germag
Gone But Not Forgotten
Germag, you said that tourniquets shouldn't be used for crotalid bites because of the hemotoxic nature of their venom, which is no doubt true, but what have you read about using tourniquets for a coral snake bite? It seems that you'd want to prevent the spread of the venom to lessen its effects on your neurological and respiratory systems. Granted, there is a (somewhat) lesser chance of being envenomated by a coral bite than a crotalid, but you don't know to what degree you've been envenomated in the time frame that applying a tourniquet might be beneficial.
Also, you mentioned Wyeth above, but from what I've read, Wyeth is no longer being produced and there is currently (or very soon will be) no AV available for Micrurus bites in the US. Any thoughts?
Yeah, I should have mentioned that. For Coral Snake bites (as with many Elapids), a tourniquet could be of some benefit for the reasons you mentioned. However, a safer alternative might be a compression bandage covering the entire arm or leg. Tourniquets can cause a lot of unnecessary damage if not applied and used correctly. The idea here is to slow and limit the spread of the neurotoxic venom. If a compression bandage or something that could be used as one is not available, then I guess you're in the position of weighing the loss of limb against the loss of life.
Wyeth has indeed stopped production of the Coral Snake AV. In October 2008 they distributed a letter stating that they (in conjunction with the FDA) were extending the expiration date of the last-run batch (lot 4030026) from Oct. 2008 to Oct. 2009. Any remaining stock will expire in Oct. 2009. There is no alternative that is approved for treatment of Micrurus fulvius fulvius or M. f. tenere bites.
I'm not sure how this is going to shake out.....there have been only 2 deaths attributed to coral snake bites in the U.S. since the 1950s (when the AV became available). However, the standard protocol has been to immediately begin AV therapy since death can occur quickly and local symptoms may not necessarily be evident...plus one of the most insidious aspects of the venom is that once the venom sets and neurological symptoms do appear, it may not be readily reversed by the AV. The AV is very effective BEFORE neurological symptoms present. So, there have been several bites that may well have been fatalities if left untreated, but since AV was started immediately the patient recovered. After this coming October, we may see an upturn in fatalities from Coral Snake bites.
You have to work at it to get bitten by a coral snake, but it does happen.....people are not always the brightest bulbs on the tree.