Case report : safe tourniquet removal in black mamba (Dendroaspis polylepis) bites

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.