If using a single bandage ARC guidelines are to start from fingers or toes and move up the armpit or groin. By starting at the bite site like you have and then going back towards fingers this can cause distal odema which can cause discomfort to patient. Normally one bandage at bite site then a second bandage from fingers or toes to armpit or groin followed then immobilisation.
Seems more sensible that what they tell us in the U.S.: to just call 911 or bring them to the hospital. In rural areas, this could take a while. Where we are, copperhead and eastern diamondback rattlesnakes are pretty prevalent. Their venom is quick acting and can go to the heart very quickly, so I would think that you would want to cut off at least some of the blood flow.
TacMed what is the timeframe in which this is effective? I run in an area where I have the potential to treat a neurotoxic bite but I will most likely not be getting to the patient until some time after they've been bitten, thanks!
Have a look at this study, they say 4 hours: www.mja.com.au/journal/2017/207/3/australian-snakebite-project-2005-2015-asp-20? After 4 hours there is little use for compression bandage, but anytime up to 4 hours, yes. As well, they say most snakebite victims that have applied compresssion bandage present to the hospital with bandages too loose, you want the bandage tighter than you'd assume. Some, like those in this video, say you should be able to put a finger under the bandage, however other sources say you should not. I think the latter. A compression bandage for snakebite needs to be even tighter than for sprained ankle, and it must be tight enough that it's compressing the lymph nodes. I've done my own testing on myself and found that circulation remains good with very tight bandages, it's hard to go too tight to cut of circulation. I've left my bandages on for 10 minutes while checking my circulation with bandages tight enough to change the colour of my skin to deep bruised red sort of colour, and still circulation response was quick. The study also found that in most instances compression bandages were not doing their job well, which seems to be down to this issue of not going tight enough. Most of the demonstrations I see on UA-cam, such as this one, I believe are going too loose to be effective and not properly compressing the lymph nodes. In my opinion if you can put a finger in, you are not effectively compressing the lymph nodes and do not have it tighter than for a sprained ankle.
In the case of a bite to the lower leg... do you remove shoes and socks? And what if there's a strike through jeans or leggings... do you remove them (or cut material away from bite zone)?
Recommendation in the link below say you bandage over long pants.. If you were having trouble bandaging over the pants, then yes cut the legs off. But I've done my own testing over my long pants and it actually worked better than I expected, it seemed to work just as well as without pants, although I haven't tested on jeans: www.sorrentopreschool.kindergarten.vic.gov.au/wp-content/uploads/2019/06/BushKinderSnakeAwarenessPolicy-dec-2018.docx As for socks, you should remove socks so that you can check circulation response after applying the compression bandage. Also makes sure to do it tight enough, most people who present to hospital have it too loose to be doing it's job www.mja.com.au/journal/2017/207/3/australian-snakebite-project-2005-2015-asp-20? One issue I think is a problem with leaving the pants on is that the vemon on the pants can seap into the skin, further envenomating the bite victim. There was a case in Australia where a lady got bitten on the leg pants while bushwalking but the fangs didn't go through, but venom was left on the pant leg. The lady did not know a snake had struck and continued walking, but eventually got sick and went to hospital where they eventually found the venom on the pants. What happened was that while walking the hot sweat or whatever ended up causing the venom to seep through the pant leg and into her skin, envenomating her. So if a snake did bite through the pants, wouldn't there possibly be venom on the pants? So when you compress the bandage over the pants, the vemon will probably move to a location slightly away from the bite site and further envenomate the bite victim. What do you think? Perhaps from that point of view it is better to cut pants legs off where possible.
Yes, it's the only way to get the bandage on tight enough to suppress the lymphatic system that the venom travels through. In the case of pants, you can cut them from the bottom to right up high near the upper leg and then apply the bandage if you have shears with you (that can help preserve the patient's modesty and warmth as the groin and the non-injured leg will still be covered with clothing) or just lose the pants before you start the bandage. But hang onto the clothes as there might be traces of the venom on there for the hospital to identify.
This only works on neurotoxin venom, hemotoxin snakes (such as those in North America) require about only enough just pressure to slow lymphatic flow, and no splinting.
hi just a question. after you have finished applying the splint what should be the position of the arm when transporting her to the nearest hospital? just downwards like that? what if bitten in the foot? is it safe to only splint the bitten limb (for example right limb only) so the patient can still use his left foot?
Hi mate, you need to keep the patient completely still. No movement at all. They need to lay flat if possible and the arm by their side or their legs splinted together and still. Thanks for watching.
They recommend the limb remain below the heart. Do not raise arm or leg. As for laying or not laying, I'm not sure. Certainly it doesn't seem an ideal position in terms of blood flow to the heart, but on the other hand one can be more still and restful, conserving energy. I don't know.
@@natsqi6192 It is first spread by lymphatics but then goes to into the blood stream. But I can imagine that while the venom remains in the lymphs and hasn't made it to the blood stream that gravity may not be a bit concern. Problem is, it's still likely that some venom is going to be making it's way to the bloodstream even with compression bandage, and some people even with compression bandage still have cardiac arrest for that reason: www.mja.com.au/journal/2017/207/3/australian-snakebite-project-2005-2015-asp-20?
@@natsqi6192 Man I swear every time I look into this over my lifetime it all changes. Worst part is everyone says it with such authority on the topic, only to be proven wrong 2.5 years later. I just wish people would say "We've got no idea, we're just guessing, because no one will let my snake bite them to do human testing." or something. :P
When I served in the Australian Army it was put to us like this. Most bites occur on the limbs (arms and legs). Apply the bandage from the extremities of the limb toward the heart at the same pressure as for a sprained ankle. Wrap the entire limb starting from the fingers or toes toward the heart. Venom molecules are larger than blood molecules. What the bandage does is compress the capillaries, so the blood molecules can still move, but the bigger venom molecules cannot move. The quicker you can get the bandage on the better chance of survival. The quicker you can get the bandage the better chance of survival. There are a few other things to do. 1. Apply the bandage first before calling for help, otherwise, while you are talking on the phone the venom is spreading through the body. 2. Don't wash the bite site. Doctors can swab the skin to identify the type of snake. 3. Mark the site of the bite with an X and write down the time the bandage was applied on the outer bandage. 4. Pinch the end of the fingers or toes to make sure there is still blood flow. 5. Once you apply the bandage, don't take it off. If needs be, wrap a second bandage over the top of the first. 6. Keep the patient calm, still and immobilise the limb with a splint. 7. Help always comes to the victim. Never let them walk to help. When that is not possible then the victim is carried. 8. If you are by yourself, never get in a shower, run around getting dressed or have a nap before seeking help - these actions will kill you. The medicos don't care what you are wearing or whether you haven't had a shower for a month. I always carry two snake bite bandages in my car or with me if I am bushwalking.
Australian snakes have relatively small fangs, so envenomation occurs in the lymphatic system, not the circulatory (blood) system. The pressure bandage and immobilisation slows the movement of the venom into the circulatory system where it can circulate and cause coagulopathy (clotting/bleeding issues) or neuropathy (affecting the nervous system) as the most common life threatening effects. Depending on the site and volume of venom this can occur rapidly, but the PIT can increase that time. According to Bob Cooper from 45 minutes to potentially 20 hrs. It's important to bring help to the person if possible as any moving around or even minimal exertion can help move the venom.
Hey Sam, thanks for your question. There isn't much, if any, data to say which way is more effective. What we do know though is if you bandage from shoulder to fingers (proximal to distal), then is becomes very uncomfortable or painful to the patient. They will have this on for hours so it's important for them to be comfortable. Jez.
No-one recommends doing it that way and I have wondered why too. Perhaps it's not dangerous because the venom starts in the lymph nodes not the bloodstream, and what does get into the bloodstream in the early stages won't make a difference while bandaging as it's not as if there's all this venom collected in the blood in the arm, it's constantly on the move. I'd have to imagine that any extra venom that is forced towards the core from the limb during bandaging is only going to be a token amount, the venom that happened to be circulating in the arm at the time of the bandaging.
So that when you get to hospital the doctor can see where the bite location is suppose to be. Oftentimes snake bites can be hard to see, in some cases they are even completely non-visible, especially in the case of Australian snakes with their tiny fangs. Some bites look like a tiny scratch and it might be hard to know whether it's a scratch from another cause or the snake bite. The doctor may need to take a swab for venom at the bite location and so marking the location helps the doctor in these ways.
Actual Gudelines (2024) say different: „The bandage should be firm and tight, you should be unable to easily slide a finger between the bandage and the skin.“
If using a single bandage ARC guidelines are to start from fingers or toes and move up the armpit or groin. By starting at the bite site like you have and then going back towards fingers this can cause distal odema which can cause discomfort to patient. Normally one bandage at bite site then a second bandage from fingers or toes to armpit or groin followed then immobilisation.
Seems more sensible that what they tell us in the U.S.: to just call 911 or bring them to the hospital. In rural areas, this could take a while. Where we are, copperhead and eastern diamondback rattlesnakes are pretty prevalent. Their venom is quick acting and can go to the heart very quickly, so I would think that you would want to cut off at least some of the blood flow.
Thanks a lot for the nice demonstration.
Thank you very much for the explanation! In bleeding control i was taught the how of wound packing. But now i know the why !
Great video! Can you please put up a link to your site on which tape you used?
TacMed what is the timeframe in which this is effective? I run in an area where I have the potential to treat a neurotoxic bite but I will most likely not be getting to the patient until some time after they've been bitten, thanks!
Next day If done correctly.
Have a look at this study, they say 4 hours: www.mja.com.au/journal/2017/207/3/australian-snakebite-project-2005-2015-asp-20?
After 4 hours there is little use for compression bandage, but anytime up to 4 hours, yes.
As well, they say most snakebite victims that have applied compresssion bandage present to the hospital with bandages too loose, you want the bandage tighter than you'd assume.
Some, like those in this video, say you should be able to put a finger under the bandage, however other sources say you should not. I think the latter. A compression bandage for snakebite needs to be even tighter than for sprained ankle, and it must be tight enough that it's compressing the lymph nodes.
I've done my own testing on myself and found that circulation remains good with very tight bandages, it's hard to go too tight to cut of circulation. I've left my bandages on for 10 minutes while checking my circulation with bandages tight enough to change the colour of my skin to deep bruised red sort of colour, and still circulation response was quick.
The study also found that in most instances compression bandages were not doing their job well, which seems to be down to this issue of not going tight enough. Most of the demonstrations I see on UA-cam, such as this one, I believe are going too loose to be effective and not properly compressing the lymph nodes. In my opinion if you can put a finger in, you are not effectively compressing the lymph nodes and do not have it tighter than for a sprained ankle.
Never been told about the need to remove rings ect makes total sense
Would you place a swap pad on the skin before the bandage to collect excess venom for analysis?
In the case of a bite to the lower leg... do you remove shoes and socks?
And what if there's a strike through jeans or leggings... do you remove them (or cut material away from bite zone)?
Recommendation in the link below say you bandage over long pants.. If you were having trouble bandaging over the pants, then yes cut the legs off. But I've done my own testing over my long pants and it actually worked better than I expected, it seemed to work just as well as without pants, although I haven't tested on jeans: www.sorrentopreschool.kindergarten.vic.gov.au/wp-content/uploads/2019/06/BushKinderSnakeAwarenessPolicy-dec-2018.docx
As for socks, you should remove socks so that you can check circulation response after applying the compression bandage.
Also makes sure to do it tight enough, most people who present to hospital have it too loose to be doing it's job www.mja.com.au/journal/2017/207/3/australian-snakebite-project-2005-2015-asp-20?
One issue I think is a problem with leaving the pants on is that the vemon on the pants can seap into the skin, further envenomating the bite victim. There was a case in Australia where a lady got bitten on the leg pants while bushwalking but the fangs didn't go through, but venom was left on the pant leg.
The lady did not know a snake had struck and continued walking, but eventually got sick and went to hospital where they eventually found the venom on the pants.
What happened was that while walking the hot sweat or whatever ended up causing the venom to seep through the pant leg and into her skin, envenomating her. So if a snake did bite through the pants, wouldn't there possibly be venom on the pants? So when you compress the bandage over the pants, the vemon will probably move to a location slightly away from the bite site and further envenomate the bite victim.
What do you think? Perhaps from that point of view it is better to cut pants legs off where possible.
Yes, it's the only way to get the bandage on tight enough to suppress the lymphatic system that the venom travels through. In the case of pants, you can cut them from the bottom to right up high near the upper leg and then apply the bandage if you have shears with you (that can help preserve the patient's modesty and warmth as the groin and the non-injured leg will still be covered with clothing) or just lose the pants before you start the bandage.
But hang onto the clothes as there might be traces of the venom on there for the hospital to identify.
This only works on neurotoxin venom, hemotoxin snakes (such as those in North America) require about only enough just pressure to slow lymphatic flow, and no splinting.
Interesting. Do you have any links for further investigation?
@@bnwww .. you must be check WHO Gudeliness snakebite 👍
What should be the hand position after splinting? Can it go down?
wraps toward heart?
hi just a question. after you have finished applying the splint what should be the position of the arm when transporting her to the nearest hospital? just downwards like that? what if bitten in the foot? is it safe to only splint the bitten limb (for example right limb only) so the patient can still use his left foot?
Hi mate, you need to keep the patient completely still. No movement at all. They need to lay flat if possible and the arm by their side or their legs splinted together and still. Thanks for watching.
@Flawrence Isenhart The venom is spread by lymphatics, not veins. And no, gravity is not a big factor in venom transmission.
They recommend the limb remain below the heart. Do not raise arm or leg.
As for laying or not laying, I'm not sure. Certainly it doesn't seem an ideal position in terms of blood flow to the heart, but on the other hand one can be more still and restful, conserving energy. I don't know.
@@natsqi6192
It is first spread by lymphatics but then goes to into the blood stream. But I can imagine that while the venom remains in the lymphs and hasn't made it to the blood stream that gravity may not be a bit concern. Problem is, it's still likely that some venom is going to be making it's way to the bloodstream even with compression bandage, and some people even with compression bandage still have cardiac arrest for that reason: www.mja.com.au/journal/2017/207/3/australian-snakebite-project-2005-2015-asp-20?
@@natsqi6192 Man I swear every time I look into this over my lifetime it all changes. Worst part is everyone says it with such authority on the topic, only to be proven wrong 2.5 years later. I just wish people would say "We've got no idea, we're just guessing, because no one will let my snake bite them to do human testing." or something. :P
Thanks for this
How does this slow down the spread of the venom?
When I served in the Australian Army it was put to us like this. Most bites occur on the limbs (arms and legs). Apply the bandage from the extremities of the limb toward the heart at the same pressure as for a sprained ankle. Wrap the entire limb starting from the fingers or toes toward the heart.
Venom molecules are larger than blood molecules. What the bandage does is compress the capillaries, so the blood molecules can still move, but the bigger venom molecules cannot move.
The quicker you can get the bandage on the better chance of survival.
The quicker you can get the bandage the better chance of survival.
There are a few other things to do.
1. Apply the bandage first before calling for help, otherwise, while you are talking on the phone the venom is spreading through the body.
2. Don't wash the bite site. Doctors can swab the skin to identify the type of snake.
3. Mark the site of the bite with an X and write down the time the bandage was applied on the outer bandage.
4. Pinch the end of the fingers or toes to make sure there is still blood flow.
5. Once you apply the bandage, don't take it off. If needs be, wrap a second bandage over the top of the first.
6. Keep the patient calm, still and immobilise the limb with a splint.
7. Help always comes to the victim. Never let them walk to help. When that is not possible then the victim is carried.
8. If you are by yourself, never get in a shower, run around getting dressed or have a nap before seeking help - these actions will kill you. The medicos don't care what you are wearing or whether you haven't had a shower for a month.
I always carry two snake bite bandages in my car or with me if I am bushwalking.
Australian snakes have relatively small fangs, so envenomation occurs in the lymphatic system, not the circulatory (blood) system. The pressure bandage and immobilisation slows the movement of the venom into the circulatory system where it can circulate and cause coagulopathy (clotting/bleeding issues) or neuropathy (affecting the nervous system) as the most common life threatening effects. Depending on the site and volume of venom this can occur rapidly, but the PIT can increase that time. According to Bob Cooper from 45 minutes to potentially 20 hrs. It's important to bring help to the person if possible as any moving around or even minimal exertion can help move the venom.
Thanks for sharing knowledge
Thanks Rajesh!
Thanks bro 🇮🇳🇮🇳
Don’t you want to start rolling the bandage from the shoulder outward , distal to proximal thus forcing blood toward the hand away from vital organs
Hey Sam, thanks for your question. There isn't much, if any, data to say which way is more effective. What we do know though is if you bandage from shoulder to fingers (proximal to distal), then is becomes very uncomfortable or painful to the patient. They will have this on for hours so it's important for them to be comfortable. Jez.
Oh ok , cheers
Was wondering this myself, good response. Thanks!
No-one recommends doing it that way and I have wondered why too. Perhaps it's not dangerous because the venom starts in the lymph nodes not the bloodstream, and what does get into the bloodstream in the early stages won't make a difference while bandaging as it's not as if there's all this venom collected in the blood in the arm, it's constantly on the move. I'd have to imagine that any extra venom that is forced towards the core from the limb during bandaging is only going to be a token amount, the venom that happened to be circulating in the arm at the time of the bandaging.
Why could we mark?
So that when you get to hospital the doctor can see where the bite location is suppose to be. Oftentimes snake bites can be hard to see, in some cases they are even completely non-visible, especially in the case of Australian snakes with their tiny fangs. Some bites look like a tiny scratch and it might be hard to know whether it's a scratch from another cause or the snake bite. The doctor may need to take a swab for venom at the bite location and so marking the location helps the doctor in these ways.
Actual Gudelines (2024) say different: „The bandage should be firm and tight, you should be unable to easily slide a finger between the bandage and the skin.“
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