1. M Anto ED prov fellow MVH 12 Jan 2017
Snakes
M Anto
ED prov fellow MVH
12 Jan 2017

2. Intro 3000 snake bites per yr
Large proportion are dry bites or non-venomous
receive antivenom
1-2 fatal
50% brown snake
50% tiger/taipan/death adder

14. Hx and exam
Bite site
Neurological
Haematological

15. Hx and exam Bite site: Usually painless May have fang marks
Usually lacs/scratches
Bruising bleeding swelling
Local tissue destruction uncommon with Aus snakes
Assoc lymphadenopathy

16. Early symptoms (<1hr):
Headache
Irritability
Nausea
D+V
Confusion
Syncope (?2dary to hypotension)

17. Symptoms (1-3hrs):
CN paralysis
Abdo pain
Haemoglobinuria HT
Tachycardia
Haemorrhage

18. Late sx (>3hrs):
Limb/resp paralysis
Shock
Myoglobinuria
Death

19. Toxin syndromes
[Syncope]
VICC
Neurotoxicity
Myotoxicity + ARF

20. Sydney/NSW snakes Brown snake: - Syncope, VICC
Red-bellied black snake:
- VICC, paralysis, hypotension
Eastern tiger snake:
- Hypotension, paralysis, VICC, seizures
Death adder:
- Paralysis

21. 1st aid

22. 1st aid Do not wash site, do not suck out venom
Do not cut or incise bite
PIB - 15cm, elasticised, <4hrs from bite
Splint
Immobilise
How about head/neck/back?

23. Management Critically ill patients Other patients IV access
Bloods (?POC test)
Urine
?Other tests

25. Antivenom What to give? How to give How much to give
Once AV given, what do we do with our PIB?
What are potential complications?

26. AV indications Absolute: Abnormal INR
History of sudden collapse, seizure or cardiac arrest
Any evidence of paralysis (ptosis +/- ophthalmoplegia earliest signs)
Relative:
Systemic symptoms (vomiting, headache, abdominal pain)
Abnormal aPTT
Leukocytosis
CK > 1000U/L

27. Further management
Disposition?
Further tests?
Discharge advice?

28. Summary 1st aid AV if symptomatic, no pre-med (caution with adren)
VDK does not tell you if the patient is envenomated
Look for subtle CN/eye signs
Check ADT status
Bloods/examination up to 12hrs
Serum sickness

29. References/resources
Snakebite and Spiderbite Clinical Management Guidelines (3rd ed, 2014)
Wikipedia: List of fatal snake bites in Australia