Management of Snakebite and Research Management of Snakebite ...

Trial of Efficacy of Local Compression Immobilization First-Aid Technique in Russell’s Viper Bite Patients
villages of Taungdwingyi township with the help of local health workers who were
demonstrated the use of the first aid rubber pad (Fig. 1) and immobilization technique. Its
merits were explained to them with the view that they will impart the knowledge to local
farmers (Tun-Pe et al., 2000). A total of 800 pads, 20 pads with instruction per village,
were distributed to the farmers through the health workers. The potential victim was advised
to apply it soon after the bite, immobilize the bitten limb with a splint and to go to the
nearest health station.
The study was approved by the Institutional Ethical Committee of the Department of
Medical Research, Yangon, Myanmar. Clinical features, including degree of tightness of
the pad, immobolization of the limb and progress of the patients were recorded in a
standard proforma. A 20-minute clotting test (Warrell et al., 1977) was carried out on
admission blood sample of suspected Russell’s viper bite cases. Routinely, the medical
officer at the hospital releases the tourniquets first and gives antivenom intravenously.
Following the release of tourniquet(s), two blood samples of 15 minute apart were taken
after release of the pad while waiting to give antivenom. Since a retrospective analysis of
the serum samples of the patients suggested a rise in venom levels following release of the
pad, for ethical reasons, two samples, 15 minutes apart, with the pad in place were collected
from the remaining patients. The pad was released after antivenom therapy. The sample
collection and determination of venom antigen level by enzyme immunoassay technique
were the same as in the previous study (Tun-Pe et al., 1991).
RESULTS
Trial of the local compression immobilization technique in prospective
Russell’s viper bite cases
A prospective study of the
efficacy of the local
compression immobilization
technique in retarding spread
of venom was carried out on
23 Russell’s viper bite cases.
Fifteen of the 23 cases had
an increase of 10-40ng/ml in
serum venom antigen level
following release of the pad
(Figure 2); the central
movement of venom antigen
was retarded in 13 of them.
In the remaining 7 locally
envenomed antigenaemic
cases (venom level 10-20ng/
ml), the venom antigen
disappeared from the
circulation while they were
undergoing the pad trial (data
not shown). (Tun-Pe et al,
1995).
Figure 2. Venom levels in the 15 pad-treated Russell’s
viper bite cases (Prospective trial)
↓ Pad placed on; ↑ pad removed.
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