Early and late removal of the pressure bandage in brown snake envenomation: a report of two cases.
Two cases of brown snake envenomation are presented where the duration of bandage application in one patient was prolonged compared with the other patient and was associated with a reduction in the total amount of antivenom required. One patient had the bandage removed 2 hours and twenty minutes after application and required 25 units of brown snake antivenom to neutralise the defibrination coagulopathy and manage an upper gastrointestinal haemorrhage. This patient also sustained an urticarial reaction during administration of the final 5 vials of antivenom. The other patient had the bandage released more than 22 hours after its application and only required a total of 6 units of brown snake antivenom to neutralise the defibrination coagulopathy. In the latter case, there was no reaction to any of the vials of antivenom These cases suggest that bandage release could be delayed well beyond the usual recommended time to effect a reduction in peak and cumulative venom levels and antivenom requirements.
Intensive Care Unit, Fremantle Hospital, Fremantle, Western Australia. david.simes@health.wa.gov.au
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Simes