Is it recommended to apply a tourniquet (a tight bandage) after a snakebite?

Tourniquets Should Not Be Applied After Snakebites

The use of tourniquets to treat snake bites is potentially harmful and is not recommended. 1 Tourniquet application has been found to be ineffective or to worsen local tissue injury in systematic reviews of human and animal studies.

Current Guidelines on Snakebite Management

The 2024 American Heart Association (AHA) and American Red Cross Guidelines for First Aid provide clear recommendations for snakebite management:

1. Emergency medical services activation - Emergency services should be activated immediately for any person bitten by a venomous or possibly venomous snake 1

2. Rest and immobilization - It is reasonable to rest and immobilize the bitten extremity and minimize exertion by the person who was bitten, as long as this doesn't delay access to emergency medical care 1

3. Remove constricting items - It is reasonable to remove rings and other constricting objects from the bitten extremity 1

4. Harmful interventions to avoid:

   • Tourniquets 1
   • Pressure immobilization bandaging 1
   • Suction (with or without incision) 1
   • Application of ice 1
   • Electric shock therapy 1

Why Tourniquets Are Harmful

Tourniquets were once recommended but are now known to be potentially dangerous for several reasons:

1. Tissue damage - Tourniquets can cause gangrene distal to the application site 1

2. Systemic complications - They can lead to shock and even death if left on too long 1

3. Venom bolus effect - When a tourniquet is removed, a sudden bolus of venom can enter circulation, potentially causing rapid deterioration 2, 3

4. Worsened local injury - Systematic reviews show tourniquets can worsen local tissue injury at the bite site 1

5. Risk of limb ischemia - Tourniquets can lead to limb ischemia and in severe cases may necessitate amputation 4

Special Consideration: If a Tourniquet Is Already in Place

If a patient presents with a tourniquet already applied:

1. Do not remove immediately - Avoid immediate removal until prepared to manage acute toxicity 2

2. Start antivenom first - Begin antivenom administration before gradual tourniquet removal 2, 3

3. Gradual removal - Loosen the tourniquet gradually while monitoring for signs of decompensation 3

Recommended First Aid Approach for Snakebites

1. Call emergency services immediately 1

2. Keep the victim calm and minimize movement - Activity can increase venom absorption 1

3. Immobilize the bitten extremity - This is the simplest, safest approach while awaiting emergency services 5

4. Remove jewelry and constricting items from the affected limb 1

5. Position the bite site at or below heart level to reduce venom spread

6. Mark the leading edge of swelling/tenderness on the skin and note the time

7. Do NOT apply ice, cut the wound, apply suction, or use electrical devices 1

Key Pitfalls to Avoid

1. Outdated first aid techniques - Many traditional approaches (tourniquets, suction, ice) are now known to be harmful

2. Delay in seeking medical care - The definitive treatment for snakebite is antivenom, which is only available in medical facilities 1

3. Excessive manipulation of the bite site - This can increase venom absorption

4. Attempting to capture or kill the snake - This puts the victim or others at risk of additional bites

Remember that the definitive treatment for snake envenomation is antivenom, which is not available in first aid settings. The primary goal of first aid is to safely transport the victim to medical care while minimizing venom spread and maintaining vital functions.