Forget pressure immobilization in pre-hospital treatment of North American rattlesnake bite victims

July 3, 2011, 12:41 pm

★★★½☆

Pressure Immobilization Bandages Not Indicated in the Pre-hospital Management of North American Snakesbites. O’Connor AD et al. J Med Tox 2011 Jun 23. [Epub ahead of print]

Full Text

This short but important letter takes issue with a recommendation in the 2010 American Heart Association and American Red Cross guidelines for first aid regarding field treatment of snakebite victims:

Applying a pressure immobilization bandage with a pressure between 40 and 70 mm Hg in the upper extremity and between 55 and 70 mm Hg in the lower extremity around the entire length of the bitten extremity is an effective and safe way to slow the dissemination of venom by slowing lymph flow.

The authors of this letter — from the Department of Medical Toxicology at Banner Good Samaritan Medical Center in Phoenix — make several key points in refuting this recommendation:

  • The scanty medical literature this recommendation is based on were lab studies using animal models, with an end-point of mortality.
  • Tissue necrosis and destruction is the major toxicity associated with North American rattlesnake bites.
  • The pressure immobilizaton dressing may increase compartment pressure and exacerbate tissue injury.
  • One of the papers the Guidelines use as evidence for this recommendation explicitly states that “on the basis of our findings, we cannot recommend pressure immobilization widely for viper envenomation”.

It’s interesting to note that there are no toxicology groups listed on the advisory panel that contributed to the ANA/ARC guidlines.

Related post:

Rattlenake bite + tourniquet = amputation

2 Comments:

  1. The Cynical Pharmacist Says:

    Funny how the thought of using a tourniquet never entered my mind. Living in Arizona, we’ve always been taught to do “nothing” after a rattlesnake bite, except get to the nearest emergency room as quickly as possible.

    When I worked in Tucson, we once had a “south of the border” patient who thought he could neutralize the venom by shocking it with a pair of jumper cables hooked-up to his car battery. Not only did we treat him for envenomation, but also for acute burns. His case was my first when I was a student, and involved compartment syndrome and extensive fasciotomy. I’ll never forget it.

  2. Leon Says:

    C. Pharmacist:

    Yes, the belief that high voltage is an antidote for snake bite was not only a folk legend, but also the subject of several scientific studies. A 2001 review of the ilterature (Wilderness Environ Med 2001 Summer 12:111-7) concluded that “high voltage, low amperage direct current electric shocks to treat venomous bites and stings is not supported by the literature”.