Snake bite

Question 1

List the required features of a receiving hospital for a snakebite victim.

Answer 1

• Staff - willing and able to treat envenomation and anaphylaxis
• Resources - sufficient and appropriate stocks of antivenom
• Lab - capability to perform required path tests - FBC, CHEM20, CK, LFTs, INR, aPTT, fibrinogen, D-dimer

Question 2

Outline the approach to monitoring a patient with potential snakebite envenomation.

Answer 2

• First aid in the field:
  
  • PIB
  • Immobilise limb and patient
  • Keep patient calm
• Trf to appropriate facility
• ABC
• If clinical signs of envenomation -> administer antivenom
• If no clinical signs of envenomation, send bloods
• If no pathological signs of envenomation, remove PIB
• If develops signs of envenomation -> reapply PIB and administer anti-venom
• If does not develop signs of envenomation -> repeat bloods at 1hr post PIB removal and then 6hr and 12hrs post-bite
• If no path or clinical signs of envenomation at 12h -> d/c

Question 3

List the advantages of monovalent anti-venom.

Answer 3

• Safer -> less anaphylactogenic
• Cheaper

Question 4

What is the role of the Snake Venom Detection Kit (SVDK)?

Answer 4

• Used to determine which monovalent anti-venom to administer once the decision to treat has already been made.
• The SVDK does not help in determining whether a patient has been envenomed

Question 5

What fluids can be used for a SVDK?

Answer 5

1. Bite swab (primary method) -> taken from “keyhole” cut in the PIB
2. Urine

NB: plasma and blood should not be used

Question 6

What are the common clinical effects of Australian elapid envenomation?

Answer 6

1. Venom induced consumptive coagulopathy
2. Myotoxicity
3. Neurotoxicity
4. Non-specific systemic symptoms
   
   1. N+V
   2. Abdo pain
   3. Diaphoresis
   4. Diarrhoea
5. Collapse/cardiac arrest -> Brown snake