".....just an anatomist!" I am not a doctor either sir but your modesty reflex needs some attention urgently in my opinion. You have brought anatomy to the world of 21st century in an informative and entertaining way. What more could we ask? By the by is the same anatomical process involved with bee and wasp stings? Blessings and peace
I don't know about bee and wasp stings. They tend to be limited to local actions in humans. The venoms are similar and different - is it a volume thing maybe?
@@SamWebster I wonder! I only remember being stung by a wasp once (when a fellow kid at school had done unmentionable damage to the soon-to-be ex insect which took it's revenge on my unsuspecting finger!) That was the last time I picked up a friend's jacket that had fallen on the floor!
@@SamWebster In Hymenoptera stings, allergies of some description are the first thing that comes to the mind of victims and clinicians. Hymenoptera venom is extremely antigenic and has specific venom components that triggers the release of vasodilators and trigger Mast cell degranulation, just to mention a few. In a mass stinging event apart from the dangers of a immune response, one has to consider systemic envenomation, after all, bees, wasps ants (not all) etc. are venomous. Symptoms maybe considerably delayed, 24 hours but the onset of fatigue may signify underlying life threatening symptoms, such as haemolysis, rhabdomyolysis, secondary renal failure or hepatic injury. In some exotic species, coagulopathy has been recorded.
Love the style of presentation, relaxing, jovial and informative. Just for added information; the swelling that you see in some snakebite envenomations is not an inflammatory response but rather a direct effect of toxins within the venom. Some of these toxins cause cell-lysis and or increase blood vessel permeability, the latter not only at a local level, but also systemically too. Interesting research has shown that capacity of lymph vessels to increase internal pressure (50mmHg) even when the limb is immobilised or when lymph flow is restricted.
Hi Sam, As a person that has applied a PIB a number of times as I work with venomous snakes in Australia (for the last 25 years), I can attest that when correctly applied, along with immobilisation it's quite incredible how effective it is. On two occasions I was asymptomatic until the bandage was removed. Minutes after the bandage is removed you sometimes feel a wave as nausea, ptosis and headache all hits. Not a fun experience! Fantastic video and one that I would like to show during some of my venomous snake management courses if possible?
I live in Australia, (North Central Victoria) and there are a lot of Eastern Brown Snakes on my farm. Prevention is the best cure! I ALWAYS wear at least mid-calf length boots (Dr Martens 1914 boots are preferred) or farm-style Wellington Boots and usually also horse-riding leather gaiters (chapettes) that take the leg protection to just below my knees. I stumbled across the gaiter thing by accident, I ride my horse and was getting chafed by my stirrup leathers. Because of that, I started wearing gaiters over my Dr Martens boots when I was riding and it was only after that, that it occurred to me what excellent snake bite protectors they might be! So, I began wearing my gaiters all the time, even when I was not planning on riding my horse. Also, an old Australian Aboriginal first aid treatment for snakebite was to make your way to a cold pool of water and jump in! Stay in the cold water for as long as you can, then get out and warm up. This definitely works, I once had a small puppy that got bitten by a snake and within minutes, it began to show effects of snakebite. I picked it up, threw it into the dam as far as I could, it swam back to shore, and I did it again. and again, and again, and again, and again! I then dried it off and warmed it up, and it was fine! That puppy lived to be an adult dog and other than never liking water, it had no ill effects from the experience! I should state that I am NOT A DOCTOR, but have spent a lot of time in Aboriginal Communities, including that my brother married an Aboriginal woman and I have Australian Aboriginal in-laws, have gone hunting in the outback with Aborigines, etc. Perhaps you'd like to investigate why this might work? My theory is that the shock of jumping into the cold water clamps down on the lymphatic system, similar to the "seal-dive response" that has been observed when small children are pulled out of freezing water after 1/2 an hour of being submerged and can be resuscitated with no ill-effects. This "seal-dive" slowing of the metabolism (basically a mild hypothermia) gives the body enough time to process and eliminate the toxin. Like I mentioned, I DON'T ADVISE ANYONE TO DO THIS, but in a situation where you are snakebit in the middle of nowhere, where there's no help coming, it might be worth a try, you might well save your life or someone else's life! After all you're going to die anyway, right? So why not? God Bless, I look forward to hearing your input and response...
Dear Sam! I’m your new fan. I got familiar with you a couple of weeks ago. Good act, good tone of speaking, nice friend of the medical students. Keep on going. I myself, introduced you to anyone I could, and love your work and especcccciiiaallly your accccceeeennnnnnnntt. Such a lovely one!
Just want to give a shout out to any adders on Kilvey hill that if I step near you it is not an invitation to bite me, no matter how strong the urge is. Thanks carry on 🐍. Good episode Sam 👍
In Australian first aid courses they teach you to apply a compression bandage stating at the bite site and working your way up the leg. The instructors cannot explain why you start at the bite and work up the lymphatics. I would have thought that this bandaging up the leg would squeeze the venom up the lymphatic system faster.
Yes you would think that but there is no sound evidence to suggest up or down first. One theory is that by applying pressure from the bite site and up, there is less chance of causing discomfort if you were to start from the top and work down (possibly pushing fluid down the limb and causing discomfort). One has to bear in mind that the application of the pressure bandage should be done as quickly as possible, within 15 mins but sooner is preferable. The quicker you do it, the likelihood is that the venom is still in the tissue at the bite site and hasn't started to move yet, therefor your concern/question wouldn't technically be an issue.
Great talk! It was shared in a FB group on envenomations, and I would DEARLY love to hear how you would modify it if you ever talked with Dr. Spencer Greene at Baylor College of Medicine, who is an expert in treating envenomations. His (North American) treatment protocols as I understand them seem to focus more on dilution; decreasing local tissue damage by elevating the bite and thereby encouraging dilution of the venom at the bite site, using the full blood volume to do it, which was not at all what my "protect the heart and brain at all costs" mindset expected, but he makes a good point. I see some discussion there about long term envenomation effects that make me think that the lymphatic system might be permanently damaged (locally) by the bite event; people report bitten limbs being more likely to swell at the end of the day even a decade later. That leads me to wonder how different tissue types and body systems will interact with the venom, which tissues are most and least affected by exposure, and how we would want to encourage movement of the venom as we get it out of the bite site, so as to minimize the exposure time between the most affected tissues and /or the most highly concentrated venom. Would love to be a fly on the wall if you ever chat about this.
Kate you must remember that Spencers protocol is for snakes in the genuses Crotalus and Agkistrodon. He does not apply this to Micruroides, Micrurus, or Hydrophis.
Hi. I'd love to create Polish subtitles for this one. It's great! Thing is most people here doesn't speak English :/ You'd have to allow it first and than approve it once ready I think...
Thank you very much and very useful, now I understand the importance of immobilizing the part that was bitten by a snake, as well as the role of lymph nodes and blood flow. The body has its uniqueness where it can excrete snake venom microscopically, in 24X48 hours (WHO standard) and if there is no swelling around the bite wound, or other symptoms, it means it is safe. but instead you are in a systemic phase where an antidote is needed,
Grand video lad! Quick question, you mention that there are valves in the Lymphatic system, and more in the lower limbs than the abdomen. Is this true? There are valves in the veins as well no? Are there also more in the lower limbs than elsewhere? Can you see them? Do they have names? Marky in Sheffield
You can see them with a microscope, there are imaging techniques that let you see lymph moving and larger lymphatic vessels contracting, but no, they don't have specific names. There are valves in many veins too, yes. They are more notable and there are probably more of them in the lower limb because of the column of fluid above them. Cheers!
Interesting you advise not to use a pressure bandage. I’ve just done Basic life support through the fire service that n Australia and the advice was to absolutely immobilise the limb and apply pressure bandage
Does this mean that the higher on the body your are bit, the faster the venom will get into the blood stream? Also, why do some venoms act much faster than others?
Hi Sam, I know it is incredible dependant on the person, but as a ballpoint, how long does it take lymph from the foot to travel back to the heart? If someone was bitten on the hand, how long would it take also? Thank you- From Swansea uni human and health sciences!
Thank you for your info here!! I'm a budding anatomy tutor downunder in Australia! I appreciated your attention to snake bites :) Where is that surfing spot in England you mentioned? I couldn't quite pick it up through your accent 😄 Thank you for your videos and your energy in this "anatomy space".... we appreciate you 🙏
Hello sir... Greetings from India Nice and love the style of presentation. I think the lymphatic system works only for those species of snake whose molecular size is large. What about other venom components, having smaller in size?? This mechanism is valid only when the snake is bitten into foot? Long distance from bite site to subclavian vein?? When bitten site is arms or head?? What is route?? chances of entering into systemic circulation is short?? In that case venom entering directly into the circulation without lympahtic system? Sir can you please clarify my doubts, Components of venom is different, or all entering into lymphatic before going to circulation?
Hi Nidhi, if the venom particles are very small (very rare, the African Black Mamba has such venom, for example), then this venom can enter the blood circulation. This means that the venom spreads very rapidly through the body, with a quick manifestation of symptoms.
@@whatrtheodds I believe that compression bandaging is taught as part of Australian first aid (it isn't in Britain) probably because the risk from venomous snakes is much greater in Australia than in Britain. As with all things, practice and preparation are best. Compression bandages good, tourniquets not good is what I read in Australia first aid guidance.
Sam Webster Why do they teach the compression bandaging from the bite site up the leg? I would have thought that this would squeeze the lymphatic fluid up the leg like the skeletal muscle pumping.
@@FartyHarley I would guess that it's following the idea that you don't want to increase the pressure in the distal limb. I would also guess that applying a compression bandage at the correct pressure would close the lymphatic vessels completely, and winding the bandage from distal to proximal up the limb wouldn't push more lymphatic fluid up the limb for that reason. I haven't looked for any studies that have looked at this (there are some imaging techniques that let you see lymphatic flow).
Yes you would think that but there is no sound evidence to suggest up or down first. One theory is that by applying pressure from the bite site and up, there is less chance of causing discomfort if you were to start from the top and work down (possibly pushing fluid down the limb and causing discomfort). One has to bear in mind that the application of the pressure bandage should be done as quickly as possible, within 15 mins but sooner is preferable. The quicker you do it, the likelihood is that the venom is still in the tissue at the bite site and hasn't started to move yet, therefor your concern/question wouldn't technically be an issue. Reply
![[LIVE] : ONE ลุมพินี 89 | คู่เอก "ยอดไอคิว vs คิริลล์"](http://i.ytimg.com/vi/Z3vYkHJ_5Ig/mqdefault.jpg)
".....just an anatomist!" I am not a doctor either sir but your modesty reflex needs some attention urgently in my opinion. You have brought anatomy to the world of 21st century in an informative and entertaining way. What more could we ask?
By the by is the same anatomical process involved with bee and wasp stings?
Blessings and peace
I don't know about bee and wasp stings. They tend to be limited to local actions in humans. The venoms are similar and different - is it a volume thing maybe?
@@SamWebster I wonder! I only remember being stung by a wasp once (when a fellow kid at school had done unmentionable damage to the soon-to-be ex insect which took it's revenge on my unsuspecting finger!) That was the last time I picked up a friend's jacket that had fallen on the floor!
@@SamWebster In Hymenoptera stings, allergies of some description are the first thing that comes to the mind of victims and clinicians. Hymenoptera venom is extremely antigenic and has specific venom components that triggers the release of vasodilators and trigger Mast cell degranulation, just to mention a few. In a mass stinging event apart from the dangers of a immune response, one has to consider systemic envenomation, after all, bees, wasps ants (not all) etc. are venomous. Symptoms maybe considerably delayed, 24 hours but the onset of fatigue may signify underlying life threatening symptoms, such as haemolysis, rhabdomyolysis, secondary renal failure or hepatic injury. In some exotic species, coagulopathy has been recorded.
Love the style of presentation, relaxing, jovial and informative. Just for added information; the swelling that you see in some snakebite envenomations is not an inflammatory response but rather a direct effect of toxins within the venom. Some of these toxins cause cell-lysis and or increase blood vessel permeability, the latter not only at a local level, but also systemically too. Interesting research has shown that capacity of lymph vessels to increase internal pressure (50mmHg) even when the limb is immobilised or when lymph flow is restricted.
I am one of your medical students....Joseph from southern Africa, Zambia
Lucky you 👌🏼👌🏼
Hi Sam,
As a person that has applied a PIB a number of times as I work with venomous snakes in Australia (for the last 25 years), I can attest that when correctly applied, along with immobilisation it's quite incredible how effective it is.
On two occasions I was asymptomatic until the bandage was removed. Minutes after the bandage is removed you sometimes feel a wave as nausea, ptosis and headache all hits. Not a fun experience!
Fantastic video and one that I would like to show during some of my venomous snake management courses if possible?
I live in Australia, (North Central Victoria) and there are a lot of Eastern Brown Snakes on my farm. Prevention is the best cure! I ALWAYS wear at least mid-calf length boots (Dr Martens 1914 boots are preferred) or farm-style Wellington Boots and usually also horse-riding leather gaiters (chapettes) that take the leg protection to just below my knees. I stumbled across the gaiter thing by accident, I ride my horse and was getting chafed by my stirrup leathers. Because of that, I started wearing gaiters over my Dr Martens boots when I was riding and it was only after that, that it occurred to me what excellent snake bite protectors they might be! So, I began wearing my gaiters all the time, even when I was not planning on riding my horse.
Also, an old Australian Aboriginal first aid treatment for snakebite was to make your way to a cold pool of water and jump in! Stay in the cold water for as long as you can, then get out and warm up. This definitely works, I once had a small puppy that got bitten by a snake and within minutes, it began to show effects of snakebite. I picked it up, threw it into the dam as far as I could, it swam back to shore, and I did it again. and again, and again, and again, and again! I then dried it off and warmed it up, and it was fine! That puppy lived to be an adult dog and other than never liking water, it had no ill effects from the experience!
I should state that I am NOT A DOCTOR, but have spent a lot of time in Aboriginal Communities, including that my brother married an Aboriginal woman and I have Australian Aboriginal in-laws, have gone hunting in the outback with Aborigines, etc.
Perhaps you'd like to investigate why this might work? My theory is that the shock of jumping into the cold water clamps down on the lymphatic system, similar to the "seal-dive response" that has been observed when small children are pulled out of freezing water after 1/2 an hour of being submerged and can be resuscitated with no ill-effects. This "seal-dive" slowing of the metabolism (basically a mild hypothermia) gives the body enough time to process and eliminate the toxin.
Like I mentioned, I DON'T ADVISE ANYONE TO DO THIS, but in a situation where you are snakebit in the middle of nowhere, where there's no help coming, it might be worth a try, you might well save your life or someone else's life! After all you're going to die anyway, right? So why not?
God Bless, I look forward to hearing your input and response...
Thanks for the logic and the good advices.
Dear Sam! I’m your new fan. I got familiar with you a couple of weeks ago. Good act, good tone of speaking, nice friend of the medical students. Keep on going. I myself, introduced you to anyone I could, and love your work and especcccciiiaallly your accccceeeennnnnnnntt. Such a lovely one!
Just want to give a shout out to any adders on Kilvey hill that if I step near you it is not an invitation to bite me, no matter how strong the urge is. Thanks carry on 🐍. Good episode Sam 👍
Thanks for posting these videos.. they make anatomy so easy and fun.!
It’s the passion of this guy for me
In Australian first aid courses they teach you to apply a compression bandage stating at the bite site and working your way up the leg. The instructors cannot explain why you start at the bite and work up the lymphatics. I would have thought that this bandaging up the leg would squeeze the venom up the lymphatic system faster.
Yes you would think that but there is no sound evidence to suggest up or down first. One theory is that by applying pressure from the bite site and up, there is less chance of causing discomfort if you were to start from the top and work down (possibly pushing fluid down the limb and causing discomfort). One has to bear in mind that the application of the pressure bandage should be done as quickly as possible, within 15 mins but sooner is preferable. The quicker you do it, the likelihood is that the venom is still in the tissue at the bite site and hasn't started to move yet, therefor your concern/question wouldn't technically be an issue.
Finally .... l was waiting you doctor ...thx for this lecture🍃
In Australia we have bandages that change colour when you pull them at the correct pressure for snake bites. I carry one when I run in the bush !
Really appreciate the lymph explanation and its details. Really well informed. 🙏
Great talk! It was shared in a FB group on envenomations, and I would DEARLY love to hear how you would modify it if you ever talked with Dr. Spencer Greene at Baylor College of Medicine, who is an expert in treating envenomations. His (North American) treatment protocols as I understand them seem to focus more on dilution; decreasing local tissue damage by elevating the bite and thereby encouraging dilution of the venom at the bite site, using the full blood volume to do it, which was not at all what my "protect the heart and brain at all costs" mindset expected, but he makes a good point. I see some discussion there about long term envenomation effects that make me think that the lymphatic system might be permanently damaged (locally) by the bite event; people report bitten limbs being more likely to swell at the end of the day even a decade later. That leads me to wonder how different tissue types and body systems will interact with the venom, which tissues are most and least affected by exposure, and how we would want to encourage movement of the venom as we get it out of the bite site, so as to minimize the exposure time between the most affected tissues and /or the most highly concentrated venom. Would love to be a fly on the wall if you ever chat about this.
Kate you must remember that Spencers protocol is for snakes in the genuses Crotalus and Agkistrodon.
He does not apply this to Micruroides, Micrurus, or Hydrophis.
It's really nice! Thank You Sam! 🙏❤
Hi. I'd love to create Polish subtitles for this one. It's great! Thing is most people here doesn't speak English :/ You'd have to allow it first and than approve it once ready I think...
Sir, Could you please do a video on Pharyngeal muscles? Exams are comin up... Would be great help!! Loved this video 😍
What an incredibly explained idea so good
Another GREAT video, thank you!
Ok sir.What if snake directly bite veins?does it affect lungs first?
Gracias again Doc!!!
Great. Thanks for the information
Thank you very much and very useful, now I understand the importance of immobilizing the part that was bitten by a snake, as well as the role of lymph nodes and blood flow. The body has its uniqueness where it can excrete snake venom microscopically, in 24X48 hours (WHO standard) and if there is no swelling around the bite wound, or other symptoms, it means it is safe. but instead you are in a systemic phase where an antidote is needed,
gr8 👌👌explanation sir thanks a lot ( from India )
Grand video lad! Quick question, you mention that there are valves in the Lymphatic system, and more in the lower limbs than the abdomen. Is this true? There are valves in the veins as well no? Are there also more in the lower limbs than elsewhere? Can you see them? Do they have names? Marky in Sheffield
You can see them with a microscope, there are imaging techniques that let you see lymph moving and larger lymphatic vessels contracting, but no, they don't have specific names. There are valves in many veins too, yes. They are more notable and there are probably more of them in the lower limb because of the column of fluid above them. Cheers!
I presume the Lower limb has more valves since there is movement against gravity, cant have the blood and lymph flowing back/down.
Interesting you advise not to use a pressure bandage. I’ve just done Basic life support through the fire service that n Australia and the advice was to absolutely immobilise the limb and apply pressure bandage
Amazing video! So helpful and informative
Thank you , really love the way you explain.
Surprised to hear reference to my hometown Cheltenham! Up the Robins!
I guess post axillary lymphatic clearance surgery with subsequent lymphodema would increase your survival chance, if you were bitten on that limb?
What about the effect of drinking water or having a pee?
It just amazing thing that what you do dr 💜
owesum,sir, can I get your notes on both upper and lower limbs?🙏🏼
Does this mean that the higher on the body your are bit, the faster the venom will get into the blood stream? Also, why do some venoms act much faster than others?
Thank you so much sir
Hi Sam, I know it is incredible dependant on the person, but as a ballpoint, how long does it take lymph from the foot to travel back to the heart? If someone was bitten on the hand, how long would it take also? Thank you- From Swansea uni human and health sciences!
Thank you for your info here!! I'm a budding anatomy tutor downunder in Australia! I appreciated your attention to snake bites :) Where is that surfing spot in England you mentioned? I couldn't quite pick it up through your accent 😄 Thank you for your videos and your energy in this "anatomy space".... we appreciate you 🙏
I'm at Swansea University next to the Gower peninsula. I think I mentioned Llangennith:
magicseaweed.com/Gower-Peninsula-Surfing/11/
where am i?
Dr.House!!!!!!
Hello sir... Greetings from India
Nice and love the style of presentation.
I think the lymphatic system works only for those species of snake whose molecular size is large.
What about other venom components, having smaller in size??
This mechanism is valid only when the snake is bitten into foot? Long distance from bite site to subclavian vein??
When bitten site is arms or head?? What is route?? chances of entering into systemic circulation is short??
In that case venom entering directly into the circulation without lympahtic system?
Sir can you please clarify my doubts, Components of venom is different, or all entering into lymphatic before going to circulation?
Hi Nidhi, if the venom particles are very small (very rare, the African Black Mamba has such venom, for example), then this venom can enter the blood circulation. This means that the venom spreads very rapidly through the body, with a quick manifestation of symptoms.
where ever on the body the bite takes place, the venom would be absorbed into the lymphatic system. Exception is when a fang hits a blood vessel.
and what happens if the snake has bitten jus on the vein
Then the venom enters the blood circulation which means that systemic symptoms will manifest much quicker.
I like your voice
damnn what a sick intro!
Am i the only one that confuse Sam with Gregory House?! He looks like so similar.
His videos are cracking, why are they cracking?😭😭😭
It's kinda distracting
Is it just me tho???
coolll 🤯🤯💯💯
Alhamdulillah 💞
😎😎
I clicked on this because he looks like doctor house. (Is he?)
🐍🐍🐍Well I am in Australia. Now I know not to wrap a cloth tightly around the area. And be British and keep calm.
@@chillie000 ohhh that is interesting. I wonder why it differs. Thanks for sharing
@@whatrtheodds I believe that compression bandaging is taught as part of Australian first aid (it isn't in Britain) probably because the risk from venomous snakes is much greater in Australia than in Britain. As with all things, practice and preparation are best. Compression bandages good, tourniquets not good is what I read in Australia first aid guidance.
Sam Webster Why do they teach the compression bandaging from the bite site up the leg? I would have thought that this would squeeze the lymphatic fluid up the leg like the skeletal muscle pumping.
@@FartyHarley I would guess that it's following the idea that you don't want to increase the pressure in the distal limb. I would also guess that applying a compression bandage at the correct pressure would close the lymphatic vessels completely, and winding the bandage from distal to proximal up the limb wouldn't push more lymphatic fluid up the limb for that reason. I haven't looked for any studies that have looked at this (there are some imaging techniques that let you see lymphatic flow).
Yes you would think that but there is no sound evidence to suggest up or down first. One theory is that by applying pressure from the bite site and up, there is less chance of causing discomfort if you were to start from the top and work down (possibly pushing fluid down the limb and causing discomfort). One has to bear in mind that the application of the pressure bandage should be done as quickly as possible, within 15 mins but sooner is preferable. The quicker you do it, the likelihood is that the venom is still in the tissue at the bite site and hasn't started to move yet, therefor your concern/question wouldn't technically be an issue.
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