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Question
Posted by: Toby Marthews | 2011/01/10

Snake bite question

Dear Snake Expert,

I''m hoping I can ask you a question about snake bites? I found your webpage at health24.com/medical/Condition_centres but one piece of advice on it (about tourniquets) is contradicting what I''ve found elsewhere and I''''m hoping someone can explain?

I''m in Oxford, UK but I do fieldwork in Malaysia which has several poisonous snake species.Some debate recently arose here about tourniquets. Basically, in the event of a snake bite happening to someone in your group during fieldwork in a tropical location (thankfully this has never yet occurred to me!), should one apply a tourniquet and should one try to suck venom out of the victim''''s wound?

YES YOU SHOULD:

If you click on this (admittedly non-medical) link to a Rothco product: campingsurvival snakebitekit and scroll down to the description, we have on sale a small ''''snake bite kit'''' that
(a) includes suction cups so presumably (even without having read their "  complete instructions"  ) they are in favour of sucking venom out and

(b) the advice - apparently from the American Red Cross - is to "  Apply a bandage, wrapped two to four inches above the bite, to help slow the venom. This should not cut off the flow of blood from a vein or artery - the band should be loose enough to slip a finger under it."  and as far as I understand the term, this is a compression bandage aka. a tourniquet.

NO YOU SHOULDN''''T:

According to this Indian link: lfsru org / firstaid htm there are several drawbacks to tourniquets and one should NOT use them because they localise the venom around the wound and cause greater tissue damage. It doesn''''t mention suction.
Pages 26-27 of this Trinidadian link: I thought was very comprehensive and seems very professional. On the suction point it clearly says "  do not try suction"  though doesn''''t say why.

On the tourniquet point, it is confusing: on the one hand it advises "  Wrap a fairly tight bandage around the site if the bite is on the limb this will slow circulation but not restrict it"  (i.e. a compression bandage) but then it goes on to state clearly "  do not apply a tourniquet"  leaving me very confused!

According to your website health24.com/medical/Condition_centres you clearly advise not to use suction cup devices like Rothco''''s but you do approve of compression bandages (tourniquets).

Could you please clarify:

(1) Why are suction cups bad? Rothco recommend them in their snake bite kit so is it something specifically about South African snakes that makes them inappropriate?

(2) Why do you support the use of compression bandages despite the reasons listed in the Indian link above and the Trinidadian link specifically stating not to use tourniquets?

Thanks for any help! I thought your website the most professional of the links I found above, but these two points give me niggling doubts, which is why I''''m hoping you can clear them up, that''''s all (i.e. this email is not criticism in any way!).

Best regards,
Toby Marthews

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Our expert says:
Expert ImageEnviroHealth expert

Please check the link to make sure it was my most recent article on the topic you saw: http://www.health24.com/medical/Condition_centres/777-792-2557-2561,32367.asp
This is based on recommendations from a South African emergency medical specialist in snake bite(Dr Philip Cohen). Even so, the experts do sometimes disagree! As to your queries
1) I don't think suction cups are bad, as such, it's more that they are considered ineffective.
2) As I understand it, a tourniquet is not the same as a compression bandage. The idea behind a traditional tourniquet for snakebite, which is now widely discredited because it can lead to tissue death and limb loss, is to tie a bandage tightly to constrict bloodflow as much as possible to prevent venom travelling to vital organs. A compression bandage is applied firmly but not too tightly over a larger area, the idea being to slow venom-laden blood somewhat, but not completely. (It is not recommended at all for cytotoxic venom)
Dr Cohen's primary message, however, is that the first and most valuable action to take is to get the victim to a hospital as fast as possible. The other first-aid measures are very much secondary, and not very effectual.

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

2
Our users say:
Posted by: Caroline Mytton | 2011/02/22

I have found really helpful information on Snake Bites, Insect bites and a wide variety of other pest related subjects on the Rentokil South Africa web site.

Reply to Caroline Mytton
Posted by: EnviroHealth Expert | 2011/01/13

Please check the link to make sure it was my most recent article on the topic you saw: http://www.health24.com/medical/Condition_centres/777-792-2557-2561,32367.asp
This is based on recommendations from a South African emergency medical specialist in snake bite(Dr Philip Cohen). Even so, the experts do sometimes disagree! As to your queries
1) I don't think suction cups are bad, as such, it's more that they are considered ineffective.
2) As I understand it, a tourniquet is not the same as a compression bandage. The idea behind a traditional tourniquet for snakebite, which is now widely discredited because it can lead to tissue death and limb loss, is to tie a bandage tightly to constrict bloodflow as much as possible to prevent venom travelling to vital organs. A compression bandage is applied firmly but not too tightly over a larger area, the idea being to slow venom-laden blood somewhat, but not completely. (It is not recommended at all for cytotoxic venom)
Dr Cohen's primary message, however, is that the first and most valuable action to take is to get the victim to a hospital as fast as possible. The other first-aid measures are very much secondary, and not very effectual.

Reply to EnviroHealth Expert

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