Pressure Immobilization Bandages Research Articles

Literature Review: The Effectiveness First Aid Pressure Immobilization Bandages Technique of Snake Bite

Backgrounds: Snake bites are a medical emergency that can cause permanent disability and even death (Wintoko and Prameswari 2020). The main principle recommended for the first treatment of a snakebite is to immobilize the area with a pressure bandage (pressure immobilization bandages) then immediately referred to the hospital for further treatment.Objective: To know the effectiveness of pressure immobilization bandages (PIB) first aid against snake bite.Methods: Article searches were conducted electronically using Google Scholar, PubMed, Science direct, National Library and Pro quest databases. Articles used from 2016 to 2021. The keywords in this article search were “pressure immobilization bandages” and “snake bite. So that 5 research articles were reviewed. Inclusion criteria included articles published in 2016-2021, articles in Indonesian and English, involving snake bite patients and being given the Pressure immobilization bandage technique intervention. Meanwhile, the exclusion criteria include articles that cannot be accessed, based on meta-analysis, and journals that discuss snake bites but are not in accordance with the topic to be reviewed.Results: Pressure immobilization bandages (PIB) can be used in first aid because they can inhibit the spread of snake venom and are 20 times faster in the healing process if done in first aid.Conclusion: Pressure immobilization bandages (PIB) are effective in first aid for snake bites.Keywords: Pressure immobilization bandages; snake bite

First Aid and Pre-Hospital Management of Venomous Snakebites.

Background: Antivenom is the definitive treatment for venomous snakebites, but is expensive and not available in many rural and poorly developed regions. Timely transportation to facilities that stock and administer antivenom may not be available in rural areas with poorly developed emergency medical services. These factors have led to consideration of measures to delay onset of toxicity or alternatives to antivenom therapy. Methods: PubMed searches were conducted for articles on snakebite treatment, or that contained first aid, emergency medical services, tourniquets, pressure immobilization bandages, suction devices, and lymphatic flow inhibitors. Results: The reviewed articles describe how venoms spread after a venomous snakebite on an extremity, list the proposed first aid measures for delaying the spread of venoms, and evaluate the scientific studies that support or refute methods of snakebite first aid. The recommendations for field treatment of venomous snakebites will be discussed. Conclusions: The evidence suggests that pressure immobilization bandages and related strategies are the best interventions to delay onset of systemic toxicity from venomous snakebites but may increase local toxicity for venoms that destroy tissue at the site of the bite, so their use should be individualized to the circumstances and nature of the venom.

A Survey of Snakebite Knowledge among Field Forces in China.

Background: A snakebite is a neglected extrinsic injury associated with high morbidity and global mortality. Members of Chinese field forces are at high risk of snakebites, and their perception and knowledge of snakebites are unknown. The aim of this study is to assess perception and knowledge of snakebites in field forces in southeast China; Methods: A cross-sectional questionnaire-based survey was conducted in July 2016. A total of 216 field force members participated in this study; Results: A total of 10.3% had experienced snakebites and 86.4% rated their demands for knowledge about snakebite as “high”. No significant correlation between the actual and perceived snakebite knowledge status was detected (κ = 0.0237, p = 0.3852). Ineffective and harmful traditional first-aid methods, such as the application of tourniquets, sucking the venom out of the wound, and making local incisions, were used by more than three quarters of the respondents. However, pressure immobilization bandages were applied by only 17.3% of members. The proportion of responses for each question was not significantly different among the respondents when considering separate demographic groups; Conclusions: Snakebite knowledge among Chinese field force members is inadequate and in some cases misleading, when focusing on manifestation, prevention, and first-aid. A pragmatic, intensive educational scheme should be undertaken in at-risk populations.

Long-term efficacy of pressure immobilization bandages in a porcine model of coral snake envenomation

BackgroundPressure immobilization bandages delay mortality for 8 hours after coral snake envenomation, but long-term efficacy has not been established. ObjectiveThe objective of this study is to determine the long-term efficacy of pressure immobilization bandages after coral snake envenomation in the absence of antivenom therapy. MethodsA randomized, observational pilot study was conducted. Ten pigs (17.3-25.6 kg) were sedated, intubated for 5 hours, and injected subcutaneously with 10 mg of lyophilized Micrurus fulvius venom resuspended in water. Pigs were randomly assigned to a control group (no treatment) or a treatment group (compression bandage and splint) approximately 1 minute after envenomation. Bandage pressure was not controlled. Pigs were monitored daily for 21 days for signs of respiratory depression, decreased oxygen saturations, and paralysis. In case of respiratory depression, pigs were humanely euthanized and time to death recorded. Statistical analysis was performed with Fisher exact test, Mann-Whitney U test, and Kaplan-Meier survival curve as appropriate. ResultsMedian survival time of control animals was 307 minutes compared with 1172 minutes in treated animals (P = .10). Sixty percent of pigs in the treatment group survived to 24 hours vs 0% of control pigs (P = .08). Two of the treatment pigs survived to the end point of 21 days but showed necrosis of the distal lower extremity. ConclusionsLong-term survival after coral snake envenomation is possible in the absence of antivenom with the use of pressure immobilization bandages. The applied pressure of the bandage is critical to allowing survival without necrosis. Future studies should be designed to accurately monitor the pressures applied.

Pressure Immobilization Bandages Not Indicated in the Pre-hospital Management of North American Snakebites

To the Editor, We would like to express our concern regarding the “2010 American Heart Association and American Red Cross Guidelines for First Aid” [1] which was published in the October 2010 issue of the journal Circulation. While overall the guidelines are well written and evidence-based, we strongly disagree with the recommendations regarding pre-hospital management of snakebite victims. Specifically, the guidelines recommending the application of a pressure immobilization bandage for both neurotoxic and non-neurotoxic American snakes. The authors cite a study by Bush and colleagues, which demonstrated that pressure immobilization is associated with delayed mortality in a porcine model of rattlesnake envenomation [2]. However, tissue injury and necrosis, rather than mortality, is the primary toxicity associated with North American rattlesnake envenomations. The application of a pressure immobilization bandage may exacerbate local tissue injury and, as demonstrated in Dr. Bush’s study, may increase intracompartmental pressure, creating a surgical emergency when one did not otherwise exist. It should be noted that the very paper the guidelines cite in support of this intervention concludes “on the basis of our findings, we cannot recommend pressure immobilization widely for viper envenomation” [2]. Based on the absence of evidence for improved outcome following application of pressure immobilization devices in patients with pit viper bites and the potential risk of increased tissue injury, we advise against the use of such devices. We ask that all medical toxicologists and other experts in management of snake envenomation continue to educate and advise pre-hospital providers against the use of pressure immobilization devices in North American snakebite victims.

A Localizing Circumferential Compression Device Increases Survival after Coral Snake Envenomation to the Torso of an Animal Model

Pressure immobilization bandages have been shown to delay onset of systemic toxicity after Eastern coral snake (Micrurus fulvius) envenomation to the distal extremity. To assess the efficacy of a novel compression device in delaying onset of systemic toxicity after truncal envenomations with Eastern coral snake (Micrurus fulvius) venom in a porcine model. With University approval, nine juvenile pigs (11 kg to 22 kg) were sedated, anesthetized, and intubated but not paralyzed to ensure continuous spontaneous respirations in a university animal laboratory. Each animal was injected subcutaneously with 10 mg of M. fulvius venom in a pre-selected area of the trunk. After 1 min, six animals had the application of a novel, localizing circumferential compression (LoCC) device applied to the bite site (treatment group) and three animals had no treatment (control group). The device was composed of a rigid polymer clay form molded into a hollow fusiform shape with an internal dimension of 8 × 5 × 3 cm and an elastic belt wrapped around the animal securing the device in place. Vital signs were recorded at 30-min intervals. End points included a respiratory rate below 3 breaths/min, oxygen saturation < 80%, or survival to 8 h. Survival to 8 h was analyzed using Fisher's exact test, with p < 0.05 indicating significance. Survival analysis was performed using the Mantel-Cox test to assess time to death with outcomes represented in a Kaplan-Meier Cumulative survival plot. Five of the six pigs in the treatment group survived 8 h (293-480 min). None of the control pigs survived to 8 h (Fisher's exact p = 0.04), with mean time of respiratory failure 322 min (272-382 min). Survival analysis showed a significant delay in time to event in the treatment group compared to the control group (p = 0.04). The LoCC device used in this study delayed the onset of systemic toxicity and significantly increased survival time after artificial truncal envenomation by Eastern coral snake venom.

Pilot studies of pressure-immobilization bandages for rattlesnake envenomations

Study objective. Pressure-immobilization bandages sequester venom in extremities and are recommended for snakebites without local toxicity. Pilot studies were performed to determine the time of onset of toxicity and efficacy of pressure-immobilizations bandages in a porcine model of rattlesnake envenomation. Methods. After IACUC approval, anesthetized pigs were injected subcutaneously in a distal hind leg with 200 mg of Crotalus atrox venom. After 1 min, pigs received either a pressure-immobilization bandage (N = 3) or no treatment (N = 3). At 24 h, surviving pigs received antivenin and then the pressure-immobilization bandages were removed. Surviving subjects were followed for 1 week. Chi-square analysis and paired t-test were used. Results. Pigs with pressure-immobilization bandages survived for 24 h, whereas untreated pigs died at 13.68 ± 3.42 h (p = 0.014). Surviving pigs walked on the extremity at 7 days. Potassium rose from 4.033 ± 0.252 at baseline to 17.767 ± 5.218 mEq/L (p < 0.0001) at time of death in untreated pigs but was normal at 24 h in treated subjects. Widespread tissue necrosis was seen in the untreated group but only local necrosis in the treatment group. Conclusions. Pressure-immobilization bandages prevented death from severe C. atrox envenomations with a 24 h delay to treatment. Surviving pigs had recovery of limb use at 1 week.

Pressure-Immobilization Bandages Delay Toxicity in a Porcine Model of Eastern Coral Snake ( Micrurus fulvius fulvius) Envenomation

Pressure-immobilization bandages are used in countries where neurotoxic snake envenomations are common. They impede lymphatic egress from the bite site and delay systemic venom toxicity. The effectiveness of these devices has not been evaluated in coral snake envenomations. We investigated the efficacy of pressure-immobilization bandages in delaying the onset of systemic toxicity in a porcine model of coral snake envenomation. A randomized controlled trial of pressure-immobilization bandages was conducted in a university animal care center. Subjects were 12 anesthetized, spontaneously breathing pigs, ranging from 9.1 to 11.4 kg. After injection with 10 mg of Micrurus fulvius fulvius venom in the subcutaneous tissue of the distal foreleg, subjects were randomized to receive no treatment or application of a pressure-immobilization bandage at 1 minute after injection. Treated animals had elastic bandages applied to the extremity and splinting for immobilization. Vital signs and quality of respirations were recorded. Outcome was the onset of respiratory failure or survival to 8 hours. Necropsies and histologic analysis of the envenomation site was performed. One animal from each group was removed because of the discovery of pre-existing respiratory pathology. Four of 5 pigs in the treatment group survived to 8 hours, but none in the control group survived. Mean time to onset of respiratory compromise was 170.4 +/- 33.3 minutes in the control group. None of the pigs had histologic changes at the envenomation site consistent with ischemia or pressure-related injury. Pressure-immobilization bandages delayed the onset of systemic toxicity in our porcine model of M fulvius envenomation.

Efficacy of a Pressure-Immobilization bandage in delaying the onset of systemic toxicity in a porcine model of eastern coral snake (Micrurus fulvius) envenomation

Study objectives: Pressure-immobilization bandages (PIBs) are first-aid devices that are used in foreign regions where neurotoxic elapid envenomations are common. These devices are theorized to impede lymphatic return to the central circulation, thereby sequestering venom at the bite site and delaying systemic toxicity, which allows additional time to provide the victim with definitive care in the form of antivenom and advanced airway management. Coral snakes are New World elapids with primarily neurotoxic venoms. PIB use has never been formally examined in coral snake envenomations. We evaluate the efficacy of these devices in delaying the onset of systemic toxicity in a porcine model of Micrurus fulvius envenomation. Methods: The study design was a randomized, controlled trial of PIBs in a porcine model of M fulvius envenomation. The setting was a university animal laboratory. Subjects were 12 pigs, ranging from 9.1 to 11.4 kg. The animals were sedated, intubated, and anesthetized. Volatile anesthesia was maintained by animal care technicians at a level to ensure animal comfort and that all pigs were breathing spontaneously. Lyophilized venom was obtained from Natural Toxins Research Center (Kingsville, TX) and resuspended in pure water at a concentration of 10 mg/mL. The lethal dose of M fulvius venom in a human has been estimated at 5 mg, and the venom yield of a large snake can be 20 mg. We chose a 10-mg dose to ensure that all animals would develop severe toxicity during the study. The subjects were injected with 10 mg of M fulvius venom in the subcutaneous tissue of the left distal foreleg. Immediately after injection, the subjects were randomized to either receive a PIB 1 minute after envenomation or to have no treatment. The PIB consisted of an elastic bandage applied to the entire extremity at a pressure such that a finger could be easily passed under. The same operator applied all bandages. Aluminum and foam splints were then loosely taped on either side to immobilize the extremity. Pulse rate, respiratory rate, pulse oximetry, and quality of respirations were recorded at 10-minute intervals. The primary endpoint was survival to 8 hours, and groups were compared using χ 2 analysis. Groups were also compared with respect to time to onset of systemic toxicity in the form of respiratory compromise, and total time of survival. A veterinary pathologist performed necropsies on all animals, and the histology of the envenomation site was examined. One animal from each group was removed because of the discovery of preexisting respiratory pathology. Results: Four of 5 pigs in the treatment group survived to 8 hours, but none in the control group did ( P =.0036). Time to onset of signs of respiratory compromise was 170±33.3 minutes in the control group. Two pigs in the treatment group showed signs of respiratory compromise before 8 hours, 1 at 310 minutes and 1 at 460 minutes. One of these subjects did survive to 8 hours. None of the pigs had histologic changes at the envenomation site consistent with ischemic or pressure-related injury. Conclusion: Pressure immobilization bandages were effective in delaying the onset of systemic venom toxicity in this model of M fulvius envenomation. According to this study, the use of PIBs can be recommended as initial treatment in human envenomations by coral snakes.

The use of pressure immobilization bandages in the first aid management of cubozoan envenomings

This study is aimed to evaluate whether the application of pressure results in additional release of venom from naturally discharged, vinegar soaked nematocysts of the box jellyfish Chironex fleckeri. The results show that large quantities of venom are expressed with the application of pressures similar to that applied by compression immobilization bandages. The volume of venom expressed by this pressure was similar to the quantity expressed upon initial natural discharge of the nematocysts. The current recommended practice of applying PIB to cubozoan stings might worsen the envenomation. As the existing data now show that PIB may be detrimental to victims envenomed by cubozoans, we suggest that the current practice of the use of PIB in cubozoan envenomings be discarded until there is direct experimental evidence to support its use.

Is there a role for the use of pressure immobilization bandages in the treatment of jellyfish envenomation in Australia?

The aim of this paper was to review the literature relating to the use of pressure immobilization bandages in the first aid management of jellyfish sting in Australia and to attempt to make a recommendation about their use based on the current literature. A descriptive review of all published cases of jellyfish envenomation in Australia was performed, with specific focus on the discussion of pressure immobilization bandages in the management of such cases. A Medline search was performed using the key words listed for this article. Selected articles were reviewed and further publications were identified from the published reference lists given in the selected articles. The published articles were grouped into three groups: in vitro evidence, case reports and editorial comment (either in journals or book). Fifteen references were identified that discussed the use of pressure immobilization bandages in the management of jellyfish envenomation. Other articles were identified that had significant management issues discussion. Most of the 'jellyfish' literature is in relation to envenomation by Chironex fleckeri. This jellyfish is usually found in tropical Australia and has resulted in the deaths of 67 people in Australia. The last death was near Cairns in 2000. Unfortunately, there are few good data on marine envenomations, with most of the literature being Chironex envenomation case reports. There are minimal data on the effect of pressure immobilization bandages on other jellyfish envenomations. There is no good evidence to support the use of pressure immobilization bandages in the management of jellyfish sting in Australia [corrected].