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 scientific
evidence 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 by
splinting 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 more
it 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 spread
rapidly.
3. Wrap the bitten area with a wide elastic bandage
or 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 up
the whole arm or leg. Make sure you can still feel
the pulse.
5. Then, put on a splint to prevent the limp from
moving.




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
Transient hypotension (low bloodpressure), associated
with confusion or unconsciousness
Diplopia(double vision).

Keep airways clear and monitor breathing. Monitor for
shock. 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).
Abdominal pain, 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 Association
Jointly
Announce Revised First Aid Guidelines

WASHINGTON, Monday, October 18, 2010 The 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.