Commentary: Pressure Bandaging for North American Snake Bite? No!

Seifert, Steven A.; White, Julian; Currie, Bart J.

doi:10.1007/s13181-011-0188-9

Cited by 11 publications

(7 citation statements)

References 19 publications

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“…Furthermore, it needs to be taken into account that the pressure immobilization technique might not be appropriate for any type of snake venom. The technique has a theoretical basis for limiting the spread of neurotoxic venoms, such as those produced by elapids, but less for necrotic venoms, such as those produced by vipers [ 39 ]. However, no controlled studies have been performed in real-life snakebite patients yet, leaving this controversy unresolved.…”

Section: Discussionmentioning

confidence: 99%

The Treatment of Snake Bites in a First Aid Setting: A Systematic Review

et al. 2016

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BackgroundThe worldwide burden of snakebite is high, especially in remote regions with lesser accessibility to professional healthcare. Therefore, adequate first aid for snakebite is of the utmost importance. A wide range of different first aid techniques have been described in literature, and are being used in practice. This systematic review aimed to summarize the best available evidence concerning effective and feasible first aid techniques for snakebite.MethodsA systematic literature screening, performed independently by two authors in the Cochrane Library, MEDLINE and Embase resulted in 14 studies, fulfilling our predefined selection criteria, concerning first aid techniques for snakebite management. Data was extracted and the body of evidence was appraised according to the GRADE approach.Principal findingsThe pressure immobilization technique was identified as the only evidence-based first aid technique with effectiveness on venom spread. However, additional studies suggest that proper application of this technique is not feasible for laypeople. Evidence concerning other first aid measures, such as the application of a tourniquet, suggests avoiding the use of these techniques.ConclusionsThe practical recommendation for the treatment of snakebite in a first aid setting is to immobilize the victim, while awaiting the emergency services. However, given the low to very low quality of the data collected, high quality randomized controlled trials concerning the efficacy and feasibility of different variations of the pressure immobilization technique are warranted.

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Section: Discussionmentioning

confidence: 99%

The Treatment of Snake Bites in a First Aid Setting: A Systematic Review

et al. 2016

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“…However, the use of pressure-bandage and immobilization first-aid is particularly controversial in North America due to the perception that it may worsen localized tissue damage. Based upon this assumption, its use in American crotalids has been specifically discouraged [ 136 , 137 ]. The prevailing logic is that it is better to let the venom diffuse to reduce local tissue damage, with the trade off being a worsening of systemic effects but to a manageable degree as most pitvipers from North America are unlikely to rapidly cause lethal systemic effects.…”

Section: Issues and Controversies In Modern Medical Carementioning

confidence: 99%

“…Available evidence fails to establish the efficacy of pressure immobilization in humans, but does indicate the possibility of serious adverse events arising from its use. The use of pressure immobilization for the prehospital treatment of North American Crotalinae envenomation is not recommended.” [ 136 , 137 ]. Justification for this position was a single study using Crotalus atrox venom that showed a raised intracompartmental pressure in an animal model [ 138 ].…”

Section: Issues and Controversies In Modern Medical Carementioning

confidence: 99%

Snakebite: When the Human Touch Becomes a Bad Touch

Fry

2018

Toxins

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Many issues and complications in treating snakebite are a result of poor human social, economic and clinical intervention and management. As such, there is scope for significant improvements for reducing incidence and increasing patient outcomes. Snakes do not target humans as prey, but as our dwellings and farms expand ever farther and climate change increases snake activity periods, accidental encounters with snakes seeking water and prey increase drastically. Despite its long history, the snakebite crisis is neglected, ignored, underestimated and fundamentally misunderstood. Tens of thousands of lives are lost to snakebites each year and hundreds of thousands of people will survive with some form of permanent damage and reduced work capacity. These numbers are well recognized as being gross underestimations due to poor to non-existent record keeping in some of the most affected areas. These underestimations complicate achieving the proper recognition of snakebite’s socioeconomic impact and thus securing foreign aid to help alleviate this global crisis. Antivenoms are expensive and hospitals are few and far between, leaving people to seek help from traditional healers or use other forms of ineffective treatment. In some cases, cheaper, inappropriately manufactured antivenom from other regions is used despite no evidence for their efficacy, with often robust data demonstrating they are woefully ineffective in neutralizing many venoms for which they are marketed for. Inappropriate first-aid and treatments include cutting the wound, tourniquets, electrical shock, immersion in ice water, and use of ineffective herbal remedies by traditional healers. Even in the developed world, there are fundamental controversies including fasciotomy, pressure bandages, antivenom dosage, premedication such as adrenalin, and lack of antivenom for exotic snakebites in the pet trade. This review explores the myriad of human-origin factors that influence the trajectory of global snakebite causes and treatment failures and illustrate that snakebite is as much a sociological and economic problem as it is a medical one. Reducing the incidence and frequency of such controllable factors are therefore realistic targets to help alleviate the global snakebite burden as incremental improvements across several areas will have a strong cumulative effect.

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“… 62 63 Its use is variable, and it is discouraged in most practice and guidelines because of the uncertainty of benefit and possibility of worsening local tissue damage. 15 29 62 64 65 66 67 However, pressure immobilisation is generally recommended for neurotoxic elapid bites in some regions. 68 Its clinical efficacy and risk of worsening soft tissue injury in local envenoming have not been adequately assessed.…”

Section: What First Aid Can Be Provided?mentioning

confidence: 99%

“… 68 Its clinical efficacy and risk of worsening soft tissue injury in local envenoming have not been adequately assessed. 24 29 66 69 A small study (15 patients) in Myanmar found that pressure pads were effective in reducing venom spread in Russell’s viper bite, and local effects after pad application were no more severe than those before treatment. 70 …”

Section: What First Aid Can Be Provided?mentioning

confidence: 99%