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Application of pressure bandages for Elapis bites.
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by theemojohnm on October 26, 2008
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At the moment I only keep 1.1 Naja kaouthia, and 0.1 Naja melanoleuca. As some of you may know, Elapids are not my specialty at all. I am in the process of converting an outdoor shed into a heated until to move my animals into. I have also recently updated my bite protocols. As I now have more room, I am considering adding a few more Elapids to my collection.
I have never gotten aclear answer on what is the appropriate way to apply a pressure bandage. I get some, semi-complete info from some, and others advise to simply skip the pressure bandage, and get to the hostpital as quickly as possible.
What is the appropriate bandage type? Will "ace bandages" work?
How far from the actual bite is one advise to start wrapping the bandage?
What dangers are associated with improper application of such a bandage?
Is this limited to just generally neurotoxic elapids, or are there specific components in the venom of specific species that need to be considered? What are the species this technique should NOT be used with?
I have always been told the using this technique improperly can do alot more damage. I can see why hemotoxic venoms would leave this techniques benefit out of the question, but what specifics do I need to know for the protocol books for that "if the worst happens". I obviously do not plan on any accidents, but I would love to have this info just in case.
John, I know you were working on some kind of kit for elapid bites, with an informational instruction sheet. Perhaps you could send me some info?
Any information regarding the use of pressure-bandages for Elapid bites would be greatly appriciated! A brief, step-by-step, explanation would be great. I know the basics of how this works, but I am looking for actual instructions for application of this technique.
Thanks & Take Care.
~John Mendrola
(Pennsylvania Woodland Herpetological).
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RE: Application of pressure bandages for Elapis bi
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by Cro on October 26, 2008
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John, you have asked some very good questions.
As you have stated, I am bringing a Elapid Snake Bite Kit to marked. I will have these for sale at the upcoming Columbia Reptile Show.
This kit is modled after the ones that are used in Australia, where the use of pressure or compression / immoblization was developed.
The idea is to wrap the bitten limb tightly enough to restrict the flow of the lymph fluid. This fluid is moved through lymph capillaries and vessels that are under / and close to the surface of the skin. Elapid venoms are primarily transported by this system to other areas of the body.
The second part of this first aid treatment is the immoblization of the bitten limb. When a limb is moved, this causes the lymph system to "Pump" lymph fluid. By splinting and immobilizing the limb, you prevent that pumping of the lymph fluids from happning.
Pressure immobilization should be done as quickly as possible after a bite. You start wraping the bandage at the tips of the fingers or toes, and continue to spiral the bandage over the bite, and up the entire limb. The idea is to wrap snugly, but not overly tight. You should be able to force a couple of fingers under the wrap. Elastic "Ace" bandages can be used, as can "Cohesive Bandages," and if those are not available, any cloth material that is readilly available can be used, say a bet sheet that is torn into a few strips, or even a shirt. After the wrap is complete, the limb is splinted to keep it from moving. If the bite is on an arm, that arm can be secured with a triangular bandage "Sling" after it is wrapped and splinted.
It should only take a few minutes to wrap a limb with a compression bandage, and of course, the 911 system should be activated with a telephone call. That way, emergency help can be on the way as you apply the bandage.
Getting to the hospital quickly is very important, as Elapid bites can quickly cause respiratory paralysis, and life support equipment might be needed.
John, you asked about the dangers associated with improper application of a compression bandage. Well, if it is too loose, it will not stop the lymph flow, and the venom will spread. If it is too tight, it can restrict the flow of blood, and act as a tourniquet. For what it is worth, a study done in Australia fount that most of the folks who came into hospitals with compression bandages following Elapid bites, had the bandages "Too Loose."
After one arrives at the hospital with an Elapid bite, it is ESSENTIAL that you do not let the doctors remove the compression bandage UNTIL antivenom has been found and started, and life support equipment is on hand. As soon as the bandage is removed, the Elapid venom will rapidly spread through your body, and create a life threatning emergency. A properly applied compression bandage can be left in place for 24 to 48 hours, while antivenom is found. The first thing most hospital will want to do is remove the bandage and take a look at the bite. Do not let them do this until you have antivenom. There have been many near deaths that have happened because of this. Some of those folks are members of this site, and perhaps they might comment on the importance of this if they want.
Ok, a few other things concerning pressure bandaging. Some books will tell you to start the bandaging two inches above the bite, then wrap downward over the bite to the tips of the fingers or toes, then wrap back up over the bite again, and up the rest of the limb. This would probably be a good idea, as it immediatly restricts the lymph flow between the bite and the heart. Also, it is advisable to put an ink mark on the bandage, showing the location of the bite.
Other issues: Ok, this first aid treatment was developed in Australia, where most of the Elapid snakes have venoms that are almost 100 % neurotoxic, and do not produce much tissue damage. This type of bandaging can be used on bites that are primarily neurotoxic, like those from King Cobras, Mambas, all of the Australian Elapids, Sea Snakes, Coral Snakes, Forest Cobras, and many of the toher Cobras.
However, this should NEVER be used on bites from any of the spitting cobras. Also, it is not reccomended for the bites of Naja kaouthia, as that snake has strongly "Necrotizing" (flesh destroying) venom.
Here is were the trade off comes in. In researching how to write the the instructions for my kit, I have been in contact with some of the best Reptile Curators, Snake Bite Treatment Specialists, and advanced reptile keepers in the Country. Lets say one is bitten by a Naja kaouthia. Ok, if you use pressure bandaging, you will be trapping the flesh destroying part of the venom in a small area, where it can do horrible damage to your tissue. However, it you do not use pressure bandaging, you risk dying form respiratory paralysis before you ever get to a hospital. If you can get to a hospital quickly, where live support is available, then most of the people I talked with said that they would use the bandaging for a Naja kaouthia bite. However, many of them were only 15 minutes from a hospital, and they also had antivenom available to take along to the hospital with them.
It is important to know what type of toxins that the Elapid snakes you keep have. The best site for this is the Clinical Toxinology Resources site at:
http://www.toxinology.com/index.cfm
If an Elapid has high Necrotizing factors, then compression bandaging will be very dangerous to use.
Now, as far as using compression bandaging on non- Elapid snakes, there are some cases where is should be used. Again check the Toxinology Site for more details. However, Tiger Rattlesnakes have mostly neurotoxic venoms, as do Mojave rattlesnakes, and Neotropical rattlesnakes.
One major potential problem is that some people are keeping Elapid snakes, and do not have them identified correctly. Or, in some cases, the snakes have been hybridized, and who knows how this might change the venom composition.
Another problem is that folks like Sean Bush, have confused people by saying "snake bite kits suck." While we do not want to bring Extractor Kits into this conversation, his general statement also has caused folks to shy away from any snake bite first aid, and in the case of Elapid bites, pressure / immobilization IS the correct way to go most of the time.
So John, I guess that is my "brief," "step-by-step explanation" of pressure immobilization bandaging, LOL.
I will send you one of my kits, and will also have two versions (Coban bandage and Elastic bandage) available at the Columbia Reptile Show.
Best Regards John Z
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RE: Application of pressure bandages for Elapis bi
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by FLVenom911 on October 26, 2008
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This information would of been good to know before you got your Naja kaouthia and Naja melanoleuca.
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RE: Application of pressure bandages for Elapis bi
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by theemojohnm on October 26, 2008
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Joe, you are correct in that it probably would have been a good idea to find out this info, but I was always advised that it could possibly do some more damage than leaving the pressure off of the bite, and getting to the hostpital quickly. I hear statements such as
"...should only be applied by someone experienced"
(So what is someone to do if it is a first time? And how many people, if surviving a Naja bite, actually plan to get bit enough to become "experienced"!!!).
John, thanks for the info, now I have to go back and read through it.. LOL..
Take Care.
~John Mendrola.
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RE: Application of pressure bandages for Elapis bi
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by puffadder7 on October 26, 2008
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hey man, what species are you getting i might be keepeing some, and be able to help you out. I like to keep most of the elapids i keep out of conversation because, i dont like to deal with drama from other people and some that are not listed on my profile, so just email me, thanks arin
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RE: Application of pressure bandages for Elapis bi
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by puffadder7 on October 26, 2008
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hey cro that was some very good info, i have one question, i thought that naja kaouthia has more neurotoxic venom from the specimens from thailand, and the ones from malaysia has more necrotic compounds, arin
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RE: Application of pressure bandages for Elapis bi
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by theemojohnm on October 26, 2008
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Ok John,
I was wondering about kaouthia, as I have the venom composition info in my protocol book. I am aware of the manner the venom travels through the lymph system, so does this means that the location of the bite has a big influence on how fast it begins to take effect systematically? Thanks for for "brief, step-by-step" instructions. LOL. That is all I needed to know. Any of the snakebite specialists here know what core components in a primarily neurotoxic venom actually do the most damage (spreding quickly, causing rapid systematic damage)? I know that this technique is applied for mostly neurotoxic bites. But "neurotoxic" is only a vague term when some of the components of venom are looked at seperately in a neurotoxin. That kit is a very good idea. I may just have to purchase one of your kits. ;) The instruction set would be good to have in the protocol book.
Arin,
I will shoot you an email. I have a few friends that have a love for Elapids near me, and I know some will be at one of the smaller shows here in late November. I honestly dont have too much of an interest in most of the Elapids. I am much more of a Viperinae, Crotalinae kind of guy. ;)
Take Care.
~John Mendrola.
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RE: Application of pressure bandages for Elapis bi
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by Cro on October 26, 2008
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Arin and John,
It would not be surprising that "Naja kaouthia has more neurotoxic venom from the specimens from thailand, and the ones from malaysia has more necrotic compounds" as we are seeing this happen in many snakes. It probably has a lot to do with what those snakes eat in the various locations.
We can find Mojave rattlesnakes that have type A venoms, that are primarily neurotoxic, and ten miles down the road, we can find populations that have primarily hemo and cardio toxic venoms, or type B venoms.
We are also seeing this kind of venom "evolution" in many other rattlesnakes, like certain populations of Eastern Diamondbacks, and Timbers.
What is even more amazing though, is that new research is showing that the snakes can go "back and forth" during their life times.
We all know that many new born rattlesnakes feed mostly on lizards and frogs and such, and the venoms of many of them are "tuned" to be more neurotoxic, to work on those cold blooded food items. Then as the snake ages, it starts feeding more on warm blooded animals and birds, and the venom composition can change to match those foods to a more hemo and cardio toxic form. But guess what ? Lets say that for some reason the rats and birds become scarce. And a adult rattlesnake has to go back to eating lizards to survive. New research that should be published soon will show that the venom can change again, back to a form that will work better for lizards. In other words, the food items directly effect the composition of the venom. While I am not talking about going from total neurotoxic venom to total hemotoxic, there is still a large change that can happen.
As far as Naja kaouthia, it is supposed to have a really bad tissue destroying action. Much more than many other cobras. However, I heard first hand from several folks that they though the use of compression bandaging in preventing respiritory failure was worth the risk, as that could kill a lot faster, while the tissue damage, even though it could be severe, would not be fatal. In other words, better to loose an arm, than a life due to respiratory paralysis.
What was really surprising to me was the almost universal reccomendations against this first aid in Spitting Cobra bites. You really need to research every snake type that you keep. Originally, I planned to list appropriate species of snakes to use this first aid on. But I quickly found out that was not a very good idea, due to just what we are talking about. Differences in venom compositions that vary within populations of snakes, and hybrid snakes, and snakes that are not identified correctly. So, for legal reasons, I will not be able to list specific snakes on the first aid kit, but only general groups of snakes that it might work for. It will be up to the indivuals owning those snakes to do the research themselves, to decide if pressure immoblization is correct for the snakes they keep.
I really do not want to get into this much at this time concerning pressure / immobilization for the first aid for necrotizing pit viper bites, but I will mention that the use of this for those bites does have a following of supporters in the venomous treatment field. And with more testing and trials in the future, you MIGHT see this being reccomended more for many types of snake bites. But again, that could be several years off, if at all. The interesting thing is that some very well known researchers are doing experiments on animals like pigs that have been injected with Crotalus atrox venom, and are using pressure immobilization on those bites in a lab setting. Might be something to keep an eye on.
For now, I am concentrating on learning as much as I can about Pressure / Immobilization on Elapid bites.
Best Regards John Z
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