Pressure immobilization dressing

Background

  • Type of field dressing developed and used in Australia primarily for elapid bites[1]
  • Theoretic reduction in systemic toxicity[2]

Indications[3]

  • Only useful in extremity bites
  • Neurotoxic Elapidae (Coral Snakes) bite (mamba, king cobra, taipan, etc.)
  • Sea snake bike
  • Funnel-web spider bite
  • Consider in: large snake size, particularly lethal species, prolonged fang contact, small patient size, prior exposure to venom

Considerations Before Application

  • Not indicated in Crotaline (Pit Vipers) bites (ie. rattlesnake).
  • Consider plan for extricating the patient
    • Patient must be carried out of the field once dressing is in place
    • The dressing must not be taken down until the patient has reached definitive care. Removing the dressing may release a bolus of venom and antivenom should be immediately available.

Technique

  • Place the extremity in a neutral position
  • Use an elastic or crepe bandage to wrap the entire affected extremity (distal to proximal)
  • Wrap very firmly, with the same pressure used to splint a sprain, but not so much as to obstruct distal pulses.
  • Continue to wrap the extremity to a rigid splint (ie. dowel) to immobilize.
  • Extricate the patient
Australian Pressure Immobilization Technique[4]

Limitations

  • Insufficient pressure applied by provider
  • Challenging to self-administer
  • Contraindication to self-extricate once applied
  • Contraindication to remove until antivenom available
  • Inadequate study in use of necrotic Crotaline (Pit Vipers) envenomations. Contraindicated at this time.

See Also

References

  1. ↑ Robert L. Norris, Sean P. Bush, Michael D. Cardwell. Bites by Venomous Reptiles in the United States, Canada, and Mexico. Paul S. Auerbach. In: Auerbach’s Wilderness Medicine. 7th Ed. 2017: 742.
  2. ↑ Robert L. Norris, Sean P. Bush, Michael D. Cardwell. Bites by Venomous Reptiles in the United States, Canada, and Mexico. Paul S. Auerbach. In: Auerbach’s Wilderness Medicine. 7th Ed. 2017: 742.
  3. ↑ David A. Warrell. Bites by Venomous and Nonvenomous Reptiles Worldwide. Paul S. Auerbach. In: Auerbach’s Wilderness Medicine. 7th Ed. 2017: 816-818.
  4. ↑ Robert L. Norris, Sean P. Bush, Michael D. Cardwell. Bites by Venomous Reptiles in the United States, Canada, and Mexico. Paul S. Auerbach. In: Auerbach’s Wilderness Medicine. 7th Ed. 2017: 742.
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