Snake Bite Management for the ED Nurse

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Presentation on managing the snake bite victim for the emergency nurse in Australia.

Presentation on managing the snake bite victim for the emergency nurse in Australia.

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  • 1. Snake Bite Managementfor the ED NurseBy Kane Guthrie FCENA
  • 2. Snake Bites in Australia• Definitive or suspected bites are common• Severe envenoming rare– Potentially fatal!• Each snake has characteristic clinicalsyndrome• Limited clinicians with limited knowledge
  • 3. Quiz• How many poisonous snakesdo we have in Australia?
  • 4. Risk Assessment• Geographic area• Anatomic site of bite• Number of strikes• Use of PIB• Pre-hospital course & treatment• Previous snakebites• Systemic features• Investigations
  • 5. Physical Exam• Vital Signs• Mental Status• Evidence of bite• Lymphadenopathy• Evidence of abnormal bleeding• Signs of paralysis• Respiratory Function
  • 6. Investigations• Whole blood clotting (resource limited)• FBC• Coagulation profile• Fribrinogen, D-Dimer• U & E, CK
  • 7. Snake Venom Detection Kit• Dose not determine if envenomed or not!• Useful test to:– Confirm which one 5 groups responsible forenvenoming.– Helps determine which antivenom is required.– Best done in laboratory.– Use bite site swabs or urine.• Use geographic area & clinical examalongside!
  • 8. SVDK
  • 9. Clinical EffectsNon Specific:• Nausea & vomiting• Headache• Abdominal Pain• Diarrhoea• Dizziness• Collapse
  • 10. Specific Envenoming Syndromes• Coagulopathy• Neurotoxicity• Myotoxicity• Rhabdomyolysis
  • 11. Pre-Hospital CareFirst Aid:– PIBTransport:– ASAP –> hospital capable of:– Dr able to Mx snakebite– Laboratory open 24/7– Stocks adequate supplies antivenom
  • 12. Pressure Immobilisation BandageCanale, E. Isbister, G. Currie, B. (2009). EMA. 21, 184-190.
  • 13. Pressure Immobilisation Bandage
  • 14. In-Hospital• Resus Bay• Get help – consider PIC 131126• Determine if envenomed:– History– Physical exam– Laboratory investigations/SVDK• Determine if antivenom required• Supportive care and treatment (ADT)
  • 15. AntivenomTwo types:1. Monovalent:– More specific, cheaper, safer less serum sickness.2. Polyvalent:– Contains equivalent of 1 vial of each monovalent.• Give 1 vial 500mls N/saline over 20mins!• Risks: anaphylaxis, serum sickness!
  • 16. Major Types: by Clinical Syndromes5 major groups:1. Brown Snakes2. Tiger Snakes3. Mulga/black snakes4. Taipans5. Death Adders
  • 17. Brown Snakes• Eastern/western brown snake, Dugite• Found all throughout Aust! (except Tasmania)• Most common cause of death from snakebite!
  • 18. Brown SnakeEnvenoming:• VICC- bleeding gums, cannula site, ICH.• Renal failure & oliguria infrequent.• Rare – diplopia, ptosis & MAHA.
  • 19. Brown SnakeManagement:1. PIB- Resus bay2. Check Coag’s FBC and U&ESigns of Envenomation:• 1 vial of CSL brown snake antivenom• Serial coag test to check if safe for D/C• New recommendation only 1 vial!• White, I. Buckley, N. (2012) Antivenom Update. Australian Prescriber (35, 5).
  • 20. Tiger Snakes• 9 types of tiger snakes.• Found along coastal regions southern/easternAustralia.• Fast moving, easily alarmed that strike readily.• Have high rate of dry bites!
  • 21. Tiger SnakeSimilar to brown snake but cause paralysis!Envenoming:• VICC• Neurotoxicity – progressive flaccid paralysis– Diplopia, ptosis, Resp failure• Rhabdomyolysis– Significant pain, muscle breakdown
  • 22. Tiger SnakeManagement:1. PIB-Resus bay2. Bloods, Coag’s, FBC, U&E,3. Serial peak flow, neuro exam!Envenomed:• 1 vial Tiger snake antivenom• Consider intubation for resp failure
  • 23. Mulga/Black Snakes• Mulga, king brown, Red-bellied or black snake• Found around Australia• Large, aggressive with painful bite
  • 24. Mulga/Black SnakeEnvenomation:• Severe rhabdomyolysis• Anticoagulation abnormalities– Increased INR and aPTT.• Non specific symptoms:– Headache, nausea & vomiting
  • 25. Mulga/Black SnakeManagement:1. PIB-Resus bay2. Bloods, Coag’s, FBC, U&E, UrineEnvenomed:• IDC – fluids, monitor CK• 1 vial black snake antivenom
  • 26. Taipans• Coastal & Inland Taipans• Found northern Aust (NT & QLD)• Envenoming rare, but lethal without AV!
  • 27. TaipansEnvenoming:• VICC• Neurotoxicity– Venom causes paralysis, seizures• Rhabdomyolysis• Systemic envenoming can causes rapid onsetcollapse within minutes!
  • 28. TaipansManagement:1. PIB-Resus bay2. Bloods, Coag’s, FBC, U&E, UrineEnvenomed:• IDC – fluids, monitor CK• Prepare for resp failure – intubation• Give 1-2 vials taipan antivenom• Supportive care & monitoring
  • 29. Death Adder• Common, desert, northern, pilbra- deathadder.• Found mainland Australia.• Characterised viper like appearance, short, fatwith diamond shaped head!
  • 30. Death AdderEnvenomation:• Neurotoxicity- descending flaccid paralysis• Manifest with 6 hoursEarly signs:• Diplopia, ptosis, difficulty swallowing.
  • 31. Death AdderManagement:1. PIB-Resus bay2. Bloods, Coag’s, FBC, U&E,3. PEFR- neuro assessmentEnvenomed:• Intubation for respiratory failure.• 1 vial death adder antivenom• Sx resolve 1-2 days
  • 32. Questions
  • 33. Take Home Points• PIB always!• Envenomation is rare!• 1 vial of antivenom is usually suffice!• Make use of the experts!
  • 34. Thank-you