not. The victim’s condition provides the best information as to the seriousness of the situation. The aims of first aid for envenomated snakebites are to reduce—not stop—the circulation of blood through the bite area, delay absorption of venom, prevent aggravation of the local wound, maintain vital signs, and transport the victim as soon as possible to an MTF with minimum movement. TREATMENT OF SNAKEBITES.—The proper steps in the treatment of snakebites are listed below. 1. Try to identify the snake. Positive identification is important to selecting the correct antivenom for the treatment of the patient. NOTE: Do not risk further injury by trying to kill the snake. 2. Certain suction extractors have benefit (for example, the Sawyer extractor), especially if used within the first 3 minutes. If available immediately, use the extractor and leave it on for 30 minutes. The cups may fill up. Empty and re-use them as necessary. 3. GENTLY wash the wound with soap and water (it may remove some of the venom). Do NOT rub vigorously, as it may cause the venom to be absorbed more rapidly. 4. Place the victim in a comfortable position. 5. Tell the patient to remove any jewelry (especially rings and bracelets, as these may impede blood flow if there is swelling of the extremities). Assist, if necessary. 6. Start an IV line. 7. Monitor vital signs (including ABC+D&Es) closely, responding appropriately as necessary. 8. Until evacuation or treatment is possible, ensure the victim lies quietly and does not move any more than necessary. 9. Do not allow the victim to smoke, eat, or drink any fluids. (Water is permissible if you anticipate more than several hours will pass before arriving at a hospital and being able to establish an IV line.) 10. Transport the victim to a hospital or other appropriate facility. 11. Place a lymphatic (light) constriction on the extremity (if the bite is on an extremity). The goal is to obstruct lymphatic—not blood-flow. (See instructions below.) DO NOT USE A TOURNIQUET! 12. Splint the extremity at the level of the body (heart). DO NOT ELEVATE THE EXTREMITY! 13. Hospitalize and observe all snakebites for at least 24 hours. In the case of spitting cobras (found in Africa, Thailand, Malaysia, Indonesia, and the Philippines), which attempt to spray venom into victims’ eyes, rinse the eyes with large volumes of water (neither a blast nor a trickle, and not with hot water). Apply antibacterial (tetracycline or chloramphenicol) eye ointment, and apply a patch with just enough pressure to keep the eyelid from blinking.) Other aid will be mainly supportive:  Check pulse and respiration frequently. Give artificial ventilation, if necessary.  Treat for shock, including IV fluids (normal saline or lactated Ringer’s solution).  When possible, clean the area of the bite with soap and water, and cover the wound to prevent further contamination. 5-13 LYMPHATIC CONSTRICTION INSTRUCTIONS An appropriate lymphatic constriction device is a blood pressure cuff, inflated to the diastolic blood pressure (so the blood can be felt flowing past the cuff). Other devices may be used, but IT IS IMPORTANT THAT BLOOD CIRCULA- TION TO THE BITE AREA BE MAINTAINED. Constriction should be fully released every 30 minutes for 15 seconds. If the constriction pressure cannot be carefully controlled, THE MAXIMUM TOTAL TIME OF USE OF THE CONSTRICTION DEVICE IS 2 HOURS. (Thus, three 15-second breaks, and the fourth time the cuff, belt, or band remains OFF.) NOTE: If you use a blood pressure cuff (or device that you KNOW is not constricting more than an Ace7 bandage on a sprain), you may continue to apply constriction until the patient reaches a hospital.