First Aid 



before horse senun antiveiiin is administered. 

 Directions for tliese tests will usually be found in 

 tlie package containing the antivenin. In the 

 absence of specific instructions follow tliese steps: 



1. Inject 0.10 ml. of a 1 : 10 dilution of the horse 

 serum or antivenin intracutaneously on the inner 

 surface of the forearm. T'se the specific hypo- 

 dermic needle provided for the test. If one is 

 not i)rovided, use a short '27-gauge needle. If the 

 test is done correctly, a wheal will be raised at 

 the site of the injection. The wheal is white at 

 first but if the test is positive the area about the 

 i:)oint of injection will become red within 10 to lo 

 minutes. If any local or systemic allergic mani- 

 festations develo|) within 20 minutes of the test, 

 do not give anti\eiiin. Leave this decision to the 

 medical officer. 



If the victim develojjs a severe reaction to the 

 test (restlessness, flushing, sneezing, urticaria, 

 swelling of the eyelids and lips, respiratory dis- 

 tress or cyanosis), inject 0.;5 to 0.5 nd. of 1 : 1.000 

 adrenalin subcutaneously, and observe the victim 

 closely. Be piepared to ailministei- artificial 

 respiration. A cardiac stimulant may al.so be 

 needed if shock develops. 



2. An alternative to the skin test is the eye 

 test. One or two di-ops of a 1 : 10 solution of the 

 horse serum or antivenin aiv placed on the con- 

 junctiva of one eye. If the test is positive, red- 

 ness of the conjunctiva will develop within a few 

 minutes. If the reaction is \ery se\ere. it should 

 be controlled by depositing a drop or two of 

 1 : 1,000 adrenalin directly on the conjunctiva. 



.'5. If a serum sensitivity test is i)ositive. de- 

 sensitization should be carried out before admin- 

 istering antivenin. This should be done oi\ly by 

 a doctor. Do not attempt to desensitize a victim 

 unless the aiiiin)]>riate facilities and drugs are 

 available. 



DISCUSSION OF FIRST AID MEASURES 



It is not a puri)ose of this manual to discuss 

 or evaluate all of the first aid treatments that 

 have been suggested or advised for snake venom 

 poisoning. This has been done in the medical 

 literature. The reader is referred to the refer- 

 ences at the end of this chapter for a more thor- 

 ough consideration of this subject. It should be 

 noted here, however, that there is no single thera- 



peutic standard of procedure for all cases of 

 snake venom jwisoning. Rest, immolnlization of 

 the injured part, and reassurance are indicated in 

 every case, and in themselves are valuable thera- 

 peutic measures. l)ut beyond these, few measures 

 can be reconnnended for all cases of snakebite. 

 In the following sections some consideration will 

 be given to several of the more connnonly em- 

 ployed fii'st aid measures. 



CONSTRICTION-BAND AND TOURNIQUET 



Constriction-bands and tourniriuets have long 

 been used in the tieatment of snakebite. The ra- 

 tionale foi- their use is quite simple, that is. to re- 

 tard the al)sori)tion and spread of the venom. 

 ."studies with North Ameiican rattlesnake venom 

 labeled with radioactive iodine (I"') show that 

 the spread of certain fractions of the venom can 

 be letarded by pressure on the superficial lym- 

 plinlic channels proximal to the deposition of 

 the toxin. It ap|iears that the greater portion of 

 rattlesnake venom is absorbed directly into lym- 

 l)hatic structures. These studies support the 

 clinical findings that in cases of Xorth American 

 rattlesmxke bites, a constriction-band, apjilied 

 eaily and efTectively. can retard the spread of the 

 toxin and thus decrease the area of localized 

 necrosis. There is also some evidence to indicate 

 that the constriction-band retards the develop- 

 uient of systemic signs and symptoms. 



The use of a constriction-band or a tourni(iuet 

 in cases where deep envenomation has occurred 

 would apjiear to be of limited or no value, and 

 indeed some clinical reports support this conten- 

 tion. On the other hand, the incorrect applica- 

 tion of constriction-bands and tourniquets, par- 

 ticularly in Southeast Asia, makes it difficult to 

 evaluate these measures solely from clinical ex- 

 ])eriences. It might be concluded that a pi-operly 

 ;ipplied constriction-band is of definite value in 

 poisoning by all Xorth American crotalids and 

 many of the small \ipers from throughout the 

 \v()rld. It is probably of lesser or no value follow- 

 ing bites by the large vipers outside Xorth Amer- 

 ica. In spite of these findings and opinions, it 

 seems advisable, in view of no substantial contra- 

 indication, to recommend the use of a constric- 

 tion-band in all cases of vi])er venom poisoning 

 (luring the period when suction is being carried 

 out. 



17 



