Re: AHA recommendations RE: snakebite

[Guest guest]

Your not

Sent from my Verizon Wireless BlackBerry

AHA recommendations RE: snakebite

While watching the AHA BLS instructor update video, the first aid section

covered new recommendations for snakebite.  AHA's first aid component now

recommends compression bandages to delay the flow of the snake's venom.  

Haven't we gone through this debate before?  It would seem that coupling

pressure dressings with the hemotoxic properties of pit viper venom coupled with

the digestive enzymes would be more likely to cause tissue necrosis, compartment

syndrome, and rhabdo.  

Or am I totally missing something here?

-Wes Ogilvie

Austin, Texas 

[Guest guest]

Wes,

Do they cite studies to support the recommendation?

I have done quite a lot of reading about this and written articles about it and

done lectures, based upon what I learned from the literature and from the docs I

have talked to who do venom treatment, and it has appeared to me that

compression bandages were the Australian method, implemented because definitive

treatment was hours or days away, and the choice was life over limb.

I would be like to know why the AHA has taken this position. As far as I know,

the only effective treatment for hemotoxic venom is CroFab, and the sooner it's

administered, the better. Since hemotoxic venom is essentially a digestive

juice, using compression bandages would seem to confine it to an area where it

would be concentrated and would do significant damage to local tissues, with the

resultant tissue necrosis, compartment syndrome, and rhabdomyolysis that you

mention.

GG

AHA recommendations RE: snakebite

While watching the AHA BLS instructor update video, the first aid section

covered new recommendations for snakebite. AHA's first aid component now

recommends compression bandages to delay the flow of the snake's venom.

Haven't we gone through this debate before? It would seem that coupling

pressure dressings with the hemotoxic properties of pit viper venom coupled with

the digestive enzymes would be more likely to cause tissue necrosis, compartment

syndrome, and rhabdo.

Or am I totally missing something here?

-Wes Ogilvie

Austin, Texas

[Guest guest]

> While watching the AHA BLS instructor update video, the first aid section

covered

> new recommendations for snakebite. AHA's first aid component now recommends

> compression bandages to delay the flow of the snake's venom.

I guess I am way out of the loop on this one. AHA having a first aid component

is news to me. When did this happen?

Rob

[Guest guest]

Since they discovered that Class A daycares and manufacturing / industry

represented an untapped market for shitty first aid courses. Close to 10

years now.

>

> > While watching the AHA BLS instructor update video, the first aid

> section covered

> > new recommendations for snakebite. AHA's first aid component now

> recommends

> > compression bandages to delay the flow of the snake's venom.

>

> I guess I am way out of the loop on this one. AHA having a first aid

> component is news to me. When did this happen?

>

> Rob

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

Oh about 10 maybe 15 years now.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos.

(Cell)

LNMolino@...

On Jan 22, 2011, at 21:54, " rob.davis@... "

rob.davis@...> wrote:

>> While watching the AHA BLS instructor update video, the first aid section

covered

>> new recommendations for snakebite. AHA's first aid component now recommends

>> compression bandages to delay the flow of the snake's venom.

>

> I guess I am way out of the loop on this one. AHA having a first aid

component is news to me. When did this happen?

>

> Rob

>

>

>

> ------------------------------------

>

>

[Guest guest]

> Oh about 10 maybe 15 years now.

They sure don't promote it much. I was still an AHA instructor ten years ago,

and I never heard anything about it. I take it that it's a separate course, or

is it integrated?

Rob

[Guest guest]

> Oh about 10 maybe 15 years now.

They sure don't promote it much. I was still an AHA instructor ten years ago,

and I never heard anything about it. I take it that it's a separate course, or

is it integrated?

Rob

[Guest guest]

Can't say as it was about the same time I was exiting the AHA/ARC world Fir the

more open school of the world of ASHI.

No idea what Texas was like but in NJ and PA the AHA and ARC were (again at the

time) so restrictive and so on that many folks bailed on them and went with ASHI

and Medic First Aid or the NSC Programs.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos.

(Cell)

LNMolino@...

On Jan 22, 2011, at 23:33, " rob.davis@... "

rob.davis@...> wrote:

>> Oh about 10 maybe 15 years now.

>

> They sure don't promote it much. I was still an AHA instructor ten years ago,

and I never heard anything about it. I take it that it's a separate course, or

is it integrated?

>

> Rob

>

>

>

> ------------------------------------

>

>

[Guest guest]

Can't say as it was about the same time I was exiting the AHA/ARC world Fir the

more open school of the world of ASHI.

No idea what Texas was like but in NJ and PA the AHA and ARC were (again at the

time) so restrictive and so on that many folks bailed on them and went with ASHI

and Medic First Aid or the NSC Programs.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos.

(Cell)

LNMolino@...

On Jan 22, 2011, at 23:33, " rob.davis@... "

rob.davis@...> wrote:

>> Oh about 10 maybe 15 years now.

>

> They sure don't promote it much. I was still an AHA instructor ten years ago,

and I never heard anything about it. I take it that it's a separate course, or

is it integrated?

>

> Rob

>

>

>

> ------------------------------------

>

>

[Guest guest]

Wes,

There is interesting information regarding this in the 2010 Guidelines.

From the 2010 Guidelines...

Snakebites

Do not apply suction as first aid for snakebites (Class III, LOE C).

Suction does remove some venom, but the amount is very small.134 Suction

has no clinical benefit135 and it may aggravate the injury.136–138

Applying a pressure immobilization bandage with a pressure between 40

and 70 mm Hg in the upper extremity and between 55 and 70 mm Hg in the

lower extremity around the entire length of the bitten extremity is an

effective and safe way to slow the dissemination of venom by slowing

lymph flow (Class IIa, LOE C139,140). For practical purposes pressure is

sufficient if the bandage is comfortably tight and snug but allows a

finger to be slipped under it. Initially it was theorized that slowing

lymphatic flow by external pressure would only benefit victims bitten by

snakes producing neurotoxic venom, but the effectiveness of pressure

immobilization has also been demonstrated for bites by non-neurotoxic

American snakes.140,141 The challenge is to find a way to teach the

application of the correct snugness of the bandage because inadequate

pressure is ineffective and too much pressure may cause local tissue

damage. It has also been demonstrated that, once learned, retention of

the skill of proper pressure and immobilization application is

poor.142,143

http://circ.ahajournals.org/cgi/reprint/122/18_suppl_3/S934

http://circ.ahajournals.org/cgi/reprint/122/18_suppl_3/S934>

From the Consensus on First Aid Science:

Snake Bite

Pressure ImmobilizationFA-1001A

Consensus on Science

One LOE 5 monkey study239 showed that application of a pressure bandage

to create 55 mm Hg of pressure and simultaneous immobilization of the

bitten extremity with a splint are effective and safe in retarding snake

venom uptake into the systemic circulation. One LOE 2 human study240 and

1 LOE 5 animal study241 demonstrated that lymphatic flow and " mock

venom " uptake can be significantly or almost completely reduced by

proper application of pressure and immobilization but that either

pressure or immobilization alone was ineffective. No adverse effects

were observed within certain prescribed pressure ranges (between 40 and

70 mm Hg for upper, and 55 to

70 mm Hg in lower limbs); a useful and practical field estimation for

this pressure range is the application of a comfortably tight bandage

that allows the insertion of a finger under it. Theoretically, if a

venom produces more local tissue effects than systemic effects, damage

may be increased if the venom is " trapped " in 1 place with use

of pressure and immobilization. Two LOE 5 animal studies241,242

demonstrated the effectiveness of pressure and immobilization on

survival from the venom of nonneurotoxic North American snakes. Two LOE

5 studies243,244 using volunteer first aid providers showed that

retention of the ability to perform proper ressure/immobilization

application is poor.

Treatment Recommendation

Properly performed pressure immobilization of extremities should be

considered in first aid following snake envenomation.

Knowledge Gaps

Does first aid provider compressive wrapping of an extremity bitten by a

venomous snake improve outcome? What is the best method to teach the

optimal way to apply a compressive dressing? How often does this need to

be refreshed for retention?

http://circ.ahajournals.org/cgi/reprint/122/16_suppl_2/S582

http://circ.ahajournals.org/cgi/reprint/122/16_suppl_2/S582>

-Ben Oakley, LP

>

> While watching the AHA BLS instructor update video, the first aid

section covered new recommendations for snakebite. AHA's first aid

component now recommends compression bandages to delay the flow of the

snake's venom. Haven't we gone through this debate before? It would

seem that coupling pressure dressings with the hemotoxic properties of

pit viper venom coupled with the digestive enzymes would be more likely

to cause tissue necrosis, compartment syndrome, and rhabdo.

>

> Or am I totally missing something here?

>

> -Wes Ogilvie

> Austin, Texas

>

>

[Guest guest]

Wes,

There is interesting information regarding this in the 2010 Guidelines.

From the 2010 Guidelines...

Snakebites

Do not apply suction as first aid for snakebites (Class III, LOE C).

Suction does remove some venom, but the amount is very small.134 Suction

has no clinical benefit135 and it may aggravate the injury.136–138

Applying a pressure immobilization bandage with a pressure between 40

and 70 mm Hg in the upper extremity and between 55 and 70 mm Hg in the

lower extremity around the entire length of the bitten extremity is an

effective and safe way to slow the dissemination of venom by slowing

lymph flow (Class IIa, LOE C139,140). For practical purposes pressure is

sufficient if the bandage is comfortably tight and snug but allows a

finger to be slipped under it. Initially it was theorized that slowing

lymphatic flow by external pressure would only benefit victims bitten by

snakes producing neurotoxic venom, but the effectiveness of pressure

immobilization has also been demonstrated for bites by non-neurotoxic

American snakes.140,141 The challenge is to find a way to teach the

application of the correct snugness of the bandage because inadequate

pressure is ineffective and too much pressure may cause local tissue

damage. It has also been demonstrated that, once learned, retention of

the skill of proper pressure and immobilization application is

poor.142,143

http://circ.ahajournals.org/cgi/reprint/122/18_suppl_3/S934

http://circ.ahajournals.org/cgi/reprint/122/18_suppl_3/S934>

From the Consensus on First Aid Science:

Snake Bite

Pressure ImmobilizationFA-1001A

Consensus on Science

One LOE 5 monkey study239 showed that application of a pressure bandage

to create 55 mm Hg of pressure and simultaneous immobilization of the

bitten extremity with a splint are effective and safe in retarding snake

venom uptake into the systemic circulation. One LOE 2 human study240 and

1 LOE 5 animal study241 demonstrated that lymphatic flow and " mock

venom " uptake can be significantly or almost completely reduced by

proper application of pressure and immobilization but that either

pressure or immobilization alone was ineffective. No adverse effects

were observed within certain prescribed pressure ranges (between 40 and

70 mm Hg for upper, and 55 to

70 mm Hg in lower limbs); a useful and practical field estimation for

this pressure range is the application of a comfortably tight bandage

that allows the insertion of a finger under it. Theoretically, if a

venom produces more local tissue effects than systemic effects, damage

may be increased if the venom is " trapped " in 1 place with use

of pressure and immobilization. Two LOE 5 animal studies241,242

demonstrated the effectiveness of pressure and immobilization on

survival from the venom of nonneurotoxic North American snakes. Two LOE

5 studies243,244 using volunteer first aid providers showed that

retention of the ability to perform proper ressure/immobilization

application is poor.

Treatment Recommendation

Properly performed pressure immobilization of extremities should be

considered in first aid following snake envenomation.

Knowledge Gaps

Does first aid provider compressive wrapping of an extremity bitten by a

venomous snake improve outcome? What is the best method to teach the

optimal way to apply a compressive dressing? How often does this need to

be refreshed for retention?

http://circ.ahajournals.org/cgi/reprint/122/16_suppl_2/S582

http://circ.ahajournals.org/cgi/reprint/122/16_suppl_2/S582>

-Ben Oakley, LP

>

> While watching the AHA BLS instructor update video, the first aid

section covered new recommendations for snakebite. AHA's first aid

component now recommends compression bandages to delay the flow of the

snake's venom. Haven't we gone through this debate before? It would

seem that coupling pressure dressings with the hemotoxic properties of

pit viper venom coupled with the digestive enzymes would be more likely

to cause tissue necrosis, compartment syndrome, and rhabdo.

>

> Or am I totally missing something here?

>

> -Wes Ogilvie

> Austin, Texas

>

>

[Guest guest]

There are some courses that are integrated, but as I understand it the CPR and

First Aid courses are separate certifications. You can, of course, opt to take

them separately, also.

Alyssa Woods, NREMT-B

CPR Instructor

> Can't say as it was about the same time I was exiting the AHA/ARC world Fir

the more open school of the world of ASHI.

>

> No idea what Texas was like but in NJ and PA the AHA and ARC were (again at

the time) so restrictive and so on that many folks bailed on them and went with

ASHI and Medic First Aid or the NSC Programs.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

>

> On Jan 22, 2011, at 23:33, " rob.davis@... "

rob.davis@...> wrote:

>

> >> Oh about 10 maybe 15 years now.

> >

> > They sure don't promote it much. I was still an AHA instructor ten years

ago, and I never heard anything about it. I take it that it's a separate course,

or is it integrated?

> >

> > Rob

> >

> >

> >

> > ------------------------------------

> >

> >

[Guest guest]

There are some courses that are integrated, but as I understand it the CPR and

First Aid courses are separate certifications. You can, of course, opt to take

them separately, also.

Alyssa Woods, NREMT-B

CPR Instructor

> Can't say as it was about the same time I was exiting the AHA/ARC world Fir

the more open school of the world of ASHI.

>

> No idea what Texas was like but in NJ and PA the AHA and ARC were (again at

the time) so restrictive and so on that many folks bailed on them and went with

ASHI and Medic First Aid or the NSC Programs.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

>

> On Jan 22, 2011, at 23:33, " rob.davis@... "

rob.davis@...> wrote:

>

> >> Oh about 10 maybe 15 years now.

> >

> > They sure don't promote it much. I was still an AHA instructor ten years

ago, and I never heard anything about it. I take it that it's a separate course,

or is it integrated?

> >

> > Rob

> >

> >

> >

> > ------------------------------------

> >

> >