snake bite

[Lophophaps]

Thanks, the detail in your post was not covered in my first aid training.

[sambar358]

Anyone out in the bush during the warmer months should have a couple of compression bandages in their kit and these days the Setopress bandages are the go-to compression bandage for the effective wrapping of a limb after a snake bite. These are made specifically for this purpose unlike crepe or elastic bandages which can be used for a variety of tasks.....two 3.5m X 10cm bandages would be sufficient to do an "ankle to groin wrap" whilst one would do a "wrist to armpit wrap" for a hit there. The Setopress bandage has some indictors to show you the correct wrap-pressure too....green rectangles are printed on each side of the bandage and when sufficient tension is applied these rectangles become squares.....can't get much easier than that.

We should all be well-aware of current snake bite treatment practice and of course after correctly applying a pressure bandage to the bite site the recommendation is to sit tight and don't attempt to walk-out.....a difficult one if you are alone.....but that's where the PLB comes-in. Looks like a bad snake season already......plenty about and in recent bush trips I've had a few encounters each day up in the mountains......mostly large very lively Browns and a couple of always-grumpy Tigers. Remember that even in the cooler months a bit of sunshine will often bring out the wriggle-sticks....especially the Copperheads so having a couple of Setopress bandages in the kit as a year-round item is well-worth the initial cost. Cheers

s358

A bit of info on the Setopress bandage here : https://www.prospectingaustralia.com.au ... hp?id=4225

[slparker]

The setopress bandage was designed to treat venous ulcers and creates subcutaneous pressures less than that used in clinical studies for snake envenomation (setopress: 30mmHg green square, 40mmHg brown square) recommendations for treatment of snakebite in the lower limbs is at least 55mmHg pressure +/- 5 mmHg. The setopress juist meets the minimum for upper limb treatment. (mmHg is a measurement of pressure.)
http://www.woundsource.com/product/seto ... on-bandage

In one study that was done testing first aiders actual efficacy at applying pressures to the skin approximating the recommendation (55mmHg) this is what was found:
Crepe bandage: average:28mmHg (range - 17‐42 mmHg)
Elasticated bandages: Average 47 mmHg (range - 26‐83 mmHg)
most participants applying the elasticized bandage were closer to the estimated optimal pressure (55‐70 mmHg).
Following training, the median pressure for the 36 participants was 65 mmHg (IQR 56‐71 mmHg), closer to the optimal range than initial attempts.

Conclusion: do not rely on the SetoPress High Compression bandage to be effective if you only meet the tension indicated by the coloured squares as it is not designed to meet the pressures required for effective treatment of snakebite. Find a good first aid provider to teach you the correct tension with an elasticated bandage, practice this and you will give your casualty the best chance. I'm not saying that the setopress is useless (in fact they're elasticated bandages so they meet the requirements of the ARC for treatment of snakebite), just that you'd have to exceded the tension in the coloured squares to meet the recommended pressure on a leg.

The Australian Resuscitation Council (ARC) states the following about first aid management of snakebite:
'If on a limb, apply a broad pressure bandage over the bite site as soon as possible.. Elasticised bandages (10-15cm wide) are preferred over crepe bandages'
The ARC provides current guidelines on emergency management.
http://www.resus.org.au

Here's a good lit review on the evidence:
https://www.google.com.au/url?sa=t&rct= ... nczHluLQcQ

St John's interpretation
http://stjohn.org.au/assets/uploads/fac ... kebite.pdf

[slparker]

edited out.

[GBW]

I may need a sphygmomanometer with all these numbers.

[slparker]

I may need a sphygmomanometer with all these numbers.

I could have worded it better... summary: apply your bandage tighter than the tension squares on the setopress.

[Lindsay]

Addit:
http://www.paradisefirstaid.com.au/snak ... first-aid/
shows a setopress bandage being applied without relying on the coloured squares.

They say this: "The setopress bandage has a continuous series of brown indicators printed on the bandage. As the bandage is stretched the brown indicators become squares, this indicates the correct tension. For ease of application the brown squares are printed off centre which assists with providing a controlled wrap of half the width overlap on each turn. The bandage is textured which prevents the bandage from slipping."


Which is correct?

[slparker]

Addit:
http://www.paradisefirstaid.com.au/snak ... first-aid/
shows a setopress bandage being applied without relying on the coloured squares.

They say this: "The setopress bandage has a continuous series of brown indicators printed on the bandage. As the bandage is stretched the brown indicators become squares, this indicates the correct tension. For ease of application the brown squares are printed off centre which assists with providing a controlled wrap of half the width overlap on each turn. The bandage is textured which prevents the bandage from slipping."


Which is correct?

I missed the bit at the bottom. I do believe that they are incorrect. I'll contact them.

[Overlandman]

In the news today
Two bitten by snakes.
Two Queenslanders have fallen victim to snake bites, believed to be from the potentially deadly brown snake, in the space of a day.
A 30 year old man was bitten near Airlie Beach in central Queensland at midday on Friday. He was rushed to Proserpine Hospital. It comes after a Gold Coast woman, 43, was bitten by a snake in the garage of her home on Thursday night.

[Gadgetgeek]

Good to know, as I have setopress bandages as my snakebite kit. I think their main advantage is size, not too many bandages large and long enough to be effective.

[Overlandman]

I should try to get this topic moved to between bushwalks

Anyway I thought this story should be posted as it is sound advice.

From ABC
Pet owners warned to check vet's antivenom stocks after dachshund snakebite death

A family from Melbourne's eastern suburbs have warned fellow pet owners to check on their vet's antivenom stocks this summer after their dog died from a snake bite unnecessarily.

Shane Lewis said his family's four-year-old dachshund Rosie died from a tiger snake bite earlier this month after taking her to a local vet who did not carry antivenom.

Mr Lewis's two-year-old son Theodore was with his grandmother in their Donvale backyard playing with Rosie when the snake slid under the fence from next door.

"Our little dachshund stepped in between our son and the snake," Mr Lewis said.

"In effect she's saved his life."

The tiger snake then bit Rosie.

"She started vomiting and convulsing," Mr Lewis said.

They drove the dog to their regular vet in Croydon, but did not ring ahead to check if the clinic stocked antivenom.

On arrival, the vet informed the family they did not carry the life-saving treatment so they drove the dachshund to the Animal Emergency Centre (AEC) in Mount Waverley but she died in the car on the way.

Mr Lewis said the AEC was "pretty much the same distance" from their house as their regular vet but in the opposite direction.

"Had we known [the vet] didn't stock antivenom, we would have headed straight to animal emergency," he said.

He said Rosie would probably still be alive had they checked with their vet ahead of time.

Mr Lewis said his wife had posted on Facebook to warn other pet owners to check if their regular vet carried antivenom and that many people had responded that they thought all vets carried the product.

He said pet owners should check with their vets now before the weather became warmer.

"It takes a couple of minutes — call your vet," Mr Lewis said.

[Overlandman]

From ABC
Good onya Skitzo



Red-bellied black snake bites Mirani woman, cat comes to the rescue

Red-bellied black snake
PHOTO: Denise Thynne was rushed to the Mackay Base Hospital yesterday morning, after she was bitten by this Red-bellied black snake. (Supplied: Denise Thynne)
A north Queensland woman is recovering in hospital after being bitten by a deadly red-bellied black snake that was hiding under a garden hose.

Denise Thynne was gardening at her home in Mirani, west of Mackay, when she was bitten yesterday morning.

"I walked out to the yard to pick up the hose to water the roses. There was a little snake laying under the hose that I didn't see," she said.

"It was laying there in the sun, I didn't take any notice until I felt the sting."

Her cat Skitzo rushed to her aid, attacking and killing the reptile.

Definitely not panic, if it's a real deadly looking one, sit under a tree with a cigarette, with a cup of tea and pray, but yeah wrap it up and hope.
Denise Thynne, who has been bitten by four snakes in her life.
"She came out stalking and it looked like she was mesmerising it and then she just went in for the kill," Ms Thynne said.

"I turned the snake over and saw the red belly and thought 'oh that's not a very friendly one'."

The 66-year-old's hand started to hurt and she was taken to the Mackay Base Hospital, but she is expected to be released this morning after it was found the snake did not inject her with poison.


SOUNDCLOUD: Denise Thynne speaks to the ABC about being bitten by the snake
Ms Thynne said she was well versed in what to do, as it was the fourth time she had been bitten by a snake.

She is not keen on a fifth experience.

"I'm a bit of a pro at this snake business," she said.

"My mum always said it'll be a snake that kills me, so yeah, I'm not really planning on one [a fifth experience], but who knows.

"Just be careful, and wear your glasses when you go outside, that helps."

Ms Thynne said her experience had taught her that if you were bitten by a snake you should "definitely not panic".

"If it's a real deadly looking one, sit under a tree with a cigarette, with a cup of tea and pray, but yeah wrap it up and hope."

Dozens of snake bites at hospital this year

There have been 58 people taken to the region's emergency department this year with snake bites, 11 so far this month.

Emergency doctor Neale Thornton said it was important to stay calm and call triple-0 if you were bitten.

"No panic, no running around, just get to a phone, call the ambulance, first aid measures is what they call it," he said.

"Pressure, immobilisation bandage, if you've got the right kit, and you know how to do it, do it.

"If you see a snake minding its own business in the bush, just leave it alone, don't play with it, even if you think it's a non-poisonous one."

[slparker]

mmm.... perhaps include an adult cat in your snake bite kit as well as elastic bandages...

[Hermione]

Would be more helpful if the cat killed the snake before you were bitten

[icefest]

Thanks for the information about the setopress slparker.

[jackhinde]

Regarding the Mackay bite: Red Belly Blacks are not "deadly", as their have been no fatal bites recorded for this species. And the animal in the picture supplied isn't a red belly anyway, much more likely a Small Eyed Snake (Rhinoplocephalus nigrescens aka Cryptophis nigrescens). A small nocturnal native species often murdered by cats or brought into houses by them (ironically there has been a human fatality from the bite of this species).

[slparker]

Thanks for the information about the setopress slparker.

you're welcome.
The research on this is interesting - it's clear that most first aiders do not meet the recommended pressure requirements for cessation of lymphatic drainage from the limb - yet people are still (relatively) effectively treated by the PIM method. Which tells me that:

1. Immobilisation is possibly just as important (as the studies quoted show limb movement will negate any compressive effects of the bandage)
2. even incorrect application of the bandage slows down envenomation (or at least delays envenomation during evacuation), and/or
3. Evacuation times and in-hospital treatments are very effective

The setopress is a neat idea - it just needs a third square for lymphatic compression. the only clinical application that I can think of is for lymphoedema and snakebite. I reckon there is scope for someone to do a study on using the existing setopress with a graduation adjacent to the brown square that would indicate effective tension at 55mmHg. this could be a pen mark at a determined distance adjacent to the brown square.

of course this would need to be pre-marked on the bandage prior to use. best done on the loungeroom floor - not in the field, i imagine.

[MickyB]

How would you treat a snake bite if bitten on a finger or toe? I imagine it would be very hard to bandage a digit? Sorry if this has been answered before.

[slparker]

How would you treat a snake bite if bitten on a finger or toe? I imagine it would be very hard to bandage a digit? Sorry if this has been answered before.

To my knowledge there is no specific advice for digits. the same principles apply, though. if it is practicable you could compress the site with a small bandage and then compression bandage/splint the limb as per the guidelines.

[icefest]

My 2c,

Remembering hoop stress - paraphrased: in order to get the same internal pressure in a smaller cylinder the tension in the wrapping need to be lower than for a larger cylinder.
This means you need to be careful with wrapping a finger because it's easy to make the wrapping too tight and to cut off all blood flow.

As the venom needs to enter the systemic circulation (blood) and all lymph drains towards the chest, you just need to stop the snake venom from getting to the chest. An arm bandage and immobilization will achieve this.

[MickyB]

Thanks slparker. So if you can't compress the digit with a small bandage applying a compression bandage over the limb will still be effective?

Edit. Thanks icefest. I think you've answered my question.

[peregrinator]

Thanks for the information about the setopress slparker.

The research on this is interesting - it's clear that most first aiders do not meet the recommended pressure requirements for cessation of lymphatic drainage from the limb - yet people are still (relatively) effectively treated by the PIM method. Which tells me that:

1. Immobilisation is possibly just as important (as the studies quoted show limb movement will negate any compressive effects of the bandage)
2. even incorrect application of the bandage slows down envenomation (or at least delays envenomation during evacuation), and/or
3. Evacuation times and in-hospital treatments are very effective

The setopress is a neat idea - it just needs a third square for lymphatic compression. the only clinical application that I can think of is for lymphoedema and snakebite. I reckon there is scope for someone to do a study on using the existing setopress with a graduation adjacent to the brown square that would indicate effective tension at 55mmHg. this could be a pen mark at a determined distance adjacent to the brown square.

Of course this would need to be pre-marked on the bandage prior to use. best done on the loungeroom floor - not in the field, i imagine.

Given the detail that was involved for the testing you commented on in your earlier post

http://bushwalk.com/forum/viewtopic.php?f=5&t=295&start=150

I assume it would not be difficult to come up with a reasonable approximation for such a graduation.

On another aspect, Lophophaps asked about whether clothing in the area of the bite should be removed. That hasn't been answered thus far, but I recall reading somewhere that a patient's clothing may have collected some venom and is therefore useful as a means of species identification. Anyone have any knowledge about this?

[icefest]

Don't take it off. That's extra movement that will decrease the survival time.

Only remove it if it's that big that you cannot get the compression bandage on - in which case you were probably protected from the snakebite.

[FootTrack]

I found this document quite useful regarding snake bite first aid. I have a printed off, summarised version that I keep with my setopress. A lot of what has been spoken about above is included in it. http://www.bungendorepodiatry.com.au/im ... st_aid.pdf

I thought I should also include here an interesting question and response from another forum which I wondered about myself for a while. It may be of interest to some:

Something that's puzzled me for a very long time is that all available texts dealing with the first aid treatment of snake bite show that the affected limb should be bandaged from the site of the bite (usually the lower extremity) towards the body (many texts specify: towards the heart). Since venom is initially transported through the lymphatic system is there not a chance of "forcing" the venom up through the lymph vessels when bandaging in this manner? This would likely only happen if some time has elapsed between being bitten and applying the bandage (say if one had to first tear clothes into strips in the absence of a bandage) and some of the venom is already in some of the major lymph vessels. I assume that the reason for applying the bandage directly to the site of the bite is to restrict the lymphatic system immediately surrounding the site and slow the venom uptake. However, what would happen if some time has elapsed between being bitten and applying the bandage? Is there some research/scientific publication that has dealt with this? If so I'd be grateful for a link or a reference to read up more on this particular aspect. All papers I've found so far deal with the efficacy of the crepe bandage technique and not the experimental manipulation of it.
R.

Hi all,

First of all, the use of pressure immobilisation bandaging (PIB) for snake bite first aid is not universally endorsed, and has a number of opponents. PIB was first recommended in Australia following a series of experiments using monkeys, and one of the common criticisms is that human trials of PIB efficacy do not exist. That may change some day. PIB is endorsed by the Australian Resuscitation Council for human use as first aid for the bites of Australasian elapid snakes, which do not have significantly cytotoxic venoms. There is no published evidence to support the use of PIB after bites by Viperidae, and opinions are divided on the appropriateness of PIB for bites by cytotoxic Elapidae, such as Naja nigricollis for example. Even the use of PIB in non-cytotoxic snakebite lacks a high-confidence evidence base, and there are some studies that have shown that the use of lymphatic transport actually depends to some degree on the size of the substances (i.e.: snake venom toxins) to be shifted, with some moving via the lymphatics and some moving straight into the microvasculature.

There has been robust debate in the past about the suitability of PIB in Africa. Anyone interested should explore the South African Medical Journal backissues from the '80's and perhaps early '90's. Certainly PIB should be viewed as a potentially life-saving form of first aid following bites by Dendroaspis spp., in particular.

Based on what we know at the moment, perhaps the single most important principle of first aid for any snake bite, however, should be the complete immobilisation of the snake bitten person.

Simply lay the person down right away, and remove any rings, watches, bracelets or other objects that might be a problem if local swelling occurs. A splint can be used to keep legs and arms straight and still - splint both the bitten leg and the unbitten one together, since this will help to restrict movement of the pelvis and keep the person still on a stretcher. Arms should be splinted straight, rather than bent and put in a sling, and if necessary they can be gently strapped to the side of the body.

Only if a bite from a snake with non-cytotoxic venom is suspected, should PIB be applied. The reason why bandages should be applied distal -> proximal is one of simply fluid dynamics. If you bandage a limb very firmly from the top down to the fingers or toes, you will flatten lymph vessels and small capillaries/veins, forcing blood and fluid into the hand or foot. Remember that based on what little is known of pressures needed to restrict lympathic transport, you need between 40-70 mmHg pressure for an arm, and 55-70 mmHg pressure for a leg - this is a lot firmer than most people realise. If you apply that sort of pressure in a proximal->distal direction, the result will quickly become extremely uncomfortable for the patient (downright painful in many cases), causing them to wringle, shift around or try and flex the limb to get some relief ... this completely defeats the purpose of PIB = pressure + immobilisation.

On the other hand, experience has shown that bandaging from just above the toes or fingertips to the top of the limb at the required pressure results in far less discomfort for the patient, and as a result greater compliance with immobilisation.

Does it result in venom being squeezed upwards? Impossible to say. If a broad bandage is used, once wrapped firmly over the bite site itself, most of the lymphatic vessels and small capillaries should be effectively compressed and much of the venom sequestered locally ... but without doing the experiments necessary to prove it, I am afraid there are no guarantees. I have used PIB after 5 of my 6 snake bites, and I am still here to tell the tales ... but that, in the words of most doctors is purely an "anecdotal experience" and has limited or no scientific value.

I hope this information helps a bit.

Cheers

David
Australian Venom Research Unit
University of Melbourne
Parkville Vic 3010 AUSTRALIA

[north-north-west]

I'd just like to say a big 'Thank you' to everyone involved in this discussion. It's been very educational.

[lee737]

Good to know, as I have setopress bandages as my snakebite kit. I think their main advantage is size, not too many bandages large and long enough to be effective.

Even though they aren't specifically designed for PIB (are there any that are?), they certainly appear the pick of bandages around.... I'm about to grab a second box for the car, never want to be without them wherever we are.....

[Lindsay]

Looking at the post by the bloke from Melbourne University as quoted by FootTrack, the pressure required for an effective PIB is 40/55 - 70 mmHg. A search of several sites shows that the brown squares on a setopress bandage indicate a pressure of 40 mmHg, so we need to bind the setopress tighter than indicated by the brown squares to be effective. It is still a great bandage, so I wonder if the manufacturers would consider adding a square indicating the correct pressure for snake bite treatment.

[slparker]

On another aspect, Lophophaps asked about whether clothing in the area of the bite should be removed. That hasn't been answered thus far, but I recall reading somewhere that a patient's clothing may have collected some venom and is therefore useful as a means of species identification. Anyone have any knowledge about this?

I don't think that there is a definitive answer. Some experts have recommended leaving (tight) trousers on and bandaging over the top. I'd have to see studies on whether effective pressure could be applied over the top of trousers to be effective before I could be certain.

The times that i have treated snakebite in the field i have had trauma shears (big scissors), cut the trousers off and bandage over the bare skin because I know it is effective.

If you don't have scissors on you (and who does bushwalking, to be honest) what would be reasonable?
It IS possible to place a compressive bandage over the site of envenomation straight away (with a pad and a couple of wraps of bandage), then sequentially remove clothing, remembering that the passage of lymph through a still casualty is quite slow. Once trousers are off, bandage away. Minimal movement of the cas to remove trousers is not a massive issue. I would definitely consider getting the cas under shelter once the initial treatment is done effectively - so you're going to have to move the cas or erect a shelter over them.
Timeliness is important but 30 seconds spent exposing a casualty can be time well spent. Why?

The snake may have struck more than once

which means that removing the pants and exposing the casualty allows you, the first aider to examine both legs for bites. It is not uncommon for the strike to bite several times and some of the bites to be painless, or masked by the pain of the initial strike. Also, bites may appear as scratches, chew marks (seriously) not just the classic two puncture marks.

There is no need to leave clothes on to preserve venom as the venom detection kit is applied from a swab at the site of envenomation.

[flyfisher]

In Tassie we have one antivenom for our 3 snakes. Anything for a simple life.

FF

[Overlandman]

Bitten on the ankle whilst mowing the lawn

http://www.couriermail.com.au/news/quee ... 8fc4e1401f

A MAN is in hospital after he was bitten by a snake north of Brisbane this morning.

The 40-year-old was mowing on Oakey Flat Rd in Burpengary at 7.30am when he was bitten on the ankle.

He was taken to Caboolture Hospital in a stable condition.

It was not yet known what species of snake was responsible for the attack.