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Snake Bite Management for the ED Nurse
This document provides guidance for emergency department nurses on snake bite management in Australia. It discusses the most common poisonous snakes found in Australia and their characteristic clinical envenoming syndromes. It emphasizes the importance of a thorough risk assessment, physical exam, and investigations to determine if envenoming has occurred. The document also reviews pressure immobilization bandaging techniques, indications for antivenom administration, and supportive care for the different clinical envenoming syndromes caused by Australia's major snake groups: brown snakes, tiger snakes, mulga/black snakes, taipans, and death adders.
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Snake Bite Management for the ED Nurse
- 1. Snake Bite Management forthe ED Nurse By Kane Guthrie FCENA
- 2. Snake Bites inAustralia • Definitive or suspected bites are common • Severe envenoming rare – Potentially fatal! • Each snake has characteristic clinical syndrome • Limited clinicians with limited knowledge
- 3. Quiz • How manypoisonous snakes do we have in Australia?
- 4. Risk Assessment • Geographicarea • Anatomic site of bite • Number of strikes • Use of PIB • Pre-hospital course & treatment • Previous snakebites • Systemic features • Investigations
- 5. Physical Exam • VitalSigns • Mental Status • Evidence of bite • Lymphadenopathy • Evidence of abnormal bleeding • Signs of paralysis • Respiratory Function
- 6. Investigations • Whole bloodclotting (resource limited) • FBC • Coagulation profile • Fribrinogen, D-Dimer • U & E, CK
- 7. Snake Venom DetectionKit • Dose not determine if envenomed or not! • Useful test to: – Confirm which one 5 groups responsible for envenoming. – Helps determine which antivenom is required. – Best done in laboratory. – Use bite site swabs or urine. • Use geographic area & clinical exam alongside!
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- 9. Clinical Effects Non Specific: •Nausea & vomiting • Headache • Abdominal Pain • Diarrhoea • Dizziness • Collapse
- 10. Specific Envenoming Syndromes •Coagulopathy • Neurotoxicity • Myotoxicity • Rhabdomyolysis
- 11. Pre-Hospital Care First Aid: –PIB Transport: – ASAP –> hospital capable of: – Dr able to Mx snakebite – Laboratory open 24/7 – Stocks adequate supplies antivenom
- 12. Pressure Immobilisation Bandage Canale,E. Isbister, G. Currie, B. (2009). EMA. 21, 184-190.
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- 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. Antivenom Two 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: byClinical Syndromes 5 major groups: 1. Brown Snakes 2. Tiger Snakes 3. Mulga/black snakes 4. Taipans 5. Death Adders
- 17. Brown Snakes • Eastern/westernbrown snake, Dugite • Found all throughout Aust! (except Tasmania) • Most common cause of death from snake bite!
- 18. Brown Snake Envenoming: • VICC-bleeding gums, cannula site, ICH. • Renal failure & oliguria infrequent. • Rare – diplopia, ptosis & MAHA.
- 19. Brown Snake Management: 1. PIB-Resus bay 2. Check Coag’s FBC and U&E Signs 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 • 9types of tiger snakes. • Found along coastal regions southern/eastern Australia. • Fast moving, easily alarmed that strike readily. • Have high rate of dry bites!
- 21. Tiger Snake Similar tobrown snake but cause paralysis! Envenoming: • VICC • Neurotoxicity – progressive flaccid paralysis – Diplopia, ptosis, Resp failure • Rhabdomyolysis – Significant pain, muscle breakdown
- 22. Tiger Snake Management: 1. PIB-Resusbay 2. 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 Snake Envenomation: • Severerhabdomyolysis • Anticoagulation abnormalities – Increased INR and aPTT. • Non specific symptoms: – Headache, nausea & vomiting
- 25. Mulga/Black Snake Management: 1. PIB-Resusbay 2. Bloods, Coag’s, FBC, U&E, Urine Envenomed: • 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. Taipans Envenoming: • VICC • Neurotoxicity –Venom causes paralysis, seizures • Rhabdomyolysis • Systemic envenoming can causes rapid onset collapse within minutes!
- 28. Taipans Management: 1. PIB-Resus bay 2.Bloods, Coag’s, FBC, U&E, Urine Envenomed: • 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- death adder. • Found mainland Australia. • Characterised viper like appearance, short, fat with diamond shaped head!
- 30. Death Adder Envenomation: • Neurotoxicity-descending flaccid paralysis • Manifest with 6 hours Early signs: • Diplopia, ptosis, difficulty swallowing.
- 31. Death Adder Management: 1. PIB-Resusbay 2. Bloods, Coag’s, FBC, U&E, 3. PEFR- neuro assessment Envenomed: • Intubation for respiratory failure. • 1 vial death adder antivenom • Sx resolve 1-2 days
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- 33. Take Home Points •PIB always! • Envenomation is rare! • 1 vial of antivenom is usually suffice! • Make use of the experts!
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