Snake Bites Flashcards
(17 cards)
Initial assessment (4)
Bite - puncture site
Neuro - ptosis, descending symm paralysis, CN deficit, peripheral weakness
Resp - weakness
Myotoxicity - dark urine, muscle pain
VICC - bleeding gums, cannula site
CVS - scynope, collapse
Important hx
Snake appearance/geographic area
Site of bite
Use of PIB
Pre hospital course - hypotension, bleeding
Bloods
FBC + film, Coags, D dimer, Fibronogen, UEC, CK, LDH
Interval for bloods
On arrival
1 hour post PBI removal
6 hours post bite
12 hours post bite
Removal of PBI
Antivenom given
No evidence of systemic envenomation.
No envenomation on bloods
Pt monitored in resus.
Local access to antivenom
Bloods VICC
APTT - high/unreadable
INR - high >3 in complete, <3 partial
D dimer- high
Fibrinogen - low/ undetectable
Favtor V, VIII - low
Early admin of Antivenom - indication
Non specific symptoms - headache, N&V
Systemically unwell appearance
Early CVS collapse - cardiac arrest, hypotension, LOC, seizures
Ptosis/blur vision
Unidentified Snake Management
1x vial Brown antivenom
1x Vial Tiger antivenom
Dilute 1:10 N/s 0.9% IV q15mins
Given within 2 hrs of bite to minimise progress of envenomation
Antivenom complications
1% mono, 5% poly, 25% urticarial rash
VICC snakes
Brown
Tiger
Taipan
Neurotoxin
Death adder - post synaptic
Tiger
Taipan - both pre synaptic & post
Brown snake fx (4) - most common
VICC
Neurotoxin
Early CVS collapse 33%
MAHA 10%
Red belly/black/Mulga (4)
Myalgia / Myotoxin
Painful bite
Anticoag/coagulopathy
Ptosis, diplopia, rhabo, blur vision
Tiger (4) - SA, TAS
VICC
CVS collapse 10%
Neurotox - pre & post
Myotoxicity
AKI
-> all except anticoag
Taipan (4) - FNQ
VICC
Neurotox - pre & post
Seizures
Paralysis - ptosis, blur vision
Death Adder - triangle head, mainland Au, not VIC
Neurotoxin - post
Descending flaccid paralysis - symmetrical
hypotension
Resp depression
Discharge criteria 3
No signs envenomation post bite 12 hrs.
24 hrs post antivenom admin
No further signs envenomation & bloods return to baseline. (no AKI, TTM, MAHA)
