilisation" technique is currently recommended by the Australian Resuscitation Council, the Royal Australasian College of Surgeons and the Australian and New Zealand College of Anaesthetists.
The lymphatic system is responsible for systemic spread of most venoms. This can be reduced by the application of a firm bandage (as firm as you would put on a sprained ankle) over a folded pad placed over the bitten area. While firm, it should not be so tight that it stops blood flow to the limb or to congests the veins.
There is lots of good info on the net , so check these out :
http://www.usyd.edu.au/anaes/venom/snakebite.html
australian venom unit site.
australian reptile park site.
hope this helped .
SHAUN
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RE: Compression bandages
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by BGF on January 30, 2005
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>Do all doctors in rural areas carry anti venin?
Depends on how rural you are talking about. The Royal Flying Doctor Service however has a massive range and can bring antivenom to super-remote areas.
>Is there a test kit for identifying the snake and, if so, how long does that take?
Yes, there is an ELISA based test called the VDK (Venom Detection Kit), that will put the snake hopefully into one of five immunotypes, showing which monovalent antivenom is best. However, the name is very much a misnomer, it does not 'detect' venom per se, rather it identifies it. Thus, a negative simply means the venom is not-one of the five immunotypes, not that there was definatively an envenomation. Some snakes, like Suta and Furina species, simply don't show up at all in the VDK.
Time is about twenty minutes or so.
>Is it your opinion that the snake be caught and taken with the victim for ID?
No. Thats what the VDK is for. Someone trying to kill the snake for ID purposes is an excellent way to have two snakebite victims present simutaneously.
>Is the compression bandage technique the only acceptable treatment for initial venomous bites? (Tourniquets are right out...right?)
Yes. The key is to use a wide bandage (e.g. 13 cm) and put on 'no tighter than a sprain'. While purple fingers might look cool, they aren't terribly helpful. The key is to stop the spread of lymph. Between some gentle pressure and immobilising the lymph, the venom spread can be greatly reduced.
>Is there a snake here that the compression bandage does not help?
In the Australian elapids, it helps pretty well for all. There are some components (particularly the very small ones) that get through but the vast majority are stopped.
>When should the compression bandage be removed, after the anti venin is administered?
It should not be removed until an IV is in place and antivenom is on hand. Symptoms can show up with terrifying rapidity once the bandage is removed. If there is a definate envenomation, an ampoule of antivenom should be given five - ten minutes before the removal of the bandage in order to give the body a nice infusion of antivenom.
>Should the compression bandage be used in the same way for funnelweb spider bites?
Yes but not with redbacks (it only localises and magnifies the pain in redback spider bites, the more the venom spreads the less the pain in redback bites).
Cheers
Bryan
www.venomdoc.com
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RE: Compression bandages
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by Phobos on January 30, 2005
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Em...
This is a research abstract presented by Dr. Sean Bush of Loma Linda University Hospital. You may know him better as the focus of an Animal Planet show called Venom ER.
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Biology of the Rattlesnakes Symposium
Bush1, Sean P., Steven M. Green1, Torrey A. Laack2, William K. Hayes1, Michael D Cardwell1, David A. Tanen3. 1Department of Emergency Medicine, Loma Linda University, School of Medicine & Medical Center, Loma Linda, 2California Division of Medical Toxicology, 3Department of Emergency Medicine, University of California at San Diego Medical Center and California Poison Control System, San Diego, California
Pressure-Immobilization Delays Mortality and Increases Intra-compartmental Pressure after Artificial Intramuscular Rattlesnake Envenomation in a Porcine Model
We determined the effect of pressure immobilization on mortality and intracompartmental pressure after artificial intramuscular Crotalus atrox envenomation in a porcine model. We prospectively studied 20 pigs using a randomized, controlled design. After anesthesia, C. atrox venom (20 mg/kg) was injected with a 22-gauge needle 10 mm deep into the tibialis anterior muscle of the hind leg. Pigs were randomized to receive either pressure immobilization (applied 1 minute after envenomation and maintained throughout the duration of the experiment) or no pressure immobilization. We measured time to death, intracompartmental pressure before venom injection and at 2 hours after injection, and leg circumference at a standardized location before injection and immediately postmortem. Duration of survival was compared using Kaplan-Meier survival analysis. The dose of venom resulted in 100%mortality. The median survival was longer in the pressure immobilization group (191 minutes, range 140 to 240 minutes) than in the control group (median 155 minutes, range 119 to 187 minutes). The difference between the groups was 36 minutes (95% confidence interval [CI] = 2 to 64 minutes; P = 0.0122). The mean (± SD) intracompartmental pressures were 67 ± 13 mm Hg with pressure immobilization and 24 ± 5 mm Hg without pressure immobilization. The difference between groups was 43 mm Hg (95% CI = 32 to 53 mm Hg). The mean circumferences were 14.3 cm in the pressure immobilization group and 19.1 cm in the control group. The difference between groups was 4.8 cm (95% CI = 5.7 to 3.9 cm). Compared with control animals without treatment, the pressure immobilization group had longer survival, less swelling, and higher intracompartmental pressures after artificial, intramuscular C. atrox envenomation in our porcine model.
Regards,
Al
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RE: Compression bandages
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by LarryDFishel on January 31, 2005
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I think the most interesting point in that abstract is that just over the mouse LD50 (by weight) for c. atrox was 100% fatal within 3 hours, even with the pressure bandage! Makes me wonder how less hardy species like h. sapiens would do... (But of course, I'M not volunteering.)
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RE: Compression bandages
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by Buzztail1 on February 3, 2005
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I read that abstract too, Al, but it clearly doesn't apply in the case of Australian elapids.
I think the point of Dr. Bush's paper was that compression bandages, although providing excellent results in Australia, are not necessarily the best way to treat our crotlid snakebites in the U.S.
BGF would be the expert in this particular field and I would put my money on his answer.
Back from the Briney,
Karl
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