snake bite

[Huntsman247]

Snake bandage and plb are definately a good investment...

[Overlandman]

Sad story regarding a Sea Snake bite.
Sea Snakes are seen in Tasmanian waters during summer.

https://www.abc.net.au/news/2019-11-26/ ... t/11738216

[Lindsay]

Sad story regarding a Sea Snake bite.
Sea Snakes are seen in Tasmanian waters during summer.

https://www.abc.net.au/news/2019-11-26/ ... t/11738216

"....it was inevitable that he was going to die about when he did, no matter what was done," said counsel assisting, Kelvin Currie." Maybe, however first aid applied immediately could have made a difference.

[north-north-west]

Depends on what sort of first aid. While there is an anti-venin, you're not supposed to use it unless you're fairly confident envenomation has occurred, because it can have some nasty side-effects. Sea snake venom is a great deal more potent than even the deadliest land snakes, so if envenomation occurs (which is really rare because they effectively have to chew the venom in - a single strike and detach action won't work - plus they're usually really placid creatures, even the banded which can be riled up easier than the olives) there's sod else that would help.
Sounds like the young bloke didn't think there was any envenomation so he'd be OK.

[wildwanderer]

I wish they would specify in these types of articles what first aid should be applied.

There will be a substantial proportion of readers who wont know what to do.

Apply first aid..

oh I should just put a band aid on then.....

If a compression bandage had been applied immediately instead of the ships captain telling the poor bloke to have a shower! the young man’s survival chances may have been much greater.

I don’t understand why the fishing company is not being hauled over the coals for this with charges pending. It’s a blatant OHS and duty of care failure.

They knew sea snakes were common. (the ships engineer had been bitten previously) but no gloves, clearly no idea of snake bite protocol and their standard practice when encountering a sea snake was to pick it up by the tail and chuck it over the side!

[gayet]

I wish they would specify in these types of articles what first aid should be applied.

In this case the expert evidence indicated that there was no 'first aid' that could have been applied in the circumstances that prevailed.

"The only way to change the course is really by intubation … it was inevitable that he was going to die about when he did, no matter what was done," said counsel assisting, Kelvin Currie.

Time was of the essence, sea snake venom acts much faster than land snake venom and is more potent, so its doubtful either the equipment or the skills necessary would be available on any trawler to effectively treat the victim.

[wildwanderer]

I wish they would specify in these types of articles what first aid should be applied.

In this case the expert evidence indicated that there was no 'first aid' that could have been applied in the circumstances that prevailed.

"The only way to change the course is really by intubation … it was inevitable that he was going to die about when he did, no matter what was done," said counsel assisting, Kelvin Currie.

Time was of the essence, sea snake venom acts much faster than land snake venom and is more potent, so its doubtful either the equipment or the skills necessary would be available on any trawler to effectively treat the victim.

Maybe. I think we would need the full transcript to be clear in what the counsel was referring to. They could have been referring to once he started displaying breathing difficulties there was nothing that could be done without inserting the breathing tube 'intubation'

Applying a compression bandage immediately may have slowed the venom enough to prevent getting to the systemic failure stage before reaching medical attention.

There is no reference I can see that a compression bandage was applied at all just a reference to first aid.

But yeah really need to wait for the coroner's report.

[Overlandman]

Snake bite certainly starts conversation.
If anyone sees the coroner’s report can they post a link
Regards OLM

Edit
Thanks slparker

[slparker]

When the coroner releases their findings this is the link:
https://justice.nt.gov.au/attorney-gene ... s-findings

[Overlandman]

Sad story from ABC

Looks like no first aid was performed
Also hitting his head may have had something to do with his passing.

https://www.abc.net.au/news/2020-01-18/ ... e/11879868

Darling Downs man Roger Taylor has died in a Brisbane hospital a little over a week after being bitten multiple times by a brown snake on his Vale View property, south-west of Toowoomba.

[slparker]

Snake bite certainly starts conversation.
If anyone sees the coroner’s report can they post a link
Regards OLM

Edit
Thanks slparker

The coroner's report is now up.

[Warin]

The coroner's report makes interesting reading;

https://justice.nt.gov.au/__data/assets ... -Evans.pdf

The evidence was that when bitten a compression bandage should be applied immediately and the limb immobilised with a splint. The compression bandage should if possible be of a stretch type especially formulated for snake bites to get the appropriate tension. The suggestion was that venom will travel through the body without a compression bandage at eight centimetres per minute.3 Compression and immobilisation were said to delay the effects of the venom for about thirty minutes.4 That is often valuable time if near to medical assistance. However, when hours out to sea that was not going to be sufficient

Dr Tiemensma said The emergency management of victims bitten by snakes with primarily neurotoxic venoms consists of monitoring, airway management (intubation and ventilation), provision of intravenous fluids, administration of antivenom (in a critical area, with staff prepared to treat anaphylaxis which may develop in reaction to the antivenom), and further supportive management and monitoring in an intensive care unit.

Due to the remote location of the incident, there was little that the fellow crewmembers could do, as they were not capable of administering antivenom, or maintaining a safe airway with continuous mechanical ventilation.

Which is very unhelpful Dr Tiemensma for future treatment, it may help emotionally those who tried to help.

My take, immediately;

1) apply a compression bandage, preferably one formulated for snake bites
2) immobilize the limb with a splint
3) press the PLB button, do not wait, act now

[wildwanderer]

3 Compression and immobilisation were said to delay the effects of the venom for about thirty minutes.4 That is often valuable time if near to medical assistance. However, when hours out to sea that was not going to be sufficient

Hmm if that expert witness is correct it largely negates the usefullness of carrying snake bite bandages for bushwalkers.

I'm very sceptical to be honest. This study (done in pigs not humans for obvious reasons) found that a pressure immobilization bandage delayed mortality for 8 hours after coral snake envenomation.

From the study..

RESULTS: Median survival time of control(no pressure immobilization bandage) animals was 307 minutes compared with 1172 minutes in treated(pressure immobilization bandage applied) animals (P = .10). Sixty percent of pigs in the treatment group survived to 24 hours vs 0% of control pigs (P = .08).

https://www.ncbi.nlm.nih.gov/m/pubmed/25059885/

I'm also quite disappointed the inquest didn't identify the length of time between the bite and the application of a pressure bandage. We know he was told to go take a shower and after he did so came back onto the bridge and only then was a bandage applied. How long was he in the shower/changing? 10mins? ...20 mins? And one presumes actively moving about that entire time. (The movement enabling even faster transport of the venom through the man's body)

I also note there was no medical expert with specialisation in pre hospital treatment/survivability of snake bite or other poisonous creatures giving evidence.

[Warin]

I also note there was no medical expert with specialisation in pre hospital treatment/survivability of snake bite or other poisonous creatures giving evidence.

The report is not helpful for first aid now and into the future. I don't thing much of the doctors comments.

The coroner could have examined more into making future snake bites survivable. Why is antivenin not available to first aiders? Epi pens are..

[wildwanderer]

Agree. Seems the expert medical witnesses were unaware of the research showing the significant venom slowing ability of pressure immobilization bandages. Very unhelpful and I hope media does not pick up the story and discourage pressure bandage use for remote area treatment.

I think it's likely that anti venom isn't provided to first aiders epi pen style due to risks of side effects. Most bites are dry bites so a first aider giving anti venom for every bite may do more harm than good. Plus possible the anti venom needs refrigeration etc as well as relatively scarse and expensive.

[slparker]

Antivenene administration is not a first aid treatment, is costly, difficult to store, complex to administer, has potentially life threatening adverse effects and as WW pointed out only required in certain circumstances.

Epipen is adrenaline administered in the muscle. It has a short duration of effect and no effect on snake venom or on the immediate effects of snakebite.

It is a treatment for severe allergic reactions. I can only assume that it was used as part of the resuscitation of the deceased but normal practice in an emergency would be to give it in a vein or down the artificial airway tube. It is not a first aid treatment for snake bite.

[Warin]

I think it's likely that anti venom isn't provided to first aiders epi pen style due to risks of side effects.

I believe an epi pen can be used as a treatment for some reactions to the anti venom. However i would have to check that, and there seems little point given the following at this time.

Most bites are dry bites so a first aider giving anti venom for every bite may do more harm than good. Plus possible the anti venom needs refrigeration etc as well as relatively scarse and expensive.

A matter of training and developing a temperature hardened anti venom. Given the number of people who die I suppose this is wishful thinking.

[Lophophaps]

When treating snake bite, is there much difference between a first aid roller bandage and a pressure bandage specifically designed to treat snake bite?

[slparker]

A roller bandage is any bandage that comes in a roll form, as distinct from a folded bandage such as a triangular bandage.
To my knowledge there are no snake bite specific bandages, people selling 'snake bite bandages' are repurposing venous compression bandages - they do the job well, though.

First aid organisations recommend using an elasticated bandage for PIM, not a crepe cotton bandage.

[wildwanderer]

When treating snake bite, is there much difference between a first aid roller bandage and a pressure bandage specifically designed to treat snake bite?

The snake bite bandage (setopress) have indicators showing pressure. Mine has a brown indicator, and from what I've read, I plan to use just slightly more pressure than the indicator. Thats my personal opinion not medical advice or instructions.

As slparker mentioned it's a repurposed elastized compression bandage.

[peregrinator]

A roller bandage is any bandage that comes in a roll form, as distinct from a folded bandage such as a triangular bandage.
To my knowledge there are no snake bite specific bandages, people selling 'snake bite bandages' are repurposing venous compression bandages - they do the job well, though.

First aid organisations recommend using an elasticated bandage for PIM, not a crepe cotton bandage.

But in direct response to Lophophaps question, I think the answer may be that a compression bandage will more than likely have the comparative advantage in that it has graphic indicators enabling the user to adjust the bandage to achieve the desired degree of tension. Yes, it will be repurposing a bandage designed for other tasks. But check out the Setopress website.

[slparker]

If you apply the setopress bandage to the tension suggested by the squares you do not achieve enough compression to reach that recommended by the Australian Resuscitation Council.

This is because the setopress is designed to treat venous ulcers, not treat snakebite.

Somewhere, one one of the pages in this extensive thread I describe this at length with the evidence supplied.

[Joynz]

The coroner’s report is definitely worth reading all the way through.

Sea snakes are clearly a different kettle of fish than land snakes in terms of venom speed.

There was an interesting comment by one of the medical experts that bandaging after snakebite - any snakebite - is often not done that well or effectively - especially for bites to the arms.

[Lophophaps]

Thanks. I can recall the discussion but this is a long topic. The ulcer-bite information is quite helpful.

[Warin]

If you apply the setopress bandage to the tension suggested by the squares you do not achieve enough compression to reach that recommended by the Australian Resuscitation Council.

So you go for a rectangle rather than a square.

IIRC one of the problems is the pressure required varies depending on the limb and how well muscled it is, so there needs to be some information on this ... and it is not available.

[slparker]

If you apply the setopress bandage to the tension suggested by the squares you do not achieve enough compression to reach that recommended by the Australian Resuscitation Council.

So you go for a rectangle rather than a square.

IIRC one of the problems is the pressure required varies depending on the limb and how well muscled it is, so there needs to be some information on this ... and it is not available.

yes, it wouldn't be an exact thing but if i was carrying a setopress and I was treating a snakebite casualty i would apply the bandage so both the rectangles were stretched to a greater degree than that recommended for venous ulcer compression and also so that it was to the correct tension in my clinical judgement.

the setopress is a good calibration point to see where your less than minimum pressure would be for a treating a bite on a leg. i would have to go back and check the my notes but the setopress sia adequate for an arm if you use the rectangle guides IIRC.

I am not sure that makes any difference how much muscle is under the bandage - it is all about providing compressive force on the lymphatics and small veins; so if you have the right tension in the bandage it should compress the vessels between the bandage and the muscle fascia. i don't recall seeing any research mentioning this though.

[philm]

My understanding is the setopress tension for the brown squares is good for an arm but more tension is needed for a bike to the leg? So a stretched brown rectangle for legs?

[slparker]

That's a good rule of thumb.

[Overlandman]

From vigilante news

Winston Fish lovingly known as Bill unfortunately died at the Royal Hobart Hospital intensive care unit overnight due to a snakebite on Tuesday. Bill was airlifted from Oatlands to the RHH on Tuesday by the Tasmania Police Westpac rescue helicopter. Bill was approaching his 79th birthday. Our condolences to family and friends.

Bill died from multiple Tiger Snake bites, this is the first fatality in Tasmania since 1977.
Apparently first aid treatment was not applied. (Spokesman from Reptile Rescue)
Just heard that Bill May have fallen on the Tiger Snake

More from ABC

https://www.abc.net.au/news/2020-01-31/ ... a/11916462

OLM

[Son of a Beach]

Wow... arccording to...

https://www.abc.net.au/news/2020-01-31/ ... a/11916462

This week's snake bite victim's brother was mates with the last guy who died from snake bite in Tasmania in 1977! How bizarre.