Emergency Medicine, University of Pretoria, Pretoria, South Africa.
Am J Trop Med Hyg. 2021 Nov 1;106(1):338-341. doi: 10.4269/ajtmh.21-0374.
The black mamba is known for its notorious potent neurotoxic venom. For this reason, their bites are often erroneously treated in the field with the application of a tourniquet in the hope of delaying systemic spread of the venom. Observational studies have shown that inappropriate tourniquet application is a common, harmful practice. An arterial tourniquet is not a recommended first aid measure because of the risk of limb ischemia and gangrene. When inappropriately applied, the rapid removal of the tourniquet in the emergency department may precipitate a life-threatening venom and metabolic toxin rush, leading to respiratory arrest. We present two cases of black mamba bites in Gauteng, South Africa, where gradual tourniquet removal was used to avoid a venom rush and rapid respiratory paralysis. Venom and metabolic toxin rush with potentially fatal respiratory muscle paralysis may be averted by gradual, cautious removal of field-applied tourniquets with concomitant antivenom administration.
黑曼巴蛇以其臭名昭著的强效神经毒液而闻名。出于这个原因，它们的咬伤在野外经常被错误地用止血带处理，希望能延缓毒液的全身扩散。观察性研究表明，不合适的止血带应用是一种常见的、有害的做法。动脉止血带不是推荐的急救措施，因为有肢体缺血和坏疽的风险。当止血带应用不当，在急诊科迅速移除止血带可能会引发危及生命的毒液和代谢毒素爆发，导致呼吸停止。我们在南非豪登省报告了两例黑曼巴蛇咬伤病例，在这些病例中，逐渐移除止血带以避免毒液爆发和快速呼吸麻痹。通过逐渐、谨慎地移除现场应用的止血带并同时给予抗蛇毒血清，可以避免毒液和代谢毒素爆发，从而避免潜在致命的呼吸肌麻痹。
