Background: Pressure bandage immobilisation has remained the recommended first aid treatment for more than 40 years in Australia. However, whilst it is used in most people bitten by a snake, it is often applied poorly, and patients have been envenomed despite good pressure bandage immobilisation. We report two patients who suffered harm from this procedure.
Case reports: Two men, a 35-year-old and a 44-year-old, were bitten by snakes. Both had a prompt application of pressure bandage immobilisation, and both reported significant pain requiring opioid analgesia whilst being transferred from remote Australia to Cairns Hospital, Queensland. There were substantial delays (9.5 h and 7.5 h) before the pressure bandage immobilisation was released. As a result, both patients developed severe rhabdomyolysis (33,600 U/L and 16,800 U/L [normal < 171 U/L], respectively); there was no evidence of systemic envenoming. The 35-year-old developed a compartment syndrome that required urgent and repeated surgery. The 44-year-old has ongoing foot paraesthesia two years after the bite.
Conclusion: With limited good evidence of benefit, and many issues with its use, I recommend that pressure bandage immobilisation as a first aid measure for snakebite in Australia needs to be re-examined.
Keywords: Snakebite; first aid; pressure bandage immobilisation.