First

The aim of first aid is to delay absorption of venom from the bite site until the patient is in a facility that can administer antivenom if required. 8 The pressure-immobilization method described below is used for elapid bites because they do not manifest much local soft tissue swelling. This technique is not recommended for crotalid bites because the immobilization dressing causes severe pain when swelling develops.1 13 All patients should immediately have the bitten extremity wrapped in a snug elastic bandage from either the ankle to the hip or the wrist to shoulder. The bandage should be applied as if to a sprained joint; if it is too loose or too tight, it will be ineffective.13 The idea is to contain the venom and prevent systemic absorption. The limb is splinted to prevent motion. The patient should rest until help arrives. Examination of lymphatic flow rates with simulated venom has demonstrated that even if the upper or lower limb is appropriately bandaged and immobilized, walking will hasten systemic envenomation.13 Tourniquets are an outmoded therapy and are contraindicated because they obstruct arterial flow and add ischemia injury to venom injury. In the rare circumstance that a bite is inflicted on the trunk, firm pressure should be applied without restricting breathing.

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