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:
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
[expand title=”On Arrival:”]
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
[expand title=”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)
[expand title=”Geographical considerations:”]
Knowledge of local snakes and geographical distribution
Resources – to manage a snake bite the hospital must have
- resuscitation capabilities with adequately skilled staff,
- access to all hours laboratory testing
- access to antivenom
Transfer and retrieval options
[expand title=”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.
[expand title=”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.