General approach to snake bite
- Initial Treatment
- Resuscitate as required
- Immediate life threats
–Hypotension (brown, taipan, tiger)
–Resp failure due to paralysis (death adder, rare in brown
–Severe VICC (brown, taipan, tiger)
Was the patient envenomed?
–Area, site, appearance, PIB, early symptoms (collapse, V, bleeding, weakness), pre hosp (bleeding, hypotension, urine output)
– 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
- 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
- Local wound complications