Management of Snakebite and Research Management of Snakebite ...

Trial of Efficacy of Local Compression
Immobilization First-Aid Technique in
Russell’s Viper (Daboia russelii siamensis)
Bite Patients
Tun-Pe1 , Sann-Mya2 , Aye-Aye-Myint1 , Nu-Nu-Aung1 ,
Khin-Aye-Kyu3 and Tin-Oo3 1 Venom Research Laboratory, Department of Medical Research (Lower Myanmar), Yangon
2Department of Medicine, Institute of Medicine (2), Yangon,
3Taundwingyi Civil Hospital, Magwe Division,
Abstract
The traditional first aid techniques used for snakebite victims are ineffective and result
in some complications. The search for an effective safe and first aid technique is
essential. Local compression immobilization technique was found to be effective in
delaying spread of “mock’s venom, NaI131" and radiolabel Russell’s viper (Daboia
russelii siamensis) venom in human volunteers and monkeys respectively. The extended
study of its efficacy in 15 prospective Russell’s viper bite cases demonstrated that
movement of the venom was retarded while the pad was in place (up to 1 hour) and
a rise of the venom level of 10-40 ng/ml was observed following its release. Further
elucidation of its efficacy was tested in the field on 20 Russell’s viper bite cases. The
pad was applied on average 1.12 hours (5 min to 7 hours) after the bite for 3.40
hours (30 min to 9 hours). Venom levels measured at the hospital before and at 15
and 30 minutes after release of the pad (n10) showed a rise of 5 to 30 ng/ml of the
venom following its release. Movement of venom antigen was retarded in all cases
(n9) whose venom levels were measured at 15 and 30 minutes with the pad in place.
Pad or immobilization alone is not effective in delaying spread of the venom. The
incidence of local necrosis (8%) following use of the pad was comparable to that of
the systemic cases without the pad. No ill effects were observed following application
of the pad for as long as 9 hours. Local blackening seen in 10% cases was most likely
the result of a local venom effect.
INTRODUCTION
Russell’s viper (Daboia russelii siamensis) bite is an occupational hazard of our farmers and
carries a mortality rate of about 10%. Most snakebite patients take from 2 hours to days to
get to the nearest health center. Delay in getting antivenom combined with use of ineffective
first aid (Tun-Pe et al., 1987) lead to systemic envenoming by the time they seek medical
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