In this section
This guideline is based on the Emergency Care Improvement & Innovation Clinical Network snakebite guidelinewww.health.vic.gov.au/
Specific advice about children with potential snakebite should be sought from a clinical toxicologist (Poisons Information Centre 131126, 24 hrs/day)
Snake bite is uncommon in Victoria and envenomation (systemic poisoning from the bite) is rare. The bite site may be evidenced by fang marks, one or multiple scratches. The bite site may be painful but usually is not.
Major venomous snakes in Victoria and effects of envenomation:
Rare and mild
Cardiac arrest (5%)
VICC = Venom-induced consumptive coagulopathy (abnormal INR, fibrinogen very low, d-dimer high)Anticoagulant = APTT 1.5–2.5 x normal ± minor elevation INR. D-dimer and fibrinogen usually normalTMA = thrombotic microangiography. Fragmented red blood cells on blood film, thrombocytopenia and a rising creatinine.Systemic Symptoms = see below
Tiger snake bites may develop local swelling. Brown snake bites may result in sudden collapse and death, the mechanism of which is unclear.
Snake collectors (or their children) may be bitten by exotic or non-Victorian snakes. There are no sea snakes in Victoria, however land-based snakes can swim.
Focused on evidence of envenomation
Once the possibility of snakebite has been raised, it is important to determine whether a child has been envenomed to establish the need for anitvenom. This is usually done taking into consideration the combination of circumstances, symptoms, examination and laboratory test results. Most people bitten by snakes in Australia do not become significantly envenomed.
History and Examination:
For timing and interpretation of blood tests see management flow chart below.
Role of snake venom detection kit (VDK)
It is recommended that all cases of envenoming are discussed with a clinical toxicologist to guide treatment (including choice of antivenom) and follow-up healthcare after discharge (e.g. Poisons Centre 13 11 26).
The presence of any of the following indicates that envenomation has occurred and treatment with antivenom is indicated:
There are a number of relative indications for antivenom that require expert interpretation.
These should be discussed with a clinical toxicologist (Poisons Information Centre 131126) to determine if antivenom is required.
DO NOT remove bandage until in a centre with full treatment facilities, including available anti-venom and access to laboratory testing. Do not wash or clean the bite site in any way.
Venom induced coagulopathy takes time to reverse. More antivenom than recommended will not aid recovery of clotting factors. The role of FFP is limited. Coagulopathy correction may be indicated if the patient is bleeding and should always be discussed with a clinical toxicologist.
Discharge Criteria & Follow up
Children with suspected snakebite should only be discharged in daylight hours (neurological signs can be subtle and only evident when children are awake)
Serial blood tests and clinical examinations take a minimum of 12 hours after the time of the bite; these can occur in Emergency Departments or with inpatient units depending on local experience and level of comfort
Envenomed children should be discussed with a clinical toxicologist and considered for transfer to a tertiary centre depending on clinical signs
For advice and inter-hospital (including ICU level) transfers ring the PIPER 1300 137 650