From time to time all of us read on the new spectacular first-aid or treatments done by trained doctors on aircraft's emergencies or any other special circumstances. But, most of the times, first aid has to be applied by laypeople, that just happened to be there.
The present article is a research on the medical publications for those effective measures to be specified as Snakebite first aid guidelines for laypeople.
The present article is a research on the medical publications for those effective measures to be specified as Snakebite first aid guidelines for laypeople.
The Treatment of Snake Bites in a First Aid Setting: A Systematic Review
Bert Avau(1), Vere Borra(1), Philippe Vandekerckhove (1,2,3) Emmy De Buck (1,2)
1 Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross-Flanders, Mechelen, Belgium, 2 Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium, 3 Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
PLOS Neglected Tropical Diseases | DOI:10.1371/journal.pntd.0005079 October 17, 2016 http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005079
This is an Open Access Article.
ABSTRACT
The worldwide burden of snakebite is high, especially in remote regions with lesser accessibility to professional healthcare. Therefore, adequate first aid for snakebite is of the utmost importance. A wide range of different first aid techniques have been described in literature, and are being used in practice. This systematic review aimed to summarize the best available evidence concerning effective and feasible first aid techniques for snakebite.
Methods
A systematic literature screening, performed independently by two authors in the Cochrane Library, MEDLINE and Embase resulted in 14 studies, fulfilling our predefined selection criteria, concerning first aid techniques for snakebite management. Data was extracted and the body of evidence was appraised according to the GRADE approach.
Principal findings
The pressure immobilization technique was identified as the only evidence-based first aid technique with effectiveness on venom spread. However, additional studies suggest that proper application of this technique is not feasible for laypeople. Evidence concerning other first aid measures, such as the application of a tourniquet, suggests avoiding the use of these techniques.
Conclusions
The practical recommendation for the treatment of snakebite in a first aid setting is to immobilize the victim, while awaiting the emergency services. However, given the low to very low quality of the data collected, high quality randomized controlled trials concerning the efficacy and feasibility of different variations of the pressure immobilization technique are warranted.
AUTHOR SUMMARY
The Belgian Red Cross-Flanders develops first aid guidelines that specifically target lay- people. In the context of updating the first aid guidelines for sub-Saharan Africa, we aimed to summarize the best available evidence for the treatment of snakebite, feasible for lay people. Of the numerous first aid measures supported in literature and used in practice, we could only find evidence concerning effectiveness for the pressure immobilization technique on the spread of snake venom, which involves application of a firm pressure bandage on the bitten limb, together with immobilization of the limb. However, studies concerning its feasibility suggest this technique is difficult for laypeople to apply correctly. Keeping the limb immobilized on the other hand had a beneficial effect on the spread of the venom. However, given the low to very low quality of the evidence, high quality trials concerning the effectiveness and feasibility of different variations of the pressure immobilization technique are needed.
The high burden of snakebite and the fact that snakebite mostly occurs in rural areas, with less accessibility to professional health care and therefore rapid antivenom therapy, illustrate that adequate first aid treatments are of the utmost importance for achieving a positive outcome on both mortality and morbidity after a snakebite.
In literature, many different techniques, and a combination thereof, are claimed to be effective for the treatment of snakebite. These include:
Techniques suggested to deactivate the venom:
such as the application of electroshocks, cryotherapy or the use of traditional medicine and concoctions, a collection of practices where mixtures of herbs, oils and other products are being ingested or applied to the bite wound.
Techniques which are supposed to remove venom from the bite wound:
include suction of the wound, by mouth or specialized suction devices, incision/excision of the bite wound, irrigation of the bite wound, or the use of “snake stones”, which are believed to absorb the poison out of the wound.
Methods proposed to limit the spread of the venom:
in the body include application of a tourniquet, which completely blocks the blood flow to the bitten limb, and the pressure immobilization technique. The latter technique involves application of a pressure bandage at sufficiently high pressures to block lymphatic flow, but without actually applying a tourniquet, together with immobilization of the bitten limb.
This systematic review is the first in its kind to synthesize the available evidence concerning suggested first aid measures for snakebite, thus facilitating evidence-based decision making during the development of snakebite first aid guidelines for laypeople.
Question:
"In people with snakebites, is a certain first aid intervention, compared to another first aid intervention or no intervention, effective and feasible for laypeople as a first aid treatment to increase survival, tissue healing, functional recovery, pain, complications, time to resumption of usual activity, restoration to the pre-exposure condition, time to resolution of the symptoms or other health outcome measures (including adverse effects)?
Process of study selection:
The searches and study selection procedures were performed independently by two reviewers (BA and VB). Any discrepancy between the reviewers was resolved by consensus or by consulting a third reviewer (EDB).
A search in The Cochrane Library, MEDLINE and Embase resulted in a total of 3,893 retrieved references. (After removing 956 (BA) and 1,132 (VB) duplicates, the titles and abstracts of 2,928 (BA) and 2,761 (VB) records were screened on relevance regarding the PICO question. For 81 (BA) and 101 (VB) publications, a full-text was obtained and eligibility was assessed, resulting in 12 articles that matched the predefined selection criteria. The majority of publications excluded had an inappropriate study design. A search in the references and similar articles lists of these publications resulted in 2 additional publications matching the selection criteria, leading to a total of 14 included articles.
Characteristics of the included studies
Of the 14 included articles, 7 were experimental and 7 were observational studies. 4 experimental studies evaluated the efficacy of variants of the pressure immobilization technique, on simulated snake bites while 3 others examined the feasibility of pressure immobilization to be performed by laypeople. The observational studies all examined the outcomes of different applied first aid procedures in snakebite patients.
Synthesis of findings from the included studies:
EXPERIMENTAL STUDIES
1) Pressure immobilization:
Experimental studies used measuring the time to reach 80% of the maximal radioactivity in the blood after mock venom injection as outcome for comparing different times of pressure immobilization techniques.
Pressure immobilization using an elastic bandage with a splint was not shown to be effective as the results were almost the same than for the controls. In contrast, using a firmly bound cloth pad over the site of injection really delayed the time to reach 80% (p<0.001). The use of a firmly bound rubber pad over the site of injection together with splinting delayed the time for the mock venom to reach 80% radioactivity (p<0.001).
 |
| Pressure pad + immobilization Dr. David J. Williams |
In another study comparing the amount of radioactivity in the blood after 60min, as % of the maximal radioactivity measured, again the elastic bandage with splinting was significantly different to no treatment while a firmly bound cloth pad was found to be effective (p<0.00001).
Another data important data obtained (Howarth et al.) was that rest resulted in a significant decrease in the proportion of volunteers with tracer transit compared to the proportion of volunteers with tracer transit while walking.
Furthermore, training is needed for the correct application of the elastic bandages to get the proper pressure and even there is a high lack of retention of the ability of correctly apply the elastic bandage.
OBSERVATIONAL STUDIES
I would like to focus on the clinical studies (a total of 7) and I had a kind of difficult time trying to understand the paper, So finally I tried to found the reviewed articles on the internet with more or less good luck. See what I've found
For a better understanding I'm including the abstract available. There is only one full text article available.
Bibliography list: 13, 16, 22, 30, 31, 32, 33
13: Madaki JKA, Obilom RE, Mandong BM (2005)
Pattern of First-Aid Measures Used by Snake-bite Patients and Clinical Outcome at Zamko Comprehensive Health Centre, Langtang, Plateau State.
Nig Med Pract 48: 10–13.
Abstract
The use of first aid measures in the management of snake bite by patients in rural communities in Africa is a popular practice. Records of 103 snake bite patients admitted at Zamko Comprehensive Health Centre, were retrieved and reviewed. 84 (81.6%) of the 103 cases with snake bite used first aid measures. Common first aid measures employed include tourniquet (ropes, pieces of cloth), use of the black stone, application of traditional medicine and incision of site of bites. The use of first aid measure did not prevent spread of the venom. There was no significant increase in the proportion of patients with tissue necrosis between patient that used tourniquet and those that did not (7.9% vs 5.3%). Patients that did not employ first aid measures required significantly higher doses (mls) of antivenom compared to those who used tourniquet (39.33 Vs 24.52 P< 0.01); those who use traditional medicine (39.33 Vs 27.5 P < 0.01); and those who used black stone (39.33 Vs 28.75 P < 0.01). Also those who used the black stone required significantly higher quantity of antivenom as compared to those that used the tourniquet (28.75 vs 24.52 P < 0.05). The use of the tourniquet, traditional herbs and the black stone appears to have beneficial effects by reducing the average antivenom requirement of patients and more studies are needed to identify the most appropriate approaches to their use.
16: Michael GC, Thacher TD, Shehu MI. The effect of pre-hospital care for venomous snake bite on outcome in Nigeria. Trans R Soc Trop Med Hyg 2011;105: 95–101
Abstract
We studied pre-hospital practices of 72 consecutive snake bite victims at a hospital in north-central Nigeria. The primary outcome assessed was death or disability at hospital discharge. Victims were predominantly male farmers, and in 54 cases (75%) the snake was identified as a carpet viper (Echis ocellatus), with the remainder unidentified. Most subjects (58, 81%) attempted at least one first aid measure after the bite, including tourniquet application (53, 74%), application (15, 21%) or ingestion (10, 14%) of traditional concoctions, bite site incision (8, 11%), black stone application (4, 5.6%), and suction (3, 4.2%). The majority (44, 61%) presented late (after 4 hours). Most (53, 74%) had full recovery at hospital discharge. Three deaths (4.2%) and thirteen (18%) disabilities (mainly tissue necrosis) occurred. The use of any first aid was associated with a longer hospital stay than no use (4.6 ± 2.0 days versus 3.6 ± 2.7 days, respectively, P = 0.02). The antivenom requirement was greater in subjects who had used a tourniquet (P = 0.03) and in those who presented late (P = 0.02). Topical application (Odds Ratio 15, 95% CI 1.4-708) or ingestion of traditional concoctions (OR 20, 95% CI 1.4-963) were associated with increased risk of death or disability. Ingestion and application of concoctions were associated with a longer time interval before presentation, a higher cost of hospitalization, and an increased risk of wound infection.
22: Amaral CF, Campolina D, Dias MB, Bueno CM, Rezende NA. Tourniquet ineffectiveness to reduce the severity of envenoming after Crotalus durissus snake bite in Belo Horizonte, Minas Gerais, Brazil. Toxicon 1998;36: 805–808
Abstract
Clinical and laboratory data from patients who applied a tourniquet (tourniquet group, n = 45) and who did not apply it (non-tourniquet group, n = 52) after being bitten by Crotalus durissus were compared. The patients were treated with 100-200 ml of Crotalus durissus antivenom. The gender, age, time elapsed between bite and hospital admission, dose of antivenom and the frequency of local paresthesia, myalgia and palpebral ptosis did not differ between the two groups. Plasma creatine kinase enzyme activity and partial thromboplastin time, plasma whole venom and crotoxin concentrations and the frequency of acute renal and respiratory failure and number of deaths also did not differ between both groups. Data from this study show the ineffectiveness of tourniquet applied by patients in the fields to reduce the severity of Crotalus durissus envenoming.
30: Bhat RN. Viperine snake bite poisoning in Jammu. J Indian Med Assoc 1974;63: 383–392
Nor Abstract / No Article available
31: Franca FO, et al. Envenoming by Bothrops jararaca in Brazil: association between venom antigenaemia and severity at admission to hospital. Trans R Soc Trop Med Hyg 2003;97: 312–317
Abstract
The association between the clinical severity of Bothrops jararaca envenoming at admission and serum venom and plasma fibrinogen concentrations before antivenom administration is reported in 137 patients admitted to Hospital Vital Brazil, Instituto Butantan, São Paulo, Brazil, between 1989 and 1990. Other variables such as age, gender, site of the bite, use of tourniquet and the time interval between the bite and start of antivenom therapy, spontaneous systemic bleeding, and the 20 minute whole blood clotting test (20WBCT) at admission showed no association with either severity or serum venom antigen concentration (SVAC). Mean SVAC in patients with mild envenoming was significantly lower than in the group with moderate envenoming (P = 0.0007). Patients with plasma fibrinogen concentrations > 1.5 g/L had a lower mean SVAC than patients with plasma fibrinogen concentrations < or = 1.5 g/L (P = 0.02). Those admitted with a tourniquet in place had significantly higher plasma fibrinogen concentrations than those without a tourniquet (P = 0.002). A multiple logistic regression model showed independent risk factors for severity: bites at sites other than legs or forearms, SVACs > or = 400 ng/mL, and the use of a tourniquet. Rapid quantification of SVAC before antivenom therapy might improve initial evaluation of severity in B. jararaca bites.
32: Khin OL, Aye AM, Tun P, Theingie N, Min N. Russell's viper venom levels in serum of snake bite victims in Burma. Trans R Soc Trop Med Hyg 1984;78: 165–168
Abstract
Serum levels of venom antigen were measured using enzyme-linked immunosorbent assay (ELISA) in 38 Russell's viper bite victims before and after administration of 40 ml of monovalent liquid antivenom. Initial serum levels ranged from one with less than 10·0 ng to 290 ng/ml and in one case a level of 75 ng/ml was detected 27 hours after the bite. Serum venom levels after liquid monospecific antivenom therapy indicated that venom clearance was similar in each case to the natural clearance of venom in the absence of antivenom therapy. In one case a venom level of 11·5 ng/ml was detected 66 hours after liquid antivenom therapy whereas in two fatal cases, serum venom levels of 95 ng/ml and 185 ng/ml were detected after the same interval. Failure of complete neutralization of venom is probably the result of loss of potency of antivenom during improper storage. The amount of venom excreted in the urine was not related to initial serum levels.
33: Wang W, Chen QF, Yin RX, Zhu JJ, Li QB, Chang HH, Wu YB, Michelson E. Clinical features and treatment experience: a review of 292 Chinese cobra snakebites. Environ Toxicol Pharmacol 2014;37: 648–655
Abstract
Although Chinese cobra snakebite is the most common type of snake venenation in China, it still lacks a comprehensive and systematic description. Hence, we aimed to study Chinese cobra bite cases with particular attention to demography, epidemiology and clinical profile. In this study, a total of 292 cases of Chinese cobra snakebite, presenting between January 1, 2008 and December 31, 2012, were retrospectively reviewed. To investigate the effect of treatment at different presentation times (time from snakebite to admission), the patients were divided into two groups: group A included 133 cases that presented <12h after the bite; group B included 159 cases that presented ≥12h after the bite. To assess the correlation between application of a tourniquet and skin grafting, the cases were re-divided into two groups according to whether or not a tourniquet was used after the snakebite: tourniquet group (n=220) and non-tourniquet group (n=72). The results showed that Chinese cobra snakebites were most commonly seen during the summer, in the upper limbs, and in males, young adults, and snake-hunters. Group A experienced milder intoxication than group B (P<0.001). The rate of skin grafting was significantly higher in the tourniquet group (20.0%, compared with 9.7% in the non-tourniquet group, P<0.05). The results of this study indicate that anti-cobra venom and swift admission (within 12h of the snakebite) are recommended for Chinese cobra snakebite. Tourniquet use is not recommended.
You can download full article here:
2) TOURNIQUET (13,16,22,30,31,32,33)
The study by Bhat found a significantly increased incidence of local swelling in snakebite victims treated with a tourniquet ,p<0.001) or a tourniquet with incisions in the wound p<0.001), compared to snakebite victims receiving no first aid [30].
França et al. described a significantly increased odds for an increased severity of local envenomation in snakebite victims receiving a tourniquet, compared to those not receiving a tourniquet (p = 0.015) [31].
Furthermore, Wang et al. showed a significantly increased risk of skin grafting needed in snakebite victims treated with a tourniquet (44/220), compared to those not treated with a tourniquet (7/72, RR: 2.06, p = 0.046) [33].
No significant differences were found between snakebite victims treated with a tourniquet (with or without additional incisions in the bite wound) and victims who received no tourniquet or no first aid for the following outcomes:
acute renal failure p = 0.75) [22],
acute respiratory failure p = 0.67) [22],
death (p = 0.77) [22],
local edema (p = 0.95) [22],
occurrence of hemorrhagic syndrome (p = 0.62) [30],
concentration of venom in the serum (p = 0.38) [32] ([p = 0.16) [31],
incidence of multiple organ dysfunction syndrome (p = 0.31) [33],
incidence of envenoming (p = 0.66) [13],
tissue necrosis (p = 0.74) [13]
occurrence of death or disability (p = 0.16) [16].
Inconclusive evidence exists concerning the effects of tourniquet use on the duration of hospital stay. Madaki et al. found no significant difference in the duration of hospital stay between snakebite victims treated with a tourniquet and those receiving no first aid (6±2.6 days vs 6.3±3 days,p = 0.71), while Michael et al. described a significant increase in the duration of hospital stay between snakebite victims treated with a tourniquet and those receiving no first aid (4.6±2.0 days vs 3.7±2.5 days, MD = 0.9, p = 0.04) [13,16].
Conflicting evidence was reported concerning the effects of tourniquet use on the amount of antivenom required. Amaral et al. reported no difference in the amount of antivenom required between snakebite victims treated with or without a tourniquet (139±56.4 mL vs 156.5±65.8 mL, MD = -17.5, 95%CI [-41.82;6.82], p = 0.16), while Madaki et al. found a significantly decreased amount of antivenom required in snakebite victims receiving a tourniquet (24.52±13.6 mL), compared to snakebite victims receiving no first aid (39.33±34.32 mL, MD = -14.81, p<0.01) and Michael et al. found a significantly increased amount of antivenom required in snakebite victims receiving a tourniquet compared to those receiving no tourniquet (p = 0.03)
3) INCISION OF THE BITE WOUND: (16,30)
Bhat investigated the effects of incision of the bite wound, compared to no first aid treatment and found a significantly increased incidence of local swelling upon incision ( p<0.0001), but not of hemorrhagic syndrome (p = 0.53) [30].
Furthermore, Michael et al. reported no difference between snakebite victims with incisions in the bite wound compared to victims receiving no first aid in the incidence of death or disability (p = 0.53) or between snakebite victims with incisions in the bite wound compared to victims not receiving incisions in the bite wound for the amount of antivenom required (p = 0.71) [16].
On the other hand, a statistically significant decrease in the duration of hospital stay in snakebite victims receiving incisions in the bite wound compared to not receiving incisions in the bite wound (2.9±1.6 days vs 4.6±2.2 days, MD = -1.70, p = 0.03) was demonstrated.
Here I'm confused. As the abstract says "The use of any first aid was associated with a longer hospital stay than no use (4.6 ± 2.0 days versus 3.6 ± 2.7 days, respectively, P = 0.02)". If the advantage was so clear, I imagine they would have said that but... do not have the full text...
4) SNAKE STONES: (13,16)
Madaki et al. could not show a significantly decreased incidence of envenoming in snakebite victims using snake stones compared to those receiving no first aid (p = 0.87) [13]. Furthermore, a significantly decreased duration of hospital stay in snakebite victims treated with snake stones compared to those not receiving first aid (6.1±3.3 days vs 6.3±3 days, p = 0.87) or to those not being treated with snake stones (2.5 vs 4, median, p = 0.09) could not be demonstrated [13,16]. Also a difference in the occurrence of death or disability between snakebite victims treated with snake stones or those receiving no first aid could not be demonstrated (p = 0.11) [16].
In contrast, inconclusive results were reported for the amount of antivenom required. Madaki et al. reported a significantly decreased amount of antivenom required in snakebite victims treated with snake stones compared to those receiving no first aid (28.75±20.31 mL vs 39.33±34.32 mL, MD = -10.58, p<0.05), while Michael et al. reported no significant differences in the amount of antivenom required between snakebite victims treated with snake stones and those not treated with snake stones (30.0 [15;35] vs 20.0 [15;35], median[IQR], p = 0.71) [13,16].
5) TRADITIONAL MEDICINE AND CONCOCTIONS:
In the study of Madaki et al., the use of traditional medicine (both ingested or applied to the bite wound) in snakebite victims was not found to be significantly associated with a decreased occurrence of envenoming, compared to receiving no first aid (p = 0.94) [13]. Furthermore, a decreased duration of hospital stay could not be demonstrated in snakebite victims receiving traditional medicine, compared to those receiving no first aid (6.9±2.6 days vs 6.3±3.0 days, MD = 0.6, 95%CI [-1.23;2.43], p = 0.52).
This latter finding was confirmed by Michael et al., who observed no significant difference in the duration of hospital stay between snakebite victims treated with concoctions applied to the bite wound, compared to snakebite victims with no concoctions applied to the bite wound (5 vs 4, median, p = 0.6) or snakebite victims treated with concoctions ingested, compared to snakebite victims with no concoctions ingested (4 vs 4, median, p = 0.84) [16].
In contrast, a significantly increased odds for death or disability was shown in snakebite victims treated with concoctions applied to the bite wound (8/15), compared to snakebite victims with no concoctions applied to the bite wound (p = 0.01) and snakebite victims treated with concoctions ingested (6/10), compared to snakebite victims with no concoctions ingested (p = 0.009) [16].
Inconclusive reports were made concerning the use of traditional medicine and concoctions in snakebite victims on the amount of antivenom required. Madaki et al. reported a significantly decreased antivenom requirement in snakebite victims receiving traditional medicine, compared to those receiving no first aid (27.5±23.63 mL vs 39.33±34.32 mL, MD = -11.83, p<0.01), while Michael et al. found no significant difference in antivenom requirement between snakebite victims treated with applied concoctions, compared to those not treated with applied concoctions (p = 0.07) or snakebite victims treated with ingested concoctions, compared to those not treated with ingested concoctions (30.0 [20;30] vs 20.0 [10;40], median[IQR], p = 0.13)
6) SUCTION OF THE BITE WOUND:
The study by Michael et al. compared the effect of suction of a bite wound, and found no significant difference in the occurrence of death or disability, compared to no first aid (0/3 vs 1/15, RR: 1.33, 95%CI [0.07; 26.98], p = 0.85) [16]. Furthermore, a significant difference could not be demonstrated between snakebite victims treated by suction of the wound, compared to snakebite victims not treated by suction of the wound, concerning the amount of antivenom required (p = 0.45) or the duration of hospital stay (p = 0.7).
Quality of evidence
Experimental studies concerning the efficacy of pressure immobilization.
The final level of quality for the experimental studies concerning the efficacy of pressure immobilization is “very low”, which means that any estimate of effect is very uncertain.
Experimental studies concerning the feasibility of pressure immobilization to be performed by laypeople.
The final level of quality for the experimental studies concerning the feasibility of pressure immobilization is “low”, which means that further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Observational studies concerning first aid measures applied in real-life snakebite.
The 7 studies included were observational studies, leading to an initial “low” quality level The quality of evidence was downgraded for limitations in study design or execution.
In addition, the overall quality of evidence was also downgraded because of imprecision due to limited sample sizes, low numbers of events and large variability of the results. There was no need to downgrade due to indirectness, inconsistency or a risk of publication bias. Therefore, the final level of quality for the observational studies concerning first aid measures is “very low”, which means that any estimate of effect is very uncertain.
The experimental studies all concern the pressure immobilization technique, based on the use of a crepe or elastic bandage. This technique received a lot of attention in Australia, and is being recommended in official Australian first aid guidelines. However, the effectiveness of this technique has only been demonstrated in animal models with evidence from human studies being limited to case reports.
The feasibility of correctly applying pressure immobilization using an elastic bandage is questionable, especially regarding the tension generated. Intense training is warranted, but even then, retention is low.
Furthermore, it needs to be taken into account that the pressure immobilization technique might not be appropriate for any type of snake venom.
For tourniquets, most outcomes that were studied show no benefit of using a tourniquet in snakebite victims.
The evidence available for other first aid measures is scarce. In conclusion, these alternative methods for the treatment of snakebite are most likely not beneficial and perhaps even harmful.
Most of these management strategies are applied by traditional healers, who might be preferred over healthcare professionals in first instance. The use of this type of ineffective pre-hospital care might cause a delay in the presentation of the snakebite victim to healthcare facilities, further increasing the detrimental impact of the snakebite on morbidity and mortality.
Habib et al. previously showed a 1% increase in odds of dying from snakebite for every 1 h delay in healthcare facility presentation in a case-control study of snakebite victims in north-eastern Nigeria [40]. Evidence concerning the time to application for specific first aid measures and their influence on the timing of presentation at a healthcare facility is currently unavailable.
This systematic review has some limitations.
Thus, the overall quality of the available evidence was low to very low, according to the GRADE approach [21].
The evidence collected in this systematic review has been used for the development of a first aid guideline for sub-Saharan Africa [41], according to the principles of Evidence-Based Practice [19], which is being updated in 2016.
No new evidence, concerning first aid treatments for snake bites, could be identified in the 2016 update.
Conclusion
 |
| Remove any rings, tight clothes... |
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.
here is the link for the lay people on snake bite first aid published in 2010 by the Belgium Red Cross.
If the bite is in the leg: immobilize the leg by bandaging it to the other leg.
Additional recommendations based on good practice points:
Additional recommendations based on good practice points:
stop the bitten person from moving, calm the person, take off any rings, watches, or tight clothing that may cut off blood ow because of swelling, and take actions to obtain medical help.
OK. Done! I really value all the effort the authors did and I do like very much the concept and that the results should be applicable by lay people. One comment: Really, from almost 3,000 articles only 14 were fulfilling the criteria??? really??? That is only a 0,5%
Some commentaries I do have:
Two or the articles were from Nigeria (Madaki 13 and Michael 16) with completely different results.
Why do not include in the study the time to reach hospital?
The pressure pad technique that really, really was significant should be more differentiate from the pressure bandage. Sound almost the same but they are not. Effort should be done on this technique as seems really useful.
Application of the findings should be country specific and even region specific, like in the case of the pressure bandage that should be applied only for Australian elapids.
Well, that's all friends, need some dose of humor!!!
ॐ लोकाः समस्ताः सुखिनो भवन्तु ॥
Om Lokah Samasthah Sukhino Bhavantu
May all beings everywhere be happy and peaceful
