In this section
This guideline should not be used outside Victoria
due to regional differences in Snake species.
For 24 hour advice, contact Victorian Poisons Information Centre 131126
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, swollen or bruised, but usually is not for snakes in Victoria.
There are no sea snakes in Victoria, however land-based snakes can swim.
Major venomous snakes in Victoria and effects of envenomation:
Rare and mild
Cardiac arrest (5%)
Mild increase in aPTT and INR with normal fibrinogen; usually no significant bleeding
Often significant bite site pain and limb swelling
TMA: thrombotic microangiography. Haemolysis with fragmented red blood cells on blood film, thrombocytopenia and a rising creatinine.
Myotoxicity muscle pain, tenderness, rhabdomyolysis
Systemic Symptoms see
history and examination.
VICC: Venom-induced consumptive coagulopathy (abnormal INR, high aPTT, fibrinogen very low, D-dimer high).
Focus on evidence of envenomation.
History and Examination
For timing and interpretation of blood tests see
management flowchart below.
Do not use point of care devices for coagulation profile as they are inaccurate in the setting of snakebite envenomation.
Role of snake venom detection kit (VDK)
Location of care
Uncomplicated snakebites can be managed at a regional centre as long as the following resources are available:
Apply a broad pressure immobilisation bandage,
Immobilise the joints either side of the bite site (use a splint),
Immobilise the entire child as well (lay the child down).
DO NOT remove the bandage until in a centre with full treatment facilities, as discussed above.
Venom induced coagulopathy takes time to reverse.
Other management considerations:
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.
All children with evidence of envenomation should be admitted to hospital (See
Location of care above).
Envenomed children should be discussed with a clinical toxicologist (Poisons Information Centre 13 11 26, 24 hrs/day) and considered for transfer to a tertiary centre depending on clinical signs.
In complicated snakebites or where the above resources are not available to manage snakebite, the child should be transferred to a tertiary paediatric centre.
For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.
Children with suspected snakebite should only be discharged in daylight hours (neurological signs can be subtle and only evident when children are awake).
If antivenom was administered, ensure that the family is given advice on how to recognise serum sickness:
Children undergoing serial testing are suitable for both the ED Short Stay ward and the Short Stay Unit.
Envenomed children should be considered for PICU admission but may be suitable for a ward General Medical admission depending on clinical signs and degree of coagulopathy.
The Monash Health clinical toxicologist on-call should be consulted in all cases of suspected snakebite.
Children undergoing serial bloods tests are suitable for either ED Short Stay or ward admission, depending on site.
Children who have received anti-venom may be suitable for a toxicology, inpatient or PICU (Clayton) admission depending on age and clinical features.
Last updated January 2018