LYMPHATIC FLOW-RATES AND FIRST-AID IN SIMULATED PERIPHERAL SNAKE OR SPIDER ENVENOMATION

Objectives: To demonstrate and define normal lymphatic transit times by lymphoscintigraphy and to evaluate the efficacy of the currently recommended first-aid measures for the management of snake or spider envenomation. Setting: The nuclear medicine department of a major teaching hospital. Participants and design: Twenty-four subjects received either intradermal or subcutaneous injections of (99m)technetium antimony sulfur colloid (0.1 ml) in both hands/forearms and feet/legs. This simulated a snake or spider bite, Fifteen of the subjects had first-aid in the form of firm bandages and splints applied to an upper and a lower limb immediately after injection. Main outcome measures: The progress of the radiotracer was followed with a large field of view gamma camera. If no egress of radiotracer was seen in the bandaged limbs, the subject walked until radioactivity was detected. Results: The mean (+/- SEM) periphery-to-systemic circulation transit time after subcutaneous injection was 58 (+/- 7) minutes. The first-aid was found to be very effective when applied with bandage pressures ranging from 40 to 70 mmHg (5.3-9.3 kPa) in the upper limb and 55 to 70 mmHg (7.3-9.3 kPa) in the lower limb. Lower and higher bandage pressures were ineffective. However, despite first-aid measures, egress of radiotracer, even in the upper limbs, was seen in all subjects who walked for 10 minutes or more. Conclusions: Firm pressure bandaging is an effective means of restricting the lymphatic now of toxins after envenomation, provided the bandage is applied within the defined pressure range. Strict limb immobilisation is necessary to minimise lymphatic now, and walking after upper or lower Limb envenomation will inevitably result in systemic envenomation despite first-aid measures.