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Basic Principles

There are several important principles of first aid for bites

and stings that should guide decisions on what is, and as

importantly, what is not good first aid.

First aid should do no harm!

First aid should be practical and achievable.

First aid should be supported by both clinical and scientificevidence of effectiveness.

Older "first aid" methods for snakebite are classic

examples of techniques with the potential to cause the

patient harm. Indeed, the use of tourniquets and cut and

suck has resulted in numerous cases of permanent and

severe injury to patients, even deaths.

First Aid for Snakebite

Keep the patient still and reassure them.

Maintain vital functions, if imperilled (e.g. "ABC")

Try and maintain the patient as still as possible and bring

transport to them.

Always seek medical help at the earliest opportunity.

If the snake has been killed, bring it with the patient, but

do not waste time, risk further bites and delay application

of pressure bandage and splint by trying to kill the snake.

Do not wash the wound.

Do not use a tourniquet.

Do not cut or suck the wound.

Do not give alcohol to the patient.

Do not give food and only non-alcoholic clear fluids may

be used for drinks.

Do NOT apply cold compresses to a snake bite.Do NOT cut into a snake bite with a knife or razor.

Do NOT try to suck out the venom by mouth.

Do NOT give the person stimulants or pain medications

unless a doctor tells you to do so.

Do NOT raise the site of the bite above the level of the

person's heart.

IMMEDIATELY APPLY A PRESSURE IMMOBILISATION

BANDAGE

The Pressure Immobilisation Method

This important first aid method was developed by Dr.

Struan Sutherland and colleagues at CSL and first published

in 1978 in the prestigious international journal, "The

Lancet". It is based on knowledge of the structure of

important snake and spider toxins and previous clinical and

experimental experience. It has been known for many

years that the lymphatic system plays a key role in

transport of toxins from the periphery to the circulation. In

the case of snake venom toxins this is easily explained by

the large size of these toxins. Clinically, adenopathy in

nodes draining the bite site is often an early sign of

absorption of venom, and in those tragic cases ending

fatally, Sutherland was able to show high concentrations of

venom in regional nodes.

The aim of this method is therefore to retard venom

transport via the lymphatic system. This is achieved in a

dual approach. Firstly the lymphatic vessels at the bite site

are compressed by bandaging, extended to much of the

rest of the bitten limb as possible. Secondly, proximal

movement of lymph in the vessels is slowed or stopped bysplinting the limb, thus also stopping the "muscle pump"

effect of muscle movement. Correctly applied, this

technique can virtually stop venom movement into the

circulation until removed, up to hours later, without any

threat to limb tissue oxygenation, which is just one of the

major problems in using tourniquets. It must be

remembered, however, that this method is only first aid. It

is not definitive medical treatment for envenoming. Once

in a hospital equipped to treat the bite with antivenin, if

necessary, then all first aid should be removed after initial

tests and precautions are taken.

In summary, the pressure immobilisation method of first

aid is:

Apply a firm broad bandage or similar (even clothing

strips or pantyhose will do in an emergency) over the bite

site, at the same pressure as for a sprain. Do not occlude

the circulation.

Apply further bandage over as much of the rest of the

bitten limb as practical. Ensure fingers or toes are covered

to immobilise them. It is often easiest to go over the top of

clothing such as jeans, rather than move the limb to

remove clothing.

Ensure the bitten limb is kept motionless by applying a

splint and instructing the patient to cease all use of the

limb and any general activity.

Treatment for poisonous snakebite

1. Stay quiet; do not move the bitten part. The moreit is moved, the faster the poison will spread

through the body. If the bite is on the foot, the

person should not walk at all. Send for medical

help.

2. Remove jewelry because swelling can spreadrapidly.

3. Wrap the bitten area with a wide elastic bandageor clean cloth to slow the spread of poison.

Keeping the arm or leg very still, wrap it tightly,

but not so tight it stops the pulse at the wrist or

on top of the foot. If you cannot feel the pulse,

loosen the bandage a little.

4. Wind the bandage over the hand or foot, and upthe whole arm or leg. Make sure you can still feel

the pulse.

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5. Then, put on a splint to prevent the limp frommoving.

REMINDERS

Monitor the patient and remain vigilant should their

condition deteriorate, and treat for shock when or if

necessary. If a patient loses consciousness, roll the victim

into the recovery position and ensure the airways are

clear, if breathing ceases, apply CPR until medical

personnel can assume responsibility.

Less than an hour after snakebite:

Headache

Vomiting

Transienthypotension (low bloodpressure), associated

with confusion or unconsciousness

Diplopia(doublevision).

Keep airways clear and monitor breathing. Monitor forshock. In the event, raise patients legs and lower head if

the skin is clammy and pallor, these symptoms are a

possible indicator of hypotension (shock).

1 to 3 hours after the bite:

Paralysis of cranial nerves, e.g. ptosis (eyelid dysfunction),

dysphagia (difficulty swallowing), dysphasia (speech

impairment), and diplopia (double vision).

Abdominalpain, increasing confusion.

Hemoglobinuria(reddish urine, caused by the presence of

blood cells).

Haemorrhage (bleeding from snakebite wound).

Hypertension (high blood pressure) and tachycardia

(rapid heartbeat).

Apply CPR if necessary.

More than 3 hours:

Paralysis of large muscles of limbs.

Severe bodily function damage.

Dark urine

Monitor conscious status, apply CPR if breathing ceases

and seek immediate emergency assistance.

Monitor the person's vital signs -- temperature, pulse, rate

of breathing, and blood pressure -- if possible. If there are

signs of shock (such as paleness), lay the person flat, raise

the feet about a foot, and cover the person with a blanket.

Keep the person calm, reassuring them that bites can be

effectively treated in an emergency room. Restrict

movement, and keep the affected area below heart level

to reduce the flow of venom.

Bring in the dead snake only if this can be done safely. Do

not waste time hunting for the snake, and do not risk

another bite if it is not easy to kill the snake. Be careful of

the head when transporting it -- a snake can actually bite

for several hours after it's dead (from a reflex).

American Red Cross and American Heart AssociationJointly

Announce Revised First Aid Guidelines

WASHINGTON, Monday, October 18, 2010The American

Red Cross and American Heart Association today

announced changes to guidelines for administering first

aid. Among the revisions are updated recommendations

for the treatment of snake bites, anaphylaxis (shock),

jellyfish stings and severe bleeding. The First Aid Guidelines

are being published in Circulation: Journal of the American

Heart Association.

(Sentence 4, Paragraph 5)

...The treatment for snake bites has been amended

slightly to recommend applying a pressure immobilization

bandage to any venomous snake bite, with pressure being

applied around the entire length of the bitten extremity.