Lab Case 142 – Interpretation

General approach to snake bite

  • PIB
  • Immobilise

ED treatment

  • Initial Treatment

–Iv access

–Resuscitation

  • Resuscitate as required
  • Immediate life threats

–Hypotension (brown, taipan, tiger)

–Resp failure due to paralysis (death adder, rare in brown

–Seizures (taipan)

–Severe VICC (brown, taipan, tiger)

Was the patient envenomed?

  • History

–Area, site, appearance, PIB, early symptoms (collapse, V, bleeding, weakness), pre hosp (bleeding, hypotension, urine output)

  • Examination

– vital signs, mental state, evidence of bite (do not remove PIB), L/N, bleeding, descending paralysis, resp function PEFR)

–Serial physical exams for bleeding, paralysis, rhabdo

  • Lab tests

–Coags, d dimer, fbc, uec, CK, fibrinogen, FDP, LDH

Timing

  • Assessment normal and first set of bloods normal (ie. nothing in red medway) –  remove PIB.
  • Reapply PIB if any symptoms, repeat bloods and consider antivenom
  • No symptoms – repeat bloods at 1, 6, 12 hours after PIB removal.
  • Discuss all abn blood tests with tox if uncertain

Complications from Australian Snakebites

  • Paralysis
  • Rhabdomyolysis
  • ARF
  • MAHA
  • Thrombocytopaenia
  • Local wound complications

 

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