SNAKEBITE MANAGEMENT CHART

PLEASE NOTE: This

chart cannot cover all
Patient presents with possible snakebite possible situations and
assumes an understanding
Patient is severely envenomed Patient is symptom free or has of the symptoms and signs
ie has one or more of: only mild or general symptoms of local, general and
collapse/unconscious, paralytic ie has one or more of: headache, specific envenoming by
signs, coagulopathy, myolysis nausea/vomiting, abdominal pain Australian venomous
snakes (see Snakebite
section and preceeding
FIRST AID FIRST AID FIRST AID FIRST AID pages). If in doubt, seek
Patient has had No effective first Patient has had No effective first aid advice from the Poisons
correct first aid aid has been correct first aid has been applied Information Centre
applied ie PIB applied APPLY applied ie PIB DO NOT apply now (131126) and from your
PIB first aid if >1hr post-bite local Critical Care Referral
Network

Leave PIB first aid in place until patient is stabilised, T R E AT M E N T FIRST AID FOR
fully assessed, and antivenom given (if required) •Insert IV line, give IV fluid load SNAKEBITE
•Take blood for lab tests† PIB = Broad bandage over
•Cut away first aid bandage (if present) over bite site bite site, then rest of bitten
and swab bite site for venom detection* limb, including
TREATMENT
•Collect urine and check for haemoglobin/myoglobin toes/fingers, at same
•Attend to “ABC” but be careful of causing bleeding (dip stick) + keep for venom detection pressure as for ankle
•Insert IV line, give IV fluid load •Secure supply of antivenom (use Polyvalent AV or sprain, then splint limb,
•Take blood for lab tests† and swab bite site for keep imobile
mixture of monovalent AVs if snake identity uncertain)
venom detection*, collect urine and check for •Monitor fluid balance, consider catheterising if in
haemoglobin/myoglobin (dip stick) + keep bite site doubt about urine output SVDK
swab for venom detection SNAKE VENOM
•Commence IV antivenom (use Polyvalent AV or
mixture of monovalent AVs if snake identity uncertain -
DETECTION KIT
Develops or has Remains symptom free
do not delay giving AV by waiting for venom detection significant symptoms or or minor general * Cut away first aid
results) signs or abnormal blood symptoms only (ie bandage over bite site only,
•Consider giving increased starting doses of antivenom tests ie paralytic signs, headache, nausea etc) to allow visual access and
•Monitor fluid balance, catheterise if in doubt about coagulopathy, myolysis, and blood tests are swab for venom detection
urine output renal impairment normal, do not give NOTE: bite site swab is
antivenom best sample
Repeat blood tests at 3hrs & 6hrs post AV TREATMENT Only test urine if no bite
Give appropriate Remove first aid once IV site available AND patient
Antivenom IV, diluted, line inserted, venom has systemic envenoming
adrenaline ready (in case of detection* and blood DO NOT use SVDK to
Coagulopathy is Coagulopathy not
anaphylactoid reaction) tests performed and determine if patient has
resolving resolving
reported as normal snakebite
(rise in fibrinogen/ (no rise in fibrinogen/
reduction in whole grossly prolonged
Leave PIB first aid in
blood clotting time) whole blood clotting † LABORATORY TESTS
place until patient is
time) Coagulation
stabilised and
•If no lab quickly available
antivenom given
•Whole Blood Clotting Time (WBCT)
(5-10ml venous blood in glass test tube,
TREATMENT TREATMENT TREATMENT measure time to clot; >10mins suggests
Continue to monitor Give more Check patient for signs of
coagulopathy, but test staff member’s blood
closely Antivenom IV, envenoming frequently and repeat
as normal control)
repeat blood tests to diluted, adrenaline blood tests after about 2hrs, then
•If lab available request
ensure continuing ready (in case of 2-3hrs later
•Prothrombin time/INR
improvement anaphylactoid
•aPTT
reaction)
•FDP/ XDP (d-dimer)
•CBP/ FBE (platelet count
TREATMENT TREATMENT Remains symptom free or minor & blood
Once recovered, send Admit overnight general symptoms only (ie film for schistocytes)
home, but follow up for if remains well, repeat headache, nausea etc) and blood Other
serum sickness. blood tests next tests are normal, do not give •Creatinine & urea
Consider prophylactic morning and if normal, antivenom •Electrolytes (especially K+)
oral steroids for 1 week send home •CK (for myolysis)
•CBP/ FBE (WCC for leukocytosis ±
Patient Discharged Home lymphopenia)

Flowchart developed by Professor Julian White