Pressure immobilization dressing

Background

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

Indications

• 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

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

• Snake Bites
• Funnel-web spider bite