Snake Bite Managementfor the ED NurseBy Kane Guthrie FCENA
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
Quiz• How many poisonous snakesdo we have in Australia?
Risk Assessment• Geographic area• Anatomic site of bite• Number of strikes• Use of PIB• Pre-hospital course & treatment• Previous snakebites• Systemic features• Investigations
Physical Exam• Vital Signs• Mental Status• Evidence of bite• Lymphadenopathy• Evidence of abnormal bleeding• Signs of paralysis• Respiratory Function
Investigations• Whole blood clotting (resource limited)• FBC• Coagulation profile• Fribrinogen, D-Dimer• U & E, CK
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!
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)
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!
Major Types: by Clinical Syndromes5 major groups:1. Brown Snakes2. Tiger Snakes3. Mulga/black snakes4. Taipans5. Death Adders
Brown Snakes• Eastern/western brown snake, Dugite• Found all throughout Aust! (except Tasmania)• Most common cause of death from snakebite!
Brown SnakeEnvenoming:• VICC- bleeding gums, cannula site, ICH.• Renal failure & oliguria infrequent.• Rare – diplopia, ptosis & MAHA.
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).
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!
Tiger SnakeSimilar to brown snake but cause paralysis!Envenoming:• VICC• Neurotoxicity – progressive flaccid paralysis– Diplopia, ptosis, Resp failure• Rhabdomyolysis– Significant pain, muscle breakdown