What prehospital care interventions are ineffective and possibly harmful?

Updated: Apr 09, 2021
  • Author: Spencer Greene, MD, MS, FACEP, FACMT, FAAEM; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

Most of the interventions that had once been proposed to treat snakebites in the prehospital environment have failed to show benefit, and many have proven to be harmful. Tourniquets were once recommended, but the harm of compromising arterial blood supply is much greater than any benefit in limiting the spread of venom. Methods of obstructing lymphatic flow (eg, constriction bands, pressure immobilization) were also once touted because they may limit systemic absorption of venom. However, they also expose the local tissue to venom for a longer duration and increase the local hydrostatic pressure that contributes to tissue injury. [43] The American College of Medical Toxicology issued a position statement condemning these interventions whenever tissue damage is expected. [44] Pressure immobilization may be considered in envenomations from exclusively neurotoxic snakes (eg, Eastern coral snakes. [45]

Electrical therapy has been proposed to treat snakebites as well as other envenomations, but there is no evidence that it neutralizes venom. [46] Furthermore, there is ample evidence of harm, including burns, hypopigmentation, and death. [47]

Prolonged cryotherapy also does not appear to offer any benefit and may be harmful to tissue. Animal studies have indicated that local cooling may increase tissue injury without improving mortality. [48, 49] Anecdotally, some snakebite victims report relief following cold application. It is reasonable to consider using icepacks briefly (eg, 5 min on for every 15-20 min), but prolonged application is discouraged.

Surgical intervention such as excising the affected tissue and “cutting and sucking”, in which an incision is made and then someone uses his or her mouth to “suck” out the venom, confers no benefit and potentially worsens outcomes by causing a bigger wound and introducing mouth flora into the tissue. [50]

The prehospital intervention for which there still seems to be much popularity, despite evidence that it is harmful, is venom extraction. Various commercially available suction devices promise to remove venom if applied shortly after the envenomation. However, the amount of venom they can remove is negligible. In an animal study using radioactive-labeled mock venom, these devices removed 0.04-2% of the envenomation load. [51] In a different animal study, tissue damage was increased following application of the negative-pressure device. [52] An editorial summarizing the use of extraction devices concluded that the risks of harm greatly outweigh any benefits and their use should be abandoned. [53]


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