Snake bite treatment - Rectogesic ointment

[slparker]

Thanks for attaching the PDF of the original study article. I agree this looks promising but I'd just like to add a couple of points.
At this stage, there is no recommendation as to the amount or rectogesic (dosage), area (in e study the ointment was applied proximally to the bite), requirement for PIM placement before, during or after the application of ointment, reapplication or (more importantly) duration of effect.
How might the duration of effect of GTN ointment affect snake envenomations? GTN has a short half life, that means It wears off very quickly, what are the consequences physiologically if this means a sudden increase in venom dumped into the lymphatic system? Particularly if the PIM has been ignored or ignorantly applied. Rectogesic is an ointment which means that the GTN would be held in suspension and theoretically slowly leach the drug subcutaneously. How variable is this dosage? What are the clinical effects of variability? The answer to these questions is that we don't know yet.

This is why it's important to wait until clinical guidelines are developed before you leap to enormous conclusions about the safety or efficacy of a new treatment.
I'd hate to read in the papers that a reader of this forum was severely envenomated and suffered deleterious consequences because they applied a treatment based upon one paper, or worse delayed or I appropriately applied a known effective treatment.
It is negligent to recommend any treatment until full understanding of its effects under a range of conditions is tested. Landsailor, you state that you contacted the authors of the paper, did they actually recommend that this treatment be implemented in the event of snakebite envenomation? If so can you tell me which researcher recommended it, I'd be interested to communicate with him/her.
If not, on what basis do you recommend it?

Yes, in two years time this may prove to be a safe and efficacious treatment, I have strong suspicions tha the authors of this article are on to something. I also caution readers that using a pharmaceutical to treat snakebite may have unintended consequences for the victim. But, by all means experiment upon yourselves -we may get some interesting data that way.

FYI, I am not a toxicologist I am a crit care nurse and have treated snakebites in the field, including using a snakebite detection kit, and also in ICU hours post-envenomation. I am not an expert in toxicology which is why I tend to rely on those that are and use caution and clinical judgement before experimenting on humans with new treatments. Would I use rectogesic? Not yet. Why not? Because PIM applied early works.

[LandSailor]

It is negligent to recommend any treatment until full understanding of its effects under a range of conditions is tested. Landsailor, you state that you contacted the authors of the paper, did they actually recommend that this treatment be implemented in the event of snakebite envenomation? If so can you tell me which researcher recommended it, I'd be interested to communicate with him/her. If not, on what basis do you recommend it?

The word "recommended" were my words which Ive now since updated in my original post to be more objective. This is all based on a personal email to me only.
It would not be fair to hold the researcher to account as no doubt he would have chosen more careful language for a public forum.

Anyway, slparker have sent you a PM on this. Cheers for all the good info...Ive certainly reached the limits of my knowledge on this particular issue ; )

[corvus]

We do tend to get a bit excited with Snake Bite on this forum check this out
http://www.bobinoz.com/blog/2011/austra ... continued/
corvus

[GPSGuided]

Redirected from the 'First Aid Kit' thread.

Interesting study but more data needed before consideration for mainstream. For a start, a snake bite is often more complex than just exposure to sole lymphatic drainage areas. It can involve the venous and arterial vessels as well. As such, the effect of nitro must not be considered on lymphatic flow alone, even if it may be the major contributor. The present study focused on the lymphatics alone. Whilst a good study but it's insufficient to alter clinical management at this point. We need to understand more and to have the data for the exact indication for such administration (if truly beneficial) as well as potential contra-indications.

[slparker]

I have contacted the Vic poisons Info centre and the author of the aforementioned study on the use of GTN ointment (rectogesic) for snakebite.

The victorian poisons information centre recommends the use of the Pressure Immobilisation method, in line with the Australian Resuscitation Council website. GTN is not recommended for pre-hospital or inpatient care of snake envenomation.

The co-author of the rectogesic study stated to me that Pressure immobilisation should be used as
'when it is applied correctly it can near completely inhibit venom movement into the circulation (this is certainly upheld by our animal model studies).' however, he goes on to state that theoretically GTN ointment should help in cases where the PIM is not applied correctly'.

The use of GTN ointment as an adjunct therapy (ie with PIM) has theoretical benefit, although I caution that the studies are very limited and in the aforementioned study the ointment was applied contemporaneous with the envenomation, certainly not a circumstance always applicable in the real-world treatment of snakebite. There are known dangers with GTN ointment usage, particularly in cardiovascularly unstable casualties.

In summary: PIM works (in retrospective studies and in animal modelling with envenomatiomn of pigs) to slowdown the systemic envenomation of snakebite. You are better off learning to apply the PIM well than to adopt theoretical modes of treatment. In order to treat a snakebite well do a wilderness first aid course is my advice...