Speedy said:

Rule 303 said:

Speedy said:

On another note, I am interested to hear more about your thoughts on snake compression bandages and why they may not work. Just about to head out but will BBL :)

I can’t find any evidence that compression of the whole limb ¹ slows the movement of the lymphatic fluid ² any more than just keeping the limb still. Indeed, all the rest of the scientific work on compression of the whole limb is about increasing the lymphatic return to prevent or reduce swelling associated with injury.

From this I arrive at this position: The evidence supports compression of the bite and immobilisation (without compression) of the limb.

1. as distinct from just compression at the bite.
2. which carries the venom to the lymph node, from where it is pumped to heart.

That seems to make sense. Compression at the bite site only and immobilisation.

You may remember there was a change to first aid when bandaging the entire limb. It used to be to bandage from the bite up, then it changed to bandage down to the extremity, then back up for as far as the bandage would reach. I guess there would have been a reason to change it when patient outcomes were reviewed. With so few people dying of snakebite in Australia, better outcomes may be measured differently, with minimising permanent injury to limbs also being a strong factor.

I’ve spent a couple of hours reading what I could find in the scientific literature, and would like to add:

1. There’s a few variations in venoms. Nurotoxic? Haemotoxic? Tissue necrotic?
2. I couldn’t find anything in research that would get through the first-pass (<5yrs) filtering for academic work.
3. Although only one or two people die each year in Australia, the WHO estimates 80-140,000 around the world, with India and Africa leading the pack.
4. There is some ambiguity (there often is) in the ANZCOR recommendations: Based on consensus of expert opinion, lack any support for the technique of compressing the whole limb, years or even decades old.

Rule 303 said:

Speedy said:

Rule 303 said:

I can’t find any evidence that compression of the whole limb ¹ slows the movement of the lymphatic fluid ² any more than just keeping the limb still. Indeed, all the rest of the scientific work on compression of the whole limb is about increasing the lymphatic return to prevent or reduce swelling associated with injury.

From this I arrive at this position: The evidence supports compression of the bite and immobilisation (without compression) of the limb.

1. as distinct from just compression at the bite.
2. which carries the venom to the lymph node, from where it is pumped to heart.

That seems to make sense. Compression at the bite site only and immobilisation.

You may remember there was a change to first aid when bandaging the entire limb. It used to be to bandage from the bite up, then it changed to bandage down to the extremity, then back up for as far as the bandage would reach. I guess there would have been a reason to change it when patient outcomes were reviewed. With so few people dying of snakebite in Australia, better outcomes may be measured differently, with minimising permanent injury to limbs also being a strong factor.

I’ve spent a couple of hours reading what I could find in the scientific literature, and would like to add:

1. There’s a few variations in venoms. Nurotoxic? Haemotoxic? Tissue necrotic?
2. I couldn’t find anything in research that would get through the first-pass (<5yrs) filtering for academic work.
3. Although only one or two people die each year in Australia, the WHO estimates 80-140,000 around the world, with India and Africa leading the pack.
4. There is some ambiguity (there often is) in the ANZCOR recommendations: Based on consensus of expert opinion, lack any support for the technique of compressing the whole limb, years or even decades old.

Did you find this one? Lots of references there too. But as you say, not much recent stuff.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066967/

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

Rule 303 said:

Speedy said:

Rule 303 said:

I can’t find any evidence that compression of the whole limb ¹ slows the movement of the lymphatic fluid ² any more than just keeping the limb still. Indeed, all the rest of the scientific work on compression of the whole limb is about increasing the lymphatic return to prevent or reduce swelling associated with injury.

From this I arrive at this position: The evidence supports compression of the bite and immobilisation (without compression) of the limb.

1. as distinct from just compression at the bite.
2. which carries the venom to the lymph node, from where it is pumped to heart.

That seems to make sense. Compression at the bite site only and immobilisation.

You may remember there was a change to first aid when bandaging the entire limb. It used to be to bandage from the bite up, then it changed to bandage down to the extremity, then back up for as far as the bandage would reach. I guess there would have been a reason to change it when patient outcomes were reviewed. With so few people dying of snakebite in Australia, better outcomes may be measured differently, with minimising permanent injury to limbs also being a strong factor.

I’ve spent a couple of hours reading what I could find in the scientific literature, and would like to add:

1. There’s a few variations in venoms. Nurotoxic? Haemotoxic? Tissue necrotic?
2. I couldn’t find anything in research that would get through the first-pass (<5yrs) filtering for academic work.
3. Although only one or two people die each year in Australia, the WHO estimates 80-140,000 around the world, with India and Africa leading the pack.
4. There is some ambiguity (there often is) in the ANZCOR recommendations: Based on consensus of expert opinion, lack any support for the technique of compressing the whole limb, years or even decades old.

I worked with a guy who told a story of having been bitten by a snake in a rural location. Compression bandage on arm, taken to hospital, hospital staff wanted to inspect the wound. He said not until they’d sorted the antivenin out. They insisted, he refused. It escelated and they removed the bandage, and he almost didn’t make it.
/anecdote.

buffy said:

Did you find this one? Lots of references there too. But as you say, not much recent stuff.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066967/

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

Not that one, no. Thank you.

Partially relevent – and 2019:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6565734/

“Two pathways for venom toxin entry consequent to injection of an Australian elapid snake venom”

Another one (I don’t know what search you are using)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073535/

“First Aid and Pre-Hospital Management of Venomous Snakebites”

I’ve used PubMed and Google Scholar, but actually this medical search is throwing up more interesting stuff with the search term “Australian snake bite first aid”

https://www.hon.ch/med.html

I’m reluctant to say it strongly supports my initial position, because it chucks in a curve-ball (lay people Vs paramedical response), but here we are:

“Conclusion: This systematic review on first aid measures for the treatment of snakebite by lay first aid providers, has revealed that none of the in the literature suggested measures is proven to be both effective and feasible for the treatment of snakebite. The pressure immobilization technique was found to be effective but not feasible for laypeople. Therefore, evidence supporting a first aid guideline used in daily practice is limited to supportive therapy until professional help arrives. However, given the low quality of the evidence found, high quality studies concerning the efficacy and feasibility of different forms of pressure immobilization are warranted.”

Rule 303 said:

I’m reluctant to say it strongly supports my initial position, because it chucks in a curve-ball (lay people Vs paramedical response), but here we are:

“Conclusion: This systematic review on first aid measures for the treatment of snakebite by lay first aid providers, has revealed that none of the in the literature suggested measures is proven to be both effective and feasible for the treatment of snakebite. The pressure immobilization technique was found to be effective but not feasible for laypeople. Therefore, evidence supporting a first aid guideline used in daily practice is limited to supportive therapy until professional help arrives. However, given the low quality of the evidence found, high quality studies concerning the efficacy and feasibility of different forms of pressure immobilization are warranted.”

Yeah..I don’t really understand why it is not feasible for lay people. If they mean people who don’t know about it, fair enough, but people trained/shown how to put on a pressure bandage should be able to do it well enough. Personally I’d like my limb to be bandaged away from the bite site if the idea is to squish the venom away from the heart. Our elapids do neurotoxins predominantly, don’t they?

buffy said:

Another one (I don’t know what search you are using)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073535/

“First Aid and Pre-Hospital Management of Venomous Snakebites”

I’ve used PubMed and Google Scholar, but actually this medical search is throwing up more interesting stuff with the search term “Australian snake bite first aid”

https://www.hon.ch/med.html

Yeah, there seems to be plenty of good work on what happens at hospital.

buffy said:

Rule 303 said:

I’m reluctant to say it strongly supports my initial position, because it chucks in a curve-ball (lay people Vs paramedical response), but here we are:

“Conclusion: This systematic review on first aid measures for the treatment of snakebite by lay first aid providers, has revealed that none of the in the literature suggested measures is proven to be both effective and feasible for the treatment of snakebite. The pressure immobilization technique was found to be effective but not feasible for laypeople. Therefore, evidence supporting a first aid guideline used in daily practice is limited to supportive therapy until professional help arrives. However, given the low quality of the evidence found, high quality studies concerning the efficacy and feasibility of different forms of pressure immobilization are warranted.”

Yeah..I don’t really understand why it is not feasible for lay people. If they mean people who don’t know about it, fair enough, but people trained/shown how to put on a pressure bandage should be able to do it well enough. Personally I’d like my limb to be bandaged away from the bite site if the idea is to squish the venom away from the heart. Our elapids do neurotoxins predominantly, don’t they?

Yep. And with the new generation of snake-specific bandages, it should be simple enough to train people to apply them proximally -> distally, but if you look in 95% of first aid kits you’ll find the bandages unsuitable for anything more than holding a dressing on a wound.

I admire the sense of humour in this discussion:

“A venomous snake can inject venom into subcutaneous tissues, muscle, a vein, or an artery. Intravascular injections result in rapid onset of systemic toxicity and can be difficult to treat, even when antivenom is readily available. No first aid measure, other than supportive care and advanced life support, will be of benefit in intravascular venom injections.”

If you cop it in a vein you’re fucked. Pray.

Hehe

Mind you, you probably shouldn’t read anything I link to because Witty declared yesterday that I am unscientific and don’t know how to search and read the literature.

;)

Rule 303 said:

I admire the sense of humour in this discussion:

“A venomous snake can inject venom into subcutaneous tissues, muscle, a vein, or an artery. Intravascular injections result in rapid onset of systemic toxicity and can be difficult to treat, even when antivenom is readily available. No first aid measure, other than supportive care and advanced life support, will be of benefit in intravascular venom injections.”

If you cop it in a vein you’re fucked. Pray.

Hehe

Yeah. But it will be pretty fast.

buffy said:

Mind you, you probably shouldn’t read anything I link to because Witty declared yesterday that I am unscientific and don’t know how to search and read the literature.

;)

Not to make light of his obvious aggression and observe that the poor fella was clearly raised by wolves – The irony of a discussion on venom and toxicity has not escaped me.

I’ve got the proper snakebite bandages, one up at the redoubt and one in the glovebox.
They have a leaflet with instructions etc.

Peak Warming Man said:

I’ve got the proper snakebite bandages, one up at the redoubt and one in the glovebox.
They have a leaflet with instructions etc.

I’ve got a dozen or so, but I’ve chucked the labels out. What do the instructions say?

Rule 303 said:

Peak Warming Man said:

I’ve got the proper snakebite bandages, one up at the redoubt and one in the glovebox.
They have a leaflet with instructions etc.

I’ve got a dozen or so, but I’ve chucked the labels out. What do the instructions say?

Cant read it all as it’s wrapped around the bandage and sealed with plastic and I don’t want to break in.
Anyway I can see some of the instructions.
Quote “Firmly bandage starting from the toes or fingers then continuing up the limb as far as possible”
The rest is standard stuff, keep them calm, don’t move, wait for rescuers etc.

Peak Warming Man said:

… wait for rescuers etc.

could be a long wait in most of australia.

Peak Warming Man said:

Rule 303 said:

Peak Warming Man said:

I’ve got the proper snakebite bandages, one up at the redoubt and one in the glovebox.
They have a leaflet with instructions etc.

I’ve got a dozen or so, but I’ve chucked the labels out. What do the instructions say?

Cant read it all as it’s wrapped around the bandage and sealed with plastic and I don’t want to break in.
Anyway I can see some of the instructions.
Quote “Firmly bandage starting from the toes or fingers then continuing up the limb as far as possible”
The rest is standard stuff, keep them calm, don’t move, wait for rescuers etc.

Ahhh, yep. That sounds right. Thank you.

I wonder where they got the ‘starting from the toes or fingers’ advice from.

Rule 303 said:

Peak Warming Man said:

Rule 303 said:

I’ve got a dozen or so, but I’ve chucked the labels out. What do the instructions say?

Cant read it all as it’s wrapped around the bandage and sealed with plastic and I don’t want to break in.
Anyway I can see some of the instructions.
Quote “Firmly bandage starting from the toes or fingers then continuing up the limb as far as possible”
The rest is standard stuff, keep them calm, don’t move, wait for rescuers etc.

Ahhh, yep. That sounds right. Thank you.

I wonder where they got the ‘starting from the toes or fingers’ advice from.

It’s from the Reptile Awareness Displays of Australia.
Don’t remember buying anything from them, must have been a gift.

Whatever happened to the old tourniquet?

It used to be recommended.
Then not recommended.
Then?

Personally try to avoid upsetting snakes.

mollwollfumble said:

Whatever happened to the old tourniquet?

It used to be recommended.
Then not recommended.
Then?

then the leg fell off

mollwollfumble said:

Whatever happened to the old tourniquet?

It used to be recommended.
Then not recommended.
Then?

I am not aware of who, when or where a tourniquet was recommended. I suspect the advice might have been learned informally.

Rule 303 said:

mollwollfumble said:

Whatever happened to the old tourniquet?

It used to be recommended.
Then not recommended.
Then?

I am not aware of who, when or where a tourniquet was recommended. I suspect the advice might have been learned informally.

As is all of the wisdom of the ancients.

Rule 303 said:

mollwollfumble said:

Whatever happened to the old tourniquet?

It used to be recommended.
Then not recommended.
Then?

I am not aware of who, when or where a tourniquet was recommended. I suspect the advice might have been learned informally.

Oh, it was definitely a thing. The earliest copy of the St John First Aid book I’ve got is 1979 and it’s got the full limb bandaging method. Mr buffy remembers the cut, suck and spit method and the use of Condy’s Crystals (potassium permanganate). He also remembers the Time of the Tourniquet. However, we also have a copy of “Venomous Creatures of Australia” by Struan Sutherland and John Sutherland. From that:

—————————————————————————————————————-
The Old Type of First Aid

The old methods of first aid were danerous, often very painful, and could only b used for a very short time.

For many years people were taught to cut into the area that had been bitten in order to get rid of the venom. This was pretty severe treatment, as only small amounts of venom could be removed that way and snakes often inject little or no venom, even though the fang marks may be clearly visible.

The next change to the first aid involved the use of arterial tourniquets (which nowadays should never be used to treat bites). If someone was bitten by a dangerous snake of spider, say on the foot, then the blood supply to the leg was stopped as soon as possible. The problems associated with arterial tourniquets are threefold: They can only be used for a short time because the tissues of the leg start dying after about 20 minutes due to lack of oxygen They can cause severe damage to nerves and arteries, or even the whole leg They are terribly painful; few people can stand them for long.

———————————————————-

Here you go:

https://biomedicalsciences.unimelb.edu.au/departments/department-of-biochemistry-and-pharmacology/engage/avru/blog/first-aid-through-the-ages

buffy said:

Here you go:

https://biomedicalsciences.unimelb.edu.au/departments/department-of-biochemistry-and-pharmacology/engage/avru/blog/first-aid-through-the-ages

This one gives the source of the tourniquet technique as Hollywood movies.

Rule 303 said:

buffy said:

Here you go:

https://biomedicalsciences.unimelb.edu.au/departments/department-of-biochemistry-and-pharmacology/engage/avru/blog/first-aid-through-the-ages

This one gives the source of the tourniquet technique as Hollywood movies.

Well the snakebite kits of the 1950s and 1960s apparently included a tourniquet. I doubt they were based on Hollywood movies. They may not have been based on science, but I do doubt the movies as the source.

https://www.psa.org.au/wp-content/uploads/flipbook/24/files/basic-html/page15.html

Wait wait wait Hollywood is wrong?!?

Divine Angel said:

Wait wait wait Hollywood is wrong?!?

What would you do if you were bitten by Spiderman?

buffy said:

Rule 303 said:

buffy said:

Here you go:

https://biomedicalsciences.unimelb.edu.au/departments/department-of-biochemistry-and-pharmacology/engage/avru/blog/first-aid-through-the-ages

This one gives the source of the tourniquet technique as Hollywood movies.

Well the snakebite kits of the 1950s and 1960s apparently included a tourniquet. I doubt they were based on Hollywood movies. They may not have been based on science, but I do doubt the movies as the source.

https://www.psa.org.au/wp-content/uploads/flipbook/24/files/basic-html/page15.html

I’m with buffy. It is only vague memories but I’m certain we were taught to use a tourniquet in the late 60s.

sibeen said:

buffy said:

Rule 303 said:

This one gives the source of the tourniquet technique as Hollywood movies.

Well the snakebite kits of the 1950s and 1960s apparently included a tourniquet. I doubt they were based on Hollywood movies. They may not have been based on science, but I do doubt the movies as the source.

https://www.psa.org.au/wp-content/uploads/flipbook/24/files/basic-html/page15.html

I’m with buffy. It is only vague memories but I’m certain we were taught to use a tourniquet in the late 60s.

The Australian Museum has a kit:

https://australian.museum/blog-archive/science/snake-bite-kit/

Thanks Rule.

With no evidence that better outcomes are achieved when the entire limb is bandaged, for the official guidelines stating to do it anyway, there must also be no evidence that poorer outcomes result from limb bandaging.

From https://survive-student-resource.austererisk.com/environmental/anzcor_9_4_8_pressure_immobilisation.html:

If resuscitation is needed it takes precedence over the PIT (refer to ARC Guideline 8). However the resuscitation team should apply PIT as soon as possible to potentially minimise further venom flow.

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, if neither are available, clothing or other material should be used.(5) The bandage should be firm and tight, you should be unable to easily slide a finger between the bandage and the skin.

In order to further restrict lymphatic flow and to assist in immobilisation of the limb, apply a further pressure bandage, commencing at the fingers or toes of the bitten limb and extending upward covering as much of the limb as possible.(3) The bandage should be applied over existing clothing if possible. The purpose of this bandage is to further restrict lymphatic flow and assist immobilisation. (Alternatively, a single bandage may be used to achieve both pressure on the bite site and immobilisation of the limb. In this method, the bandage is initially applied to the fingers or toes and extended up the limb as far as possible including the bite site)

Do you think that, if application of the bandage to the entire limb increases flow of venom by increasing lymphatic return, its application also assists so much with further immobilising the limb that it counteracts it?

I found this in an old first aid book somebody sent me a couple of years ago, which I am still yet to find a good home for.

Tamb said:

Divine Angel said:

Wait wait wait Hollywood is wrong?!?

What would you do if you were bitten by Spiderman?

Pfft as if I’d ever be in the same room with anything spider related.

Speedy said:

Thanks Rule.

With no evidence that better outcomes are achieved when the entire limb is bandaged, for the official guidelines stating to do it anyway, there must also be no evidence that poorer outcomes result from limb bandaging.

From https://survive-student-resource.austererisk.com/environmental/anzcor_9_4_8_pressure_immobilisation.html:

If resuscitation is needed it takes precedence over the PIT (refer to ARC Guideline 8). However the resuscitation team should apply PIT as soon as possible to potentially minimise further venom flow.

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, if neither are available, clothing or other material should be used.(5) The bandage should be firm and tight, you should be unable to easily slide a finger between the bandage and the skin.

In order to further restrict lymphatic flow and to assist in immobilisation of the limb, apply a further pressure bandage, commencing at the fingers or toes of the bitten limb and extending upward covering as much of the limb as possible.(3) The bandage should be applied over existing clothing if possible. The purpose of this bandage is to further restrict lymphatic flow and assist immobilisation. (Alternatively, a single bandage may be used to achieve both pressure on the bite site and immobilisation of the limb. In this method, the bandage is initially applied to the fingers or toes and extended up the limb as far as possible including the bite site)

Do you think that, if application of the bandage to the entire limb increases flow of venom by increasing lymphatic return, its application also assists so much with further immobilising the limb that it counteracts it?

~In order to further restrict lymphatic flow.

Divine Angel said:

Tamb said:

Divine Angel said:

Wait wait wait Hollywood is wrong?!?

What would you do if you were bitten by Spiderman?

Pfft as if I’d ever be in the same room with anything spider related.

You, DA are a special case. :)

buffy said:

sibeen said:

buffy said:

Well the snakebite kits of the 1950s and 1960s apparently included a tourniquet. I doubt they were based on Hollywood movies. They may not have been based on science, but I do doubt the movies as the source.

https://www.psa.org.au/wp-content/uploads/flipbook/24/files/basic-html/page15.html

I’m with buffy. It is only vague memories but I’m certain we were taught to use a tourniquet in the late 60s.

The Australian Museum has a kit:

https://australian.museum/blog-archive/science/snake-bite-kit/

This looks like a venous, not arterial, tourniquet.

One of the papers I read yesterday supported the idea of applying a venous tourniquet to a particular venom type (Rattlesnake, necrotic) to reduce the concentration at the site and thus damage to the tissue in the area.

Speedy said:

Thanks Rule.

With no evidence that better outcomes are achieved when the entire limb is bandaged, for the official guidelines stating to do it anyway, there must also be no evidence that poorer outcomes result from limb bandaging.

From https://survive-student-resource.austererisk.com/environmental/anzcor_9_4_8_pressure_immobilisation.html:

If resuscitation is needed it takes precedence over the PIT (refer to ARC Guideline 8). However the resuscitation team should apply PIT as soon as possible to potentially minimise further venom flow.

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, if neither are available, clothing or other material should be used.(5) The bandage should be firm and tight, you should be unable to easily slide a finger between the bandage and the skin.

In order to further restrict lymphatic flow and to assist in immobilisation of the limb, apply a further pressure bandage, commencing at the fingers or toes of the bitten limb and extending upward covering as much of the limb as possible.(3) The bandage should be applied over existing clothing if possible. The purpose of this bandage is to further restrict lymphatic flow and assist immobilisation. (Alternatively, a single bandage may be used to achieve both pressure on the bite site and immobilisation of the limb. In this method, the bandage is initially applied to the fingers or toes and extended up the limb as far as possible including the bite site)

Do you think that, if application of the bandage to the entire limb increases flow of venom by increasing lymphatic return, its application also assists so much with further immobilising the limb that it counteracts it?

Yeah, I believe that’s the thinking. As for how this compares with just staying still, or splinting by securing to a stick with a bandage above and below each joint, is something I haven’t seen any work on.

I think the more bandages the better, the ANCIENTS knew that.
Which leads me to believe that those mummies in Egypt died of snake bite.

Peak Warming Man said:

I think the more bandages the better, the ANCIENTS knew that.
Which leads me to believe that those mummies in Egypt died of snake bite.

Asp was all the rage, back in Cleopatra’s day.

buffy said:

Rule 303 said:

mollwollfumble said:

Whatever happened to the old tourniquet?

It used to be recommended.
Then not recommended.
Then?

I am not aware of who, when or where a tourniquet was recommended. I suspect the advice might have been learned informally.

Oh, it was definitely a thing. The earliest copy of the St John First Aid book I’ve got is 1979 and it’s got the full limb bandaging method. Mr buffy remembers the cut, suck and spit method and the use of Condy’s Crystals (potassium permanganate). He also remembers the Time of the Tourniquet. However, we also have a copy of “Venomous Creatures of Australia” by Struan Sutherland and John Sutherland. From that:

—————————————————————————————————————-
The Old Type of First Aid

The old methods of first aid were danerous, often very painful, and could only b used for a very short time.

For many years people were taught to cut into the area that had been bitten in order to get rid of the venom. This was pretty severe treatment, as only small amounts of venom could be removed that way and snakes often inject little or no venom, even though the fang marks may be clearly visible.

The next change to the first aid involved the use of arterial tourniquets (which nowadays should never be used to treat bites). If someone was bitten by a dangerous snake of spider, say on the foot, then the blood supply to the leg was stopped as soon as possible. The problems associated with arterial tourniquets are threefold: They can only be used for a short time because the tissues of the leg start dying after about 20 minutes due to lack of oxygen They can cause severe damage to nerves and arteries, or even the whole leg They are terribly painful; few people can stand them for long.

———————————————————-

I was given a first aid kit when I was quite young (6?). It had a rubber tourniquet, condy’s crystals, and instructions about how to treat a snake bite using them and the cut-suck-spit method.

Got a tattered old one of those lying around.

Rule 303 said:

Speedy said:

Thanks Rule.

With no evidence that better outcomes are achieved when the entire limb is bandaged, for the official guidelines stating to do it anyway, there must also be no evidence that poorer outcomes result from limb bandaging.

From https://survive-student-resource.austererisk.com/environmental/anzcor_9_4_8_pressure_immobilisation.html:

If resuscitation is needed it takes precedence over the PIT (refer to ARC Guideline 8). However the resuscitation team should apply PIT as soon as possible to potentially minimise further venom flow.

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, if neither are available, clothing or other material should be used.(5) The bandage should be firm and tight, you should be unable to easily slide a finger between the bandage and the skin.

In order to further restrict lymphatic flow and to assist in immobilisation of the limb, apply a further pressure bandage, commencing at the fingers or toes of the bitten limb and extending upward covering as much of the limb as possible.(3) The bandage should be applied over existing clothing if possible. The purpose of this bandage is to further restrict lymphatic flow and assist immobilisation. (Alternatively, a single bandage may be used to achieve both pressure on the bite site and immobilisation of the limb. In this method, the bandage is initially applied to the fingers or toes and extended up the limb as far as possible including the bite site)

Do you think that, if application of the bandage to the entire limb increases flow of venom by increasing lymphatic return, its application also assists so much with further immobilising the limb that it counteracts it?

Yeah, I believe that’s the thinking. As for how this compares with just staying still, or splinting by securing to a stick with a bandage above and below each joint, is something I haven’t seen any work on.

Staying still is not as easy as it seems, so anything that helps must be of some use.

FWIW, a relative was bitten by a brown snake in her backyard a couple of years ago. She felt it but did not see it, and walked around the outside of the house to ask her husband what he thought of the mark on her calf. They called an ambulance and followed the instructions, then spent the night in hospital. Thankfully it was a dry bite and then next morning it was decided to slowly remove the bandage from her leg which was applied from foot to groin. Although she had felt fine all along, here she began to feel very unwell so stayed in hospital until it passed. Her theory is that it was from built-up toxin that had been released too quickly. Is she right?

Ian said:

Got a tattered old one of those lying around.

What is the metal part for?

Speedy said:

Ian said:

Got a tattered old one of those lying around.

What is the metal part for?

A bullet in case the tourniquet doesn’t work.

Divine Angel said:

Speedy said:

Ian said:

Got a tattered old one of those lying around.

What is the metal part for?

A bullet in case the tourniquet doesn’t work.

Probably the scalpel.

Speedy said:

Ian said:

Got a tattered old one of those lying around.

What is the metal part for?

Locks the bands when drawn tight.

Ian said:

Speedy said:

Ian said:

Got a tattered old one of those lying around.

What is the metal part for?

Locks the bands when drawn tight.

That’s terribly boring. I thought it might have been a venom extraction/suction device.

Speedy said:

Ian said:

Speedy said:

What is the metal part for?

Locks the bands when drawn tight.

That’s terribly boring. I thought it might have been a venom extraction/suction device.

The capsule thing has the Condy’s crystals in it.

Speedy said:

Ian said:

Speedy said:

What is the metal part for?

Locks the bands when drawn tight.

That’s terribly boring. I thought it might have been a venom extraction/suction device.

No, sorry. I was talking about the metal part of the tourniquet.

I think the other is a lance.

So now what do you do if bitten by a snake?

buffy said:

Speedy said:

Ian said:

Locks the bands when drawn tight.

That’s terribly boring. I thought it might have been a venom extraction/suction device.

The capsule thing has the Condy’s crystals in it.

Ah. Not seen that hi-tech component.

Peak Warming Man said:

So now what do you do if bitten by a snake?

Many many hours of research.

Ian said:

Peak Warming Man said:

So now what do you do if bitten by a snake?

Many many hours of research.

LOL, triffic.

Peak Warming Man said:

Ian said:

Peak Warming Man said:

So now what do you do if bitten by a snake?

Many many hours of research.

LOL, triffic.

While not moving the affected limb so as not to spread the venom.

Speedy said:

Ian said:

Got a tattered old one of those lying around.

What is the metal part for?

that is a capsule of cyanide in case the tourniquet doesn’t work…

Divine Angel said:

Speedy said:

Ian said:

Got a tattered old one of those lying around.

What is the metal part for?

A bullet in case the tourniquet doesn’t work.

LOL, sorta snap.

Speedy said:

Rule 303 said:

Speedy said:

Thanks Rule.

With no evidence that better outcomes are achieved when the entire limb is bandaged, for the official guidelines stating to do it anyway, there must also be no evidence that poorer outcomes result from limb bandaging.

From https://survive-student-resource.austererisk.com/environmental/anzcor_9_4_8_pressure_immobilisation.html:

If resuscitation is needed it takes precedence over the PIT (refer to ARC Guideline 8). However the resuscitation team should apply PIT as soon as possible to potentially minimise further venom flow.

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, if neither are available, clothing or other material should be used.(5) The bandage should be firm and tight, you should be unable to easily slide a finger between the bandage and the skin.

In order to further restrict lymphatic flow and to assist in immobilisation of the limb, apply a further pressure bandage, commencing at the fingers or toes of the bitten limb and extending upward covering as much of the limb as possible.(3) The bandage should be applied over existing clothing if possible. The purpose of this bandage is to further restrict lymphatic flow and assist immobilisation. (Alternatively, a single bandage may be used to achieve both pressure on the bite site and immobilisation of the limb. In this method, the bandage is initially applied to the fingers or toes and extended up the limb as far as possible including the bite site)

Do you think that, if application of the bandage to the entire limb increases flow of venom by increasing lymphatic return, its application also assists so much with further immobilising the limb that it counteracts it?

Yeah, I believe that’s the thinking. As for how this compares with just staying still, or splinting by securing to a stick with a bandage above and below each joint, is something I haven’t seen any work on.

Staying still is not as easy as it seems, so anything that helps must be of some use.

FWIW, a relative was bitten by a brown snake in her backyard a couple of years ago. She felt it but did not see it, and walked around the outside of the house to ask her husband what he thought of the mark on her calf. They called an ambulance and followed the instructions, then spent the night in hospital. Thankfully it was a dry bite and then next morning it was decided to slowly remove the bandage from her leg which was applied from foot to groin. Although she had felt fine all along, here she began to feel very unwell so stayed in hospital until it passed. Her theory is that it was from built-up toxin that had been released too quickly. Is she right?

It does sound like metabolic waste chemistry hitting her suddenly. Did anyone think to get bloods?

Rule 303 said:

Speedy said:

Rule 303 said:

Yeah, I believe that’s the thinking. As for how this compares with just staying still, or splinting by securing to a stick with a bandage above and below each joint, is something I haven’t seen any work on.

Staying still is not as easy as it seems, so anything that helps must be of some use.

FWIW, a relative was bitten by a brown snake in her backyard a couple of years ago. She felt it but did not see it, and walked around the outside of the house to ask her husband what he thought of the mark on her calf. They called an ambulance and followed the instructions, then spent the night in hospital. Thankfully it was a dry bite and then next morning it was decided to slowly remove the bandage from her leg which was applied from foot to groin. Although she had felt fine all along, here she began to feel very unwell so stayed in hospital until it passed. Her theory is that it was from built-up toxin that had been released too quickly. Is she right?

It does sound like metabolic waste chemistry hitting her suddenly. Did anyone think to get bloods?

When she was telling me the story it was obvious that she had no evidence to support her theory, so probably no. FWIW, she said that the people at Yass Hospital knew exactly what they were doing but Canberra Hospital, where she was transferred to, had no idea at all.

Further to the story of the relative bitten by an Eastern Brown Snake, she has a snake catcher/person/expert come to her home to educate her about their behaviour and how to prevent another bite. He told her that walking around to the other side of the house to talk to her husband could have made a big difference to her prognosis, had she have been envenomated. She will not go into her garden now, even to hang clothes on the line, without a snake bandage and a mobile phone tucked into her back pockets.

buffy said:

Rule 303 said:

mollwollfumble said:

Whatever happened to the old tourniquet?

It used to be recommended.
Then not recommended.
Then?

I am not aware of who, when or where a tourniquet was recommended. I suspect the advice might have been learned informally.

Oh, it was definitely a thing. The earliest copy of the St John First Aid book I’ve got is 1979 and it’s got the full limb bandaging method. Mr buffy remembers the cut, suck and spit method and the use of Condy’s Crystals (potassium permanganate). He also remembers the Time of the Tourniquet. However, we also have a copy of “Venomous Creatures of Australia” by Struan Sutherland and John Sutherland. From that:

—————————————————————————————————————-
The Old Type of First Aid

The old methods of first aid were danerous, often very painful, and could only b used for a very short time.

For many years people were taught to cut into the area that had been bitten in order to get rid of the venom. This was pretty severe treatment, as only small amounts of venom could be removed that way and snakes often inject little or no venom, even though the fang marks may be clearly visible.

The next change to the first aid involved the use of arterial tourniquets (which nowadays should never be used to treat bites). If someone was bitten by a dangerous snake of spider, say on the foot, then the blood supply to the leg was stopped as soon as possible. The problems associated with arterial tourniquets are threefold: They can only be used for a short time because the tissues of the leg start dying after about 20 minutes due to lack of oxygen They can cause severe damage to nerves and arteries, or even the whole leg They are terribly painful; few people can stand them for long.

———————————————————-

Ta, yes. I learned the tourniquet from St John’s first aid. The cut and suck methods were before my time.

If we have run out of things to discuss in this thread, I think this:

Snakebite in Australia – a practical approach to diagnosis and treatment

(link opens MJA article)

Rule 303 said:

If we have run out of things to discuss in this thread, I think this:

Snakebite in Australia – a practical approach to diagnosis and treatment

(link opens MJA article)

That is outside your criterion 2 in your initial post…

;)

Ooh…I think I found the answer to the tourniquet/ligature question. It really was, as someone said, “the wisdom of the ancients”.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340534/

“TOXICOLOGY AND TREATMENT: MEDICAL AUTHORITIES AND SNAKE-BITE IN THE MIDDLE AGES”

In section 2, “Nearly all medical texts devoted the majority of their discussion to treatment, and Avicenna and Maimonides were the two authorities most followed.”

>>Bernard de Gordon numbered the procedures to be followed, which are the following (in paraphrase):

Apply a strong and painful ligature around the site of the bite. Take a rooster, pluck the feathers from its bottom and place it on the site of the bite. If the rooster dies, this is a good sign as it is attracting the venom. Repeat this with more roosters. Take a sponge or wool, dip it in hot water, and place it on the site. Repeat this action several times. Apply a cupping glass, along with scarification if necessary. Cover the bite area with a plaster of theriac. Apply a plaster made of gum resin, plant gum-juice, myrrh, asafoetida, opoponax, pepper and sulphur, all mixed up with wine. Take pomegranate leaves, crush them with figs, and apply as a plaster. Give the patient to drink a potion of pomegranates, pomegranate leaves, coriander, gentian and turbith, all cooked in water. Call a villein (persona uilis) to come and suck the punctured area. Make sure that their stomach is full of wine, rue, nuts and figs, and that their mouth is rubbed with wine and oil. If there is no other way, and the member is a small one, amputate it.26

buffy said:

Ooh…I think I found the answer to the tourniquet/ligature question. It really was, as someone said, “the wisdom of the ancients”.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340534/

“TOXICOLOGY AND TREATMENT: MEDICAL AUTHORITIES AND SNAKE-BITE IN THE MIDDLE AGES”

In section 2, “Nearly all medical texts devoted the majority of their discussion to treatment, and Avicenna and Maimonides were the two authorities most followed.”

>>Bernard de Gordon numbered the procedures to be followed, which are the following (in paraphrase):

Apply a strong and painful ligature around the site of the bite. Take a rooster, pluck the feathers from its bottom and place it on the site of the bite. If the rooster dies, this is a good sign as it is attracting the venom. Repeat this with more roosters. Take a sponge or wool, dip it in hot water, and place it on the site. Repeat this action several times. Apply a cupping glass, along with scarification if necessary. Cover the bite area with a plaster of theriac. Apply a plaster made of gum resin, plant gum-juice, myrrh, asafoetida, opoponax, pepper and sulphur, all mixed up with wine. Take pomegranate leaves, crush them with figs, and apply as a plaster. Give the patient to drink a potion of pomegranates, pomegranate leaves, coriander, gentian and turbith, all cooked in water. Call a villein (persona uilis) to come and suck the punctured area. Make sure that their stomach is full of wine, rue, nuts and figs, and that their mouth is rubbed with wine and oil. If there is no other way, and the member is a small one, amputate it.26

I’m going through this step by step.
I’m up to the ‘take a rooster’ part.
I’ll have a break for another cup of tea.

buffy said:

Ooh…I think I found the answer to the tourniquet/ligature question. It really was, as someone said, “the wisdom of the ancients”.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340534/

“TOXICOLOGY AND TREATMENT: MEDICAL AUTHORITIES AND SNAKE-BITE IN THE MIDDLE AGES”

In section 2, “Nearly all medical texts devoted the majority of their discussion to treatment, and Avicenna and Maimonides were the two authorities most followed.”

>>Bernard de Gordon numbered the procedures to be followed, which are the following (in paraphrase):

Apply a strong and painful ligature around the site of the bite. Take a rooster, pluck the feathers from its bottom and place it on the site of the bite. If the rooster dies, this is a good sign as it is attracting the venom. Repeat this with more roosters. Take a sponge or wool, dip it in hot water, and place it on the site. Repeat this action several times. Apply a cupping glass, along with scarification if necessary. Cover the bite area with a plaster of theriac. Apply a plaster made of gum resin, plant gum-juice, myrrh, asafoetida, opoponax, pepper and sulphur, all mixed up with wine. Take pomegranate leaves, crush them with figs, and apply as a plaster. Give the patient to drink a potion of pomegranates, pomegranate leaves, coriander, gentian and turbith, all cooked in water. Call a villein (persona uilis) to come and suck the punctured area. Make sure that their stomach is full of wine, rue, nuts and figs, and that their mouth is rubbed with wine and oil. If there is no other way, and the member is a small one, amputate it.26

I’m reasonably sure that those men who took a dump in the bush only to receive a snekbite to the penis, would read that in abject horror.

roughbarked said:

buffy said:

Ooh…I think I found the answer to the tourniquet/ligature question. It really was, as someone said, “the wisdom of the ancients”.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340534/

“TOXICOLOGY AND TREATMENT: MEDICAL AUTHORITIES AND SNAKE-BITE IN THE MIDDLE AGES”

In section 2, “Nearly all medical texts devoted the majority of their discussion to treatment, and Avicenna and Maimonides were the two authorities most followed.”

>>Bernard de Gordon numbered the procedures to be followed, which are the following (in paraphrase):

Apply a strong and painful ligature around the site of the bite. Take a rooster, pluck the feathers from its bottom and place it on the site of the bite. If the rooster dies, this is a good sign as it is attracting the venom. Repeat this with more roosters. Take a sponge or wool, dip it in hot water, and place it on the site. Repeat this action several times. Apply a cupping glass, along with scarification if necessary. Cover the bite area with a plaster of theriac. Apply a plaster made of gum resin, plant gum-juice, myrrh, asafoetida, opoponax, pepper and sulphur, all mixed up with wine. Take pomegranate leaves, crush them with figs, and apply as a plaster. Give the patient to drink a potion of pomegranates, pomegranate leaves, coriander, gentian and turbith, all cooked in water. Call a villein (persona uilis) to come and suck the punctured area. Make sure that their stomach is full of wine, rue, nuts and figs, and that their mouth is rubbed with wine and oil. If there is no other way, and the member is a small one, amputate it.26

I’m reasonably sure that those men who took a dump in the bush only to receive a snekbite to the penis, would read that in abject horror.

I suspect such persons would be few and far between and quite possibly mythical.

buffy said:

roughbarked said:

buffy said:

Ooh…I think I found the answer to the tourniquet/ligature question. It really was, as someone said, “the wisdom of the ancients”.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340534/

“TOXICOLOGY AND TREATMENT: MEDICAL AUTHORITIES AND SNAKE-BITE IN THE MIDDLE AGES”

In section 2, “Nearly all medical texts devoted the majority of their discussion to treatment, and Avicenna and Maimonides were the two authorities most followed.”

>>Bernard de Gordon numbered the procedures to be followed, which are the following (in paraphrase):

Apply a strong and painful ligature around the site of the bite. Take a rooster, pluck the feathers from its bottom and place it on the site of the bite. If the rooster dies, this is a good sign as it is attracting the venom. Repeat this with more roosters. Take a sponge or wool, dip it in hot water, and place it on the site. Repeat this action several times. Apply a cupping glass, along with scarification if necessary. Cover the bite area with a plaster of theriac. Apply a plaster made of gum resin, plant gum-juice, myrrh, asafoetida, opoponax, pepper and sulphur, all mixed up with wine. Take pomegranate leaves, crush them with figs, and apply as a plaster. Give the patient to drink a potion of pomegranates, pomegranate leaves, coriander, gentian and turbith, all cooked in water. Call a villein (persona uilis) to come and suck the punctured area. Make sure that their stomach is full of wine, rue, nuts and figs, and that their mouth is rubbed with wine and oil. If there is no other way, and the member is a small one, amputate it.26

I’m reasonably sure that those men who took a dump in the bush only to receive a snekbite to the penis, would read that in abject horror.

I suspect such persons would be few and far between and quite possibly mythical.

It occurred near Cairns a few years ago.

Hmmm… “snakebite to penis”…

Ian said:

Hmmm… “snakebite to penis”…

That’s not Cairns!

:)

buffy said:

roughbarked said:

buffy said:

Ooh…I think I found the answer to the tourniquet/ligature question. It really was, as someone said, “the wisdom of the ancients”.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340534/

“TOXICOLOGY AND TREATMENT: MEDICAL AUTHORITIES AND SNAKE-BITE IN THE MIDDLE AGES”

In section 2, “Nearly all medical texts devoted the majority of their discussion to treatment, and Avicenna and Maimonides were the two authorities most followed.”

>>Bernard de Gordon numbered the procedures to be followed, which are the following (in paraphrase):

Apply a strong and painful ligature around the site of the bite. Take a rooster, pluck the feathers from its bottom and place it on the site of the bite. If the rooster dies, this is a good sign as it is attracting the venom. Repeat this with more roosters. Take a sponge or wool, dip it in hot water, and place it on the site. Repeat this action several times. Apply a cupping glass, along with scarification if necessary. Cover the bite area with a plaster of theriac. Apply a plaster made of gum resin, plant gum-juice, myrrh, asafoetida, opoponax, pepper and sulphur, all mixed up with wine. Take pomegranate leaves, crush them with figs, and apply as a plaster. Give the patient to drink a potion of pomegranates, pomegranate leaves, coriander, gentian and turbith, all cooked in water. Call a villein (persona uilis) to come and suck the punctured area. Make sure that their stomach is full of wine, rue, nuts and figs, and that their mouth is rubbed with wine and oil. If there is no other way, and the member is a small one, amputate it.26

I’m reasonably sure that those men who took a dump in the bush only to receive a snekbite to the penis, would read that in abject horror.

I suspect such persons would be few and far between and quite possibly mythical.

So did Middle-Ages travellers carry a few roosters with them, just to be on the safe side?

Michael V said:

buffy said:

roughbarked said:

I’m reasonably sure that those men who took a dump in the bush only to receive a snekbite to the penis, would read that in abject horror.

I suspect such persons would be few and far between and quite possibly mythical.

It occurred near Cairns a few years ago.

https://www.news.com.au/national/deadly-brown-snake-bites-mans-penis/news-story/86d0d1edb7020e56ecb703f9105c4c15?sv=7408b17e911242c26c7e449e6c617093

buffy said:

Ian said:

Hmmm… “snakebite to penis”…

That’s not Cairns!

:)

Couldn’t find any video of the Cairns incident.

buffy said:

Ian said:

Hmmm… “snakebite to penis”…

That’s not Cairns!

:)

I remember the “Cairns” one, it was near Mareeba & there was great concern as the type of snake was unknown & the wrong antivenine could cause death. When it got to the stage of “Do nothing & he dies or give antivenine & he might live” The docs tried Taipan antivenine & the bloke lived.

Michael V said:

Michael V said:

buffy said:

I suspect such persons would be few and far between and quite possibly mythical.

It occurred near Cairns a few years ago.

https://www.news.com.au/national/deadly-brown-snake-bites-mans-penis/news-story/86d0d1edb7020e56ecb703f9105c4c15?sv=7408b17e911242c26c7e449e6c617093

I wonder what the recommened treatment is.

Rule should be along shortly..

Ian said:

Michael V said:

Michael V said:

It occurred near Cairns a few years ago.

https://www.news.com.au/national/deadly-brown-snake-bites-mans-penis/news-story/86d0d1edb7020e56ecb703f9105c4c15?sv=7408b17e911242c26c7e449e6c617093

I wonder what the recommened treatment is.

Rule should be along shortly..

no comment.

Ian said:

Michael V said:

Michael V said:

It occurred near Cairns a few years ago.

https://www.news.com.au/national/deadly-brown-snake-bites-mans-penis/news-story/86d0d1edb7020e56ecb703f9105c4c15?sv=7408b17e911242c26c7e449e6c617093

I wonder what the recommened treatment is.

Rule should be along shortly..

I would encourage the patient to find a secluded location and rub the site of the injury vigorously with a hand moisturising lotion. Because… he might as well.

The Rev Dodgson said:

buffy said:

roughbarked said:

I’m reasonably sure that those men who took a dump in the bush only to receive a snekbite to the penis, would read that in abject horror.

I suspect such persons would be few and far between and quite possibly mythical.

So did Middle-Ages travellers carry a few roosters with them, just to be on the safe side?

Is that like a rock that keeps you safe from tigers?

Rule 303 said:

Ian said:

Michael V said:

https://www.news.com.au/national/deadly-brown-snake-bites-mans-penis/news-story/86d0d1edb7020e56ecb703f9105c4c15?sv=7408b17e911242c26c7e449e6c617093

I wonder what the recommened treatment is.

Rule should be along shortly..

I would encourage the patient to find a secluded location and rub the site of the injury vigorously with a hand moisturising lotion. Because… he might as well.

and thus elapid / eyes returned

Ian said:

Michael V said:

Michael V said:

It occurred near Cairns a few years ago.

https://www.news.com.au/national/deadly-brown-snake-bites-mans-penis/news-story/86d0d1edb7020e56ecb703f9105c4c15?sv=7408b17e911242c26c7e449e6c617093

I wonder what the recommened treatment is.

Rule should be along shortly..

It’s either bandage, tourniquet or chooks bum.

Peak Warming Man said:

Ian said:

Michael V said:

https://www.news.com.au/national/deadly-brown-snake-bites-mans-penis/news-story/86d0d1edb7020e56ecb703f9105c4c15?sv=7408b17e911242c26c7e449e6c617093

I wonder what the recommened treatment is.

Rule should be along shortly..

It’s either bandage, tourniquet or chooks bum.

> I wonder what the recommened treatment is

1. Kill snake so you can take a scale count.
2. If alone without mobile phone get the heck out of there.
3. If alone with mobile phone, ring up to arrange place to meet then get the heck out of there.
4. Try not to get an erection.

mollwollfumble said:

Peak Warming Man said:

Ian said:

I wonder what the recommened treatment is.

Rule should be along shortly..

It’s either bandage, tourniquet or chooks bum.

> I wonder what the recommened treatment is

1. Kill snake so you can take a scale count.
2. If alone without mobile phone get the heck out of there.
3. If alone with mobile phone, ring up to arrange place to meet then get the heck out of there.
4. Try not to get an erection.

waits