Management of Snakebite and Research Management of Snakebite ...

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Since the mean admission venom level of the non-immobilized systemic cases (64 ng/ml) was comparable to that of the systemic cases (61ng/ml) of the Russell’s viper bite cases admitted to the Taungdwingyi Hospital (Sann-Mya et al., 1998), it is suggested that the pad alone is not effective in delaying spread of the venom (Sutherland et al., 1979). Since a majority of cases applied the pad on an average 1 hour following the bite, it is expected that a certain amount of injected venom must have already been absorbed into the circulation depending on the activity of the bitten limb. Delay in the pad application and lack of immobilization lead to rapid absorption of the venom, resulting in systemic envenoming with high admission venom levels. It has been suggested that even walking after upper limb envenomation will inevitably lead to systemic envenoming despite first aid measures (Howarth et al., 1994). It is very likely that local concentration of the venom in the pad-applied cases could lead to local necrosis. However, its incidence (8%) is comparable to that observed in systemic envenomed Russell’s viper bite cases (10%) studied in Taungdwingyi (Sann-Mya et al., 1998). Local blackening (10%) was due to the local venom effect since it was also observed in cases without the pad. Local pain was twice more common in the pad-treated cases because of local concentration of the venom. However, the intensity of pain was not severe, amounting to a demand for removal of the pad. No ill effects were observed following prolonged, up to 6-9 hours application. An effective first-aid technique is essential since victims have to travel 1.6 km (average) to get to the hospital. It was observed that one ampoule (10 ml) of intravenous antivenom given to the Russell’s viper bite patients combined with local compression immobilization first aid applied at villages prevented development of systemic complications (Tun-Pe et al., 1998). Because of insufficient number of pads distributed to the farmers, its application was delayed for one hour in some cases. However, a cotton pad of a similar thickness made from strips of cotton from personal wear (longyi) could be used in place of the pad on site (Fig 1). In spite of health education, the majority of snakebite victims still fail to immobilize their limbs. References Trial of Efficacy of Local Compression Immobilization First-Aid Technique in Russell’s Viper Bite Patients Anker, R.L., Staffon, W.G., Loiselle, D.S. and Anker, K.M.(1982). Retarding the uptake of ‘mock venom’ in humans. Comparison of three first aid treatments. Medical Journal of Australia, i: 211-214. Howarth, D.M., Southee, A.E. and Whyte, IM. (1994). Lymphatic flow rates and first aid in simulated peripherial sname or spider envenomation. Med J Australia, 161: 695-700 Sann-Mya, Tun-Pe, Aye-Aye-Myint, Nu-Nu-Aung, Khin-Aye-Kyu and Tin-Oo (1998). Russell’s viper bites in Taungdwingyi hospital: clinical features and response to antivenom. Myanmar Health Sciences Research Journal, 10:26-30. Sutherland, S.K., Coulter A.R, and Harris, R.D.(1979). Rationalization of first-aid measures for elapid snakebite. Lancet i,: 183-6 Tun-Pe, Tin-Nu-Swe, Myint-Lwin, Warrell DA, and Than-Win (1987). The efficacy of tourniquets as a first-aid measure for Russell’s viper bites in Burma. Transactions Royal Society Tropical Medicine and Hygiene, 81: 403-405. Tun-Pe, Ba-Aye, Aye-Aye-Myint, Tin-Nu-Swe and Warrell, D.A. (1991). Bites by Russell’s vipers (Daboia russelii siamensis) in Myanmar: effect of the snake’s length and recent feeding on venom antigeniamia and severity of envenoming. Transactions Royal Society Tropical Medicine and Hygiene, 85: 804-808. Tun-Pe, Maung-Maung-Thwin, Myint-Myint-Than, Aye-Aye-Myint, Kyaw-Myint and Thein-Than (1994). The efficacy of compression immobilization technique in retarding spread of radio-labelled Russell’s viper venom in rhesus monkeys and “mock venom” NaI131 in human volunteers. Southeast Asian J. Trop. Med. Pub. Hlth, 25: 349-353. 27
Management of Snakebite and Research 28 Tun-Pe, Khin-Aye-Kyu, Aye-Aye-Myint, Nu-Nu-Aung, Sann-Mya and Tin-Oo (1998). Clinical significance of early intravenous antivenom in Russell’s viper bite cases in Taungswingyi district: a preliminary study. Myanmar Health Sciences Research Journal, 10: 22-25. Tun-Pe, Aye-Aye-Myint, Khin-Ei-Han, Thi-Ha and Tin-Nu-Swe (1995). Local compression pad as a first-aid measure for victims of bites by Russell’s viper (Daboia russelii siamensis) in Myanmar. Transactions Royal Society Tropical Medicine and Hygiene, 89:292-295. Tun-Pe, Sann-Mya, Aye-Aye-Myint, Nu-Nu-Aung, Khin-Aye-Kyu and Tin-Oo (2000). Field trial of efficacy of local compression immobilization first-aid technique in Russell’s viper (Daboia russelii siamensis) bite patients. Southeast Asian J. Trop. Med. Pub. Hlth, 31:346-348. Warrell, D. A., Davidson, N. McD, and Greenwood, B.M.(1977). Poisioning by bites of the saw-scaled or carpet viper (Echis carinatus) in Nigeria. Quart J Med, 46:33-62.
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