Black mamba bite

[SBB]

I took a bend late last year and a cape cobra was in the road. Too late to react and as it stood up i lifted my legs and tried to centre it with the bike ( BMW adventure bike ). After going over it i stopped to check if id been bitten as i was in the middle of nowhere. Luckily not. If id gone left or right i think it would have had more movement to strike.

Nerve racking.

[LukeS]

Thanks for sharing Doc.

Mamba bites are nothing to sneeze at.

Doc if transit time is long would you advise tourniquet rather than compression bandage?

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Negative pressure bandage, splint limb and assist breathing if necessary.

Get to definitive care asap! No tourniquet.


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[Spliffcat]

Only one person i know she was bitten between the boobs by a black mamba, huge luck as it was a dry bite. We all thought it was game over. She did not even get a headache.
Black Mambas are very fast. I have seen the mouth hurtling at me at speed. Managed to jump out of the way thr first time as I was expecting the strike. Second time the snake had a bite at the bonnet of a Land Rover on a tweespoor bush path. Be careful out there guys.

[LukeS]

As per the African Snake bite institute:

Do not apply a tourniquet: Snake venom is absorbed by the lymphatic system, not through the blood system. Tourniquets may concentrate the venom at the site of the bite, especially with cytotoxic bites, and can promote necrosis and cause severe tissue damage. A tourniquet may even result in the need to amputate if left on for too long.


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[Spliffcat]

Pressure bandage and treat symptoms. Get pro help asap.

[Willie Barnard]

Thanks for all the well wishes. Ddeswardt is right about the antivenom.
LukeS is right about the respiratory support and fast evacuation.
Tourniquet ONLY when the victim is alone, needs to evacuate himself, and has been bitten on a limb by neurotoxic snake.
(Black and green mamba, snouted cobra and cape cobra.)
Then tourniquet should be rubber and tight enough to cut of arterial blood flow. If victim can reach phone signal, and summon help within 30 minutes, dont use the tourniquet.

Much more important to equip yourselves with BVM Resussitator (ambu bag) and know how to use it.

Much has happened here - update in next post.

[Willie Barnard]

On Friday night at 18h00 and again at 23h30 I saw him and everything seemed okay.
Was complaining a bit about swollen throat at last visit.
Gave some cortisone again. Was looking forward to discharging him the next day.

Saturday morning 04h00: CRISIS
Oxygen saturation dropped, had to resuscitate, intubated, ventilated. Lots of secretions sucked from lungs.
Adrenalin given again, blood gas analysis showed low pH. Soda-bic given.
Transfer to ICU arranged, managed to get some really competent ambulance staff for transfer.
(Helicopter cannot fly because of all the rain in Pretoria)

Reached ICU at 13h30. He is okay there, on ventilator, but I think he will survive.

What happened? I thought it was the allergic reaction. The ICU specialist thinks it was still the effect of the mamba venom causing paralysis.
I gave it a rethink, and am thinking along the lines of Acute respiratory distress syndrome (ARDS). This can be caused by the antivenom, or by the combination of stressors.

Lesson: "There are no routine mamba bites."

[Andrew Leigh]

Bloody hell Willie, must be nerve wracking times. Just when you think all is well the poor patient hits the wall again. Hoping for a successful outcome.

[CZ Fan]

There are only two types of anti venom for South African snakes. Polyvalent and monovalent
Monovalent anti venom is made only for boomslang bites. This antivenom is kept at Ondersterpoort and is only shipped out to confirmed boomslang bites. Mono = 1

Polyvalent is kept by most hospitals and made from a blend of all the other serious snakes such as Mambas, cobras, adders. It is an all in one anti venom if you like. Poly = many.

So the anti venom used to treat a Mamba bite is the same as the anti venom used to treat a puff adder bite or Rhinkals bite etc.

Interesting, you learn something new every day, thank you

Well done Doc, thoughts with patient that he makes it through without too much damage

[Yeti]

A very interesting read. thank you very much for sharing.

Im rather curious, in circumstances like this, does the mamba strike at the whole moving entity and its simply bad luck that the person gets bitten?

Or could the mamba just as likely got itself caught up in the wheel spokes or chain etc?