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Snakebite treatment
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by BufoMarinus on November 28, 2005
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I've done I can't tell you how much research on this. I have come across a wide variety of treatments, some say apply a constricting wrap right above the bite (not so tight as to constrict blood flow) others say not, some say apply "The Extractor" others say don't, bitten limb level with the heart or lower than the heart. I could go on and on. Ahhhh!!!!! Will someone just give me a straight answer here!
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RE: Snakebite treatment
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by Rabies on November 28, 2005
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Hi
the only straight answer is to procede calmy and quickly as possible to a suitable medical facility. That's the main part of first aid, suction devices have been proven useless in extracting venom (Dr Bush et al)but may be beneficial in restricting the absorption of venom that predominately affects the nervous system, while applying the pressure bandage(my personal view). The Sutherland application of pressure bandage should be applied to snakes that can inflict life threatening symptoms BUT with minimal local affects. Snakes that cause swelling and the combined use of a pressure bandage can speed up the process of compartment syndrome. Keeping the bitten limb (sling) and patient as still as possible will also be beneficial, remembering also to remove any jewelery. First aid should not interfer with the evacuation of the patient!
John
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RE: Snakebite treatment
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by LarryDFishel on November 28, 2005
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Part of the problem is that the straight answer is "it depends".
Whether to use the constriction bandage depends on the snake and how long it will take you to get help. With something almost purely neurotoxic like a mamba, I personally would apply a constriction bandage regardless of circumstances. With a taipan I would do the same unless someone gives me a good reason not to. Even though the bandage might increase the local damage, the chances of dying before reaching the hospital are too great to ignore.
With most vipers, I would not use one unless it was a large specimen and for some reason I expected it to take several hours to reach help. I would assume in this case that I would be sacrificing a limb to increase my chances, which I would not do lightly.
As far as "level with" or "lower than" the heart, I suspect that anyone who says "level with" is assuming that you will be laying on the ground or for some other reason "lower than" is impractical, and they just mean not to elevate it. What's probably more important is simply to move it as little as possible. Muscle movement plays a big part in moving fluid through the lymph system which is normally where the venom travels. That's why splinting the effected limb is often recommended.
Please note that I have no formal medical background and this is just what I've picked up through quite a bit of reading on the net and some direct discussion with people who treat bites.
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RE: Snakebite treatment
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by LarryDFishel on November 28, 2005
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Oh yeah. I think the jury is still out as to whether an extractor might help a little in some cases. If you happen to have one handy and you can stick it on with out taking time away from more important things like calling for help, it almost certainly won't make things noticably worse. The problem is that for it to do anything, it probably has to be applied almost immediately, so you have to weight that time against other things. I think I can safely say that by itself, it will not save you. Maybe with a viper bite, it might get enough venom to reduce the amount of damage, but with any bite where I would use a constriction bandage, I would not delay that long enough to use the extractor, and by the time the bandage is on it's probably too late to bother...
Note, this is pretty speculative on my part and I'd really like to hear if anyone can tell me I'm off base here.
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RE: Snakebite treatment
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by LarryDFishel on November 28, 2005
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Chapter III...
John, I missed your comments about the extractor until after I posted (twice). Are you saying that for a neurotoxic bite you would apply an extractor and THEN the bandage? I would have thought that getting the bandage on quickly would have been first priority.
Either way, have you seen some evidence that an extractor helps with neurotoxic venom or are you just taking the "it couldn't hurt" approach like I said?
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RE: Snakebite treatment
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by Rabies on November 28, 2005
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Hi Larry
I should of explained a bit more. The idea is if you are by your self, try putting a pressure bandage on correctly with no help! My personal way of thinking is by applying a suction device will give me that extra bit of time to fiddle with a bandage. Blood pressure within the capillaries is approx 5-15mmhg the vacum within the cup of the extractor is approx 750mmhg! The way I see it is, if its applied immediatley over the bite site, venom absorbtion within the cup will be slowed drasticaly or possibly halted giving me time to apply a pressure bandage and splint. I have no evidence for this, I'm purely presuming it may be affective because of the pressures involved. If I have a companion with me I will opt for the pressure bandage and splint immediatley.
With bites that have drastic affects localy I'd simply immobilise the limb with a sling/splint, with a leg this could be complicated depending on the difficulties of the evacuation.
John
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RE: Snakebite treatment
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by BufoMarinus on November 28, 2005
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rabies your hypothisis seems sound to me. All I'm going to be working with for a while are A. Contortrix and perhaps a few of the smaller rattlers, so I don't think that the bandage would be nessesary. Splint though of course. Thanks rabies, you too Larry you guys really helped clear things up
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RE: Snakebite treatment
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by Phobos on November 28, 2005
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I was not going to comment because I thought John had wrapped it up nicely with his first post.
This was the topic of "lively" discussion by the luminaries present at the Snakebite seminar in Omaha almost a month ago. I will attempt to distill it down:
Dr. David Warrell, who is by far the most experienced snakebite physician, "Yoda" if you will, that I know. Told us time & time again a properly applied compression bandage and limb immobilization was the only first aid required for an Elapid bite.
It is also indicated in certain cases when Viperid bite where the venom is predominantly Neurotoxic, as with a Bitis atropos for instance.
Dr. Sean Bush has authored research papers on the "Extractor" and found them to actually cause more damage to the tissues around the bite by Crotalids. There is no current data* suggesting that is has any use for Elapid bites. Dr. Bush also published a paper on the efficacy of compression bandages for Crotaild envenomation. He found that if you are a long way from obtaining medical care for a Crotalid bite, applying a compression bandage would save your life but it could cost you your limb. The bandage concentrates the venom in that limb causing major tissue dammage and very high compartmental pressures.
I hope this clears this up...
*J. Gennaro had a paper using radio-tagged Rattlsnake venom. about 30 years ago.
Al
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RE: Snakebite treatment
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by Matt_H on November 30, 2005
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Good answers by all.
Sorry for the long post but this topic has come up quite often on this site and there still seems to be a bit of confusion in a couple of areas. Since not everyone has formal medical training, I'll try to help clarify things. First off wether you have medical training or not your first priority is to get the patient to definitive medical care, meaning an emergency department of a medical facility, as quickly and safely as possible.
The Sawyer Extractor;
As Phobos stated, there has been no clinical data published on the effects of this device on a neurotoxic envenomation from an elapid so let's talk about the use of this device on a bite from a pit viper. As we know, the venom of a pit viper is hemotoxic. This type of venom destroys tissue (ie. skin, mucle, fat). The fangs penetrate your skin and venom is released into the fatty tissue under your skin. The tissue immediately begins to absorb the venom, at the same time the venom immediately begins to travel through your lymphatic system which consists of vessels that run paralell but separate from the blood vessels. There is only a certain amount of venom injected determined by various factors of the snake (size, species, amount of venom available, etc.) As the venom begins to travel it reduces the amount of venom at the site of injury. An Extractor will not remove the venom that has already been absorbed into your tissue. Even if the extractor is readily available, by the time you open the box, put on the tip and apply it to the bite you have spent a minimum of 3 to 5 seconds and a good portion of venom has already been absorbed. It may, at best, slow the rate of travel and contain the venom to the site of injury for a longer period of time. This will not cause the venom to stop destroying tissue, it will allow the venom to destroy more tissue in one area in a shorter time thus causing more severe local injury.
The same pricipal goes for the "Pressure Immobilization Technique". This is a technique that was developed in Australia where the majority of their snakes are neuritoxic. The bite from a neurotoxic snake does not destroy tissue, rather it prevents the transmission of nerve signals to the muscles causing paralysis, respiratory collapse, and ultimately death. Since neurotoxic venom only affects systemic functions and does not destroy tissue, slowing down the travel of venom and containing in one area is a safe and logical idea. Now in the case of a bite from a hemotoxic snake such as a pit viper (rattlesnake, cottonmouth, copperhead) slowing down the travel of venom and containing it to one area is going to cause extensive tissue destruction at the site of injury and may result in loss of a digit (finger or toe) or an entire extremity (arm or leg). However, there may be times when pressure immobilization can be beneficial in a hemotoxic envenomation. This would be when it's a choice of life or limb, when the envomation is severe enough to pose a definate risk of dying before medical treatment can be obtained.
The decision to use this technique should be done on a case by case basis and based on certain criteria such as the size and species of snake, the size and age of the patient, the location of the bite, The estimated time to the emergency room, and the appearance and progression of signs and symptoms. A small person, elderly person, or child would be considered a higher risk than an average healthy adult. A large snake is capable of delivering a greater quantity of venom. A highly toxic snake such as a Pacific Rattlesnake poses a greater risk than say a Copperhead. If the person was bitten on the head, torso, or buttox, it poses a higher risk than if bitten on the foot or hand. If you're in an area where it would take hours or days to get to a medical facility, that would pose a higher risk than if you were within a few hours of a hospital. If pain, swelling and discoloration are spreading quickly from the bite site, it may be an idicator of a severe envenomation, as opposed to if there is only a little swelling at the area of the bite that does not seem to be spreading it's probably not that severe. Then again you need to consider the species. Certain species of rattlesnake such as the Canebrake and Pacific rattlers have been found to have high concentrations of neurotoxins in their venom. All of these factors should be considered to determine the risk of life and whether or not you are willing to accept the risk of long term loss or disability when deciding whether or not to use pressure immobilization. If several of the factors involved are high risk you may want to consider using pressure immobilization. If you feel that this technique is indicated (should be used) don't wait for systemic signs to appear before applying the bandage. If systemic signs have already begun to develop it's probably not going to make much of a difference and medical intervention will be needed to apply ACLS protocols and rapid transport.
I hope this helps to better understand these subjects. The decision to use or not to use these techniques is a decision only you can make based on the information you've obtained.
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