Pelle, Ratang PholoshoEngelbrecht, AndreasLalloo, Vidya2022-06-302022-06-302021Pelle, R.P., Engelbrecht, A. & Lalloo, V. 2021, 'Case report : safe tourniquet removal in black mamba (Dendroaspis polylepis) bites', American Journal of Tropical Medicine and Hygiene, vol. 106, no. 1, pp. 338-341, doi : 10.4269/ajtmh.21-0374.0002-9637 (print)1476-1645 (online10.4269/ajtmh.21-0374https://repository.up.ac.za/handle/2263/86003The 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.en© 2022 by The American Society of Tropical Medicine and HygieneNeurotoxic venomBitesTourniquetBlack mamba (Dendroaspis polylepis)SnakebiteTourniquet RemovalVenomous BitesEmergency MedicineClinical Case ReportToxicologyEnvenomationSouth AfricaFirst AidHealth sciences articles SDG-03Health sciences articles SDG-15SDG-15: Life on landHealth sciences articles SDG-17SDG-17: Partnerships for the goalsArticle