I hope I am allowed to do this - post below from Dr Willie Barnard, a very knowledgeable medical doctor when it comes to snakebites in SA!!
Post from another forum
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I had an interesting case of mamba bite this past weekend.
I believe certain lessons can be learned by hunters, outdoorsmen and gunsiters in general.
The case:
58 year old farmer bitten on left ankle (twice), by what he described as "a 12 feet mamba". This happened at exactly 15h02 while he was alone in the bush, checking on the solar panels of a water pump. The grass was very dense and about knee height. The mamba slithered away.
At the time his farmhands were in the vicinity looking for cattle. He was about 10 km from the farmstead, cellphone reception patchy.
By sheer luck, he managed to get hold of a friend on the phone, told her about the incident, and asked her to call the ambulance.
He pressed the hooter of the bakkie, to summon the farmhands, one of whom knew how to drive. They eventually came, and they started off for the farmstead. From the farmstead the farmers wife took over the driving.
The victim felt anxious, and had an inability to swallow, and he felt short of breath. (Within minutes of the bite.)
About 50 minutes after the incident the victim was taken on board the ambulance on the tar road towards Lephalale. In the ambulance he was given medical oxygen, but was still able to breathe. An (ineffective) tourniquet (leather belt) was also applied.
At 17h00 - 2 hours after bite arrived at hospital where anti-allergic (prophylactic against antiserum allergy) was administered, followed by 2 ampules of polyvalent antivenom. All intravenous . Tourniquet was removed. 18h00 -doctor administered another 2 ampoules of antivenom slowly IVI.
18h30 allergic reaction to antivenom noted, and successfully treated with IVI adrenalin.
Patient extremely restless with dysarthria (inability to articulate words),
dysphagia (inability to swallow) and ptosis (drooping eyelids).
However he never needed artificial ventilation - managed an oxygen saturation of 96% on oxygen mask only.
The site of the bite where two pairs of puncture marks were clearly visible, was on the left ankle. There were blood drops on the socks that were penetrated by the fangs. The leg developed severe swelling and pain, similar to cytotoxic venoms such as Mozambique cobra.
Kept in hospital for three days and discharged on antibiotics.
(For the cellulitis of the leg.)
The questions: (often asked by hunters):
1-Which SA snakes are the most life-threatening?
2-How much antivenom must I keep in stock, and how should it be administered?
3-What is the place of a tourniquet in treatment of snake bite?
4-What other steps can the hunter practically take?
5-How long after a mamba bite before I die?
6-Where do we take the patient?
I do think this case study give some answers.
1 There is little doubt that the black mamba is the most life threatening of SA snakes. All snake bites are unique though. In this case, the single lifesaving factor was probably the sock that prevented a deep-penetrating full dose of venom.
2 I very seldom recommend hunters and farmers to keep the antivenom at home. The exception would be a hunting camp very remote : 6 hours + from hospital, and a hunter willing and able to get some training in the use of the different medications. (Not only antivenom, adrenalin as well.)
In this case the availability of antivenom at the farmstead would have had the following consequences: i) It would have robbed them of valuable evacuation time. ii) It would have increased the level of anxiety in everybody with inexperienced people trying to administer it. iii) It might have caused the allergic reaction before reaching the hospital.
3 The tourniquet's value is ONLY in the case of a life threatening bite (Mamba and maybe cape and snouted cobra), where the victim have no access to artificial ventilation and speedy evacuation, and makes a conscious decision to sacrifice a limb. Only a rubber tourniquet will do.
In this case the use of a leather belt was fortuitous, because it did not cut off the blood supply, and therefore serious complications was inadvertantly avoided. It also demonstrated the uselessness of non-rubber tourniquets.
4 A means of communication as a medical precaution is often overlooked, yet this probably saved this farmers life. (summoning the ambulance.)
The second most important precaution would be the availability of equipment and skills to provide artificial respiration. This can be as simple as a small one-way hygienic mask, or a full ambubag with mask. Oxygen cylinders are not necessary, very heavy, and expensive.
5 With a full blown mamba bite, this patient would probably have full respiratory paralysis 30 minutes after the bite, and be dead 5 minutes later. (Untreated) With an ambubag, and a skilled user at the farmstead, death could be avoided.
6 Where you take the patient, depends on the facilities in your area. But find out, and have your plans in place long before the incident.
PRACTICAL WAYS TO AVOID DEATH BY SNAKE BITE:
1 Try to avoid being bitten.
2 Dont hunt alone, groups of three are preferrable: No1 to be victim, No2 to be first-aider, no3 to be driver. As you cannot choose No1, everyone should be able to use ambubag, and to drive.
3. If you hunt alone, carry a rubber tourniquet, and be mentally prepared to use it and know the consequences. (That is the price you pay for the euphoria of hunting alone.)
4. Have a means of communication at hand.
5. Have an evacuation plan and destination planned.
I hope this post could maybe help some hunters out there.
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