Adult Envenomation

Question 1

Signs of systemic snake envenomation

Answer 1

Eyelid dropping, diplopia, slurred speech, drooling, generalised muscle weakness (typical of tiger
snake envenomation)

Pain: generalised muscle pain, pain in lymph nodes draining the bite area, headache, abdominal pain
(typical of tiger snake envenomation)

Nausea or vomiting, sweating

Respiratory distress (late sign)

Loss of consciousness, paralysis

Bleeding: bleeding from the bite site or elsewhere, bleeding from nose, gums, passing dark or red
urine.

Question 2

Rules of Pressure Bandage Immbolisation in Envenomation CPG

Answer 2

Pressure bandage application should be as tight as that for a sprained ankle
Ensure bandaging does not cause loss of peripheral pulses.
Use 15cm broad elasticated roller bandage

Question 3

Why do we need to consider prolonged respiratory resuscitation with Blue Ring Octopus Envenomation?

Answer 3

Due to paralysis patients will suffer respiratory arrest
prior to cardiac arrest as a result of hypoxia. With appropriate ventilatory support the prognosis is
good, even in cases of severe envenomation.

Question 4

Tick Bites

Answer 4

May cause anaphylaxis early (manage as per CPG A0704 / P0704 Anaphylaxis) or a slow developing paralysis over days.

Do not attempt to remove a tick if encountered. They require careful removal to ensure that the head
does not remain embedded.

Question 5

ALS use of antivenom

Answer 5

Maintain first aid including PBI
Closely monitor vital signs

IV access x 2 is optimal. Connect IV fluid (TKVO or OFF) and prepare IV Adrenaline in case of anaphylaxis response to antivenom

Draw up the antivenom recommended by the toxicologist (via ARV / PIPER) and add it into a
new bag of Sodium Chloride 0.9% 500 mL

Administer the full 500 mL via a separate IV giving set over 20-30 mins

There is a risk of anaphylaxis following antivenom administration. If detected, stop the infusion and provide treatment as per CPG A0704 / P0704 Anaphylaxis. Contact ARV / PIPER to discuss ongoing patient care

Question 6

Snake Bite Mgx for SD3

Answer 6

1. R+R
2. Position - Supine
3. Mgx airway if required (O2??) - MICA if required
4. Bite to Limb - Apply PBI, Splint Limb (mark site of bite) and then immobilise limb to stretcher
5. 2 x IV Access - 18g bilateral CF
6. Pain relief
7. Antiemetic
8. MICA up/downgrade/cancel
9. Extrication - Combi to Stretcher - 2nd crew?
10. Reassess 5/60 VSS
11. Load Signal ? - MICA ? ARV if req

Question 7

Indications for Application of a Pressure Bandage with Immobilisation

Answer 7

• Suspected or reported snake-bite to a limb.
• Suspected or reported big black spider bite to a limb.
• Suspected or reported blue ringed octopus bite to a limb.

Question 8

How tight should pressure bandage be

Answer 8

The bandage is designed to limit lymphatic
flow, but should not be tight enough to
impair blood flow.