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