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Note: This article applies to snake bites in the australian context. Australians live their life... dangerously.

JMS Resident Edu Spiel/Blurb:
“Most are harmless. But need to look for evidence of envenomation and consider antivenom. Timing of serial examination is also important.”
“VDK rarely helpful. Venom cross reactivity – usually will all turn blue, just in what order”.
“VDK only guides type of antivenom, not snake genus”.
“Brown snakes are milder, but kill more people from collapse/cardiac arrest(5%)”
“Two monovalent (eg tiger/brown) in Victoria is better than giving polyvalent antivenom due to high risk of immediate hypersensitivity (25-40%)”
“Lying still for 3 days is the traditional aboriginal treatment for snake bite for a reason…”
“Victoria: Brown / Tiger” “Northern regions: also Taipan”.
“Severe VICC can require a second dose of antivenom – role of giving further Cryo/FFP to correct VICC is controversial – are we just providing more substrate for the venom to clot? Risk of serum sickness and renal failure from circulating proteins?”

Outline of Management / OSCE template answer
1) PIB to stay on until antivenom available
2) Examine for signs.
3) Investigate for rhabdo, VICC, coagulopathy and renal failure
4) Given antivenom if systemic envenomation suspected.
5) Keep PIB on until no longer envenomed.
6) If not envenomed, repeat bloods 1 hr post PIB removal, 6hr post bite, 12hr post bite.
6b) In the rare instance of actual envenomation, keep PIB on, repeat examination every 6 hours. Remove PIB when well and repeat bloods/examination one hour later.

Step 1: Looking for Evidence of Envenomation

Step 2: Treating Snake Bite (Envenomation vs Stick Bite. Role of Venom Detection Kit)

Written in the negative:
CVS: No hx Collapse/syncope. No hypotension/tachycardia suggestive of shock
Neuro: No Headache, vomiting, or dizziness. No Diplopia. No CN signs opthalmoplegia and ptosis. No facial nerve palsies.
Coag: No Bleeding from site. No Bleeding from the bite site. No Petechiae. No Gingival / mucosal bleeding.
Resp: No Difficulty breathing. No WOB/SOB/hypoxia/tachypnoea suggesting resp failure.
MSK: No tenderness to muscles.
ADT status: Up To Date (<5yr)

Fibrinogen DDimer INR normal
FBE normal
CK not elevated.
ECG NSR