Click here for the most recent article from MJA: Snakebite in Australia: a practical approach to diagnosis and treatment

For a simple outline to snake bite management please click on the following drop-down headings:

Pre-Hospital:

Immediate first aid

Pressure Immobilisation Bandage

  • Delay and minimise lymphatic spread and systemic absorption of any injected venom
  • Compress the wound, immobilise the limb, immobilise the patient

Nearest hospital / clinic / outpost

On Arrival:

Resuscitation:

A – may be threatened in significant neurotoxicity

B – neurotoxicity and respiratory paralysis

C – collapse, syncope, hypotension, cardiac arrest

D – diplopia, ptosis, flaccid paralysis, seizures, headache

E – bite site, local pain, nausea / vomiting

Clinical Assessment:

Does the patient have features of envenomation already?

Laboratory (FBE, UEC, CK, APTT, INR, D-dimer, urinalysis)

Clinical (vital signs, conscious state, evidence of bite, haemorrhage, neurology, lymphadenopathy)

Geographical considerations:

Knowledge of local snakes and geographical distribution

Resources – to manage a snake bite the hospital must have

  1. resuscitation capabilities with adequately skilled staff,
  2. access to all hours laboratory testing
  3. access to antivenom

Transfer and retrieval options

Clinical and laboratory features of snake bite envenomation:

Local features – evidence of bite, local pain and swelling, lymphadenitis.

Systemic features – headache, nausea, vomiting, abdominal pain, collapse, seizures.

VICC – mucosal bleeding, haematuria, bleeding from the bite site, excessive bleeding from the cannula. Massively elevated INR (>3, usually much higher), undetectable fibrinogen, elevated D-dimer, low platelets.

TMA – may progress from VICC, haemolysis, elevated LDH, red blood cell fragments on blood film.

Anticoagulant coagulopathy – massively elevated APTT, minimally elevated INR, normal fibrinogen and D-dimer.

Neurotoxicity – ptosis, diplopia, symmetrical descending flaccid paralysis, respiratory failure, seizures.

Myotoxicity – rhabdomyolysis, myalgia, myoglobinuria.

Renal Failure – either secondary to rhabdomyolysis or direct venom toxicity.

Cardiotoxicity – syncope, collapse, cardiac arrest.

If no clinical or laboratory features of envenomation:

Remove PIB in resus with monitoring and IV access

Serial clinical examination for above features of envenomation

Repeat laboratory assessment at 1hr post PIB removal

Repeat laboratory assessment at 6h and 12h post bite

No overnight discharges even if medically clear at 12hrs

If delayed hospital arrival, final blood test but be at least 6h post removal of PIB even if initial bloods already >12hr post bite.