Snakebites worldwide: Management
停用原因. 某些蛇毒可能導致凝血功能異常, 避免飲用酒精和服用會干擾臨床判斷的藥物, 例如抗凝血劑, 阿斯匹靈, NSAID, 乙型阻斷劑 BETA BLOCKER.
Withhold all alcohol and any drugs that may confound clinical assessment or interfere with treatment (eg, anticoagulants, aspirin, nonsteroidal antiinflammatory medications, or beta blockers).
FIRST AID — Initial first aid of snake envenomation is directed at reducing the spread of venom and expediting transfer to an appropriate medical center.
General principles — Although evidence is limited, the following general principles for first aid of snakebite victims are agreed upon [2-5]:
●Remove the patient from the snake's territory. Keep the patient calm and at rest, remaining as still as possible.
●Attempt to identify the snake only if it is safe for the patient and the rescuer, and it will not delay transport of the patient to definitive medical care. Snake parts should not be handled directly. The bite reflex may remain intact in recently killed snakes and permit further biting [3]. A digital photo taken at a safe distance may be useful.
●Remove any jewelry from the affected extremity. Footwear can be removed, but other clothing can be left alone, unless clearly tight and causing circulatory compromise.
●Immobilize the injured part of the body in a functional position (table 7 and figure 1). Limited evidence exists regarding the recommended height of the bite wound relative to the level of the heart. Expert recommendations vary according to the expected degree of local injury compared to systemic toxicity. In regions where venomous snakebites result in significant local tissue damage with important but less common systemic effects (eg, North America), the bite wound may be placed at the level of the heart to manage local swelling but not encourage systemic absorption. However, in settings where neurotoxicity is likely and local tissue effects are of secondary concern (eg, Australia), the bite wound should be kept below the level of the heart to slow lymphatic venom absorption.
●Fashion a splint out of any rigid object (eg, padded piece of wood or tree branch, rolled newspaper, sleeping bag pad, or backpack frame) and apply to the extremity as follows:
•Splint the leg posteriorly in extension immobilizing the ankle and the knee.
•Splint the arm to the elbow and apply a sling.
●Transport the patient to the nearest medical facility as quickly as possible.
●Do not allow the victim to walk because exertion and, with bite wounds on the lower extremity, local muscle contraction may increase snake venom absorption.
●Do not manipulate the wound except to permit gentle bandaging or, if indicated, pressure immobilization or placement of a pressure pad. If transport to definitive care will take a prolonged period of time and a venom detection kit will not be used (countries other than Australia and Papua New Guinea), then gentle cleansing can be performed. (See 'Pressure immobilization' below and "Snakebites worldwide: Clinical manifestations and diagnosis", section on 'Venom identification'.)
●Withhold all alcohol and any drugs that may confound clinical assessment or interfere with treatment (eg, anticoagulants, aspirin, nonsteroidal antiinflammatory medications, or beta blockers).
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