Abstract:
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 departmentmayprecipitate a life-threatening venomandmetabolic
toxin rush, leading to respiratory arrest.We present two cases of blackmamba bites inGauteng, South Africa,where
gradual tourniquet removalwas used to avoid a venomrush andrapidrespiratory paralysis.Venomandmetabolic toxin rush
with potentially fatal respiratory muscle paralysis may be averted by gradual, cautious removal of field-applied tourniquets
with concomitant antivenom administration.
