Snake Bite
It was another day at the Emergency department and also a busy day with a lot of sick people. Just after the resuscitation of a respiratory distress patient, got a call (BAT call) from paramedics that they are bringing in a patient with a snake bite. According to paramedic staff, he had stable vitals (Blood Pressure, Pulse rate and O2 saturation), Bitten his Left side hand.
The patient arrived with distress and shaking due to cold. Paramedics applied a pressure bandage to the Left side upper limb and started with normal saline via a cannula. According to the patient, the snake was a “Red Bellied Black Snake”. Interestingly the snake was inside his gumboot and he has put his hand into the boot without knowing that the snake was there. The snake has bitten at the web space between the 5th and 4th finger. Furthermore, the incident happened at 3pm, and he did not call the ambulance until 6pm when he started to develop abdominal pain and vomiting.
He arrived at the ED at 7.15 pm and by that time he did not have vomiting and only had mild abdominal pain. The left side upper limb was swollen, mainly had pain in the hand.
According to Australian protocol as doctors, we have to call the poison centre, where we contact a toxicology specialist. He or She will recommend what needs to be done to the patient, what investigation needs to be done and whether needs to give antivenom and what type of antivenom is recommended. We did blood investigations on this patient and especially coagulation studies to see the function of the clotting mechanism, Fibrinogen levels (Same purpose) and Creatine Kinase, which gives an idea about muscle breakdown.
Red Bellied Black snake’s venom, causes blood-clotting disorder and muscle and nerve damage, enough to knock you off your feet, but rarely deadly.
In practice, doctors don’t give anti-venom to all snake bites, as anti-venom has a high risk of anaphylaxis. And the Reasons are
Most of the time the snakes have been identified wrongly
Most of the time even if it is a venomous snake, the bites are dry bites
So need to confirm whether the snake was truly venomous, and unless it has been identified by a snake specialist, need to confirm with a photo of at least
Otherwise, if the patient does not develop features of envenomation (Abdominal pain, vomiting, bleeding, Difficulty in breathing, Low BP and unstable vital), observation and serial blood tests are recommended.
So in this patient, as he had developed abdominal pain and vomiting, Toxicologist recommended starting with anti-venom. It ran over 15 minutes and close observation was done for anaphylaxis. After the anti-venom, the pressure bandage was removed. The patient started to feel well, admitted for 24 hours of observation.
Recommended First Aid for a snake bite in Australia
Get away from the snake
Do not wash the site as it will not help to stop envenomation and it will be helpful for doctors to collect samples of venom to identify the snake
Do not apply a tourniquet.
Apply pressure bandage from bit site to up which will reduce the lymphatic drainage and delay the envenomation (Recommended in Australia - But not in Sri Lanka)
Keep the limb immobilise as muscle contraction can increase the spread of venom
Call an ambulance and go immediately to the emergency department
Poisonous Snakes in Australia
Eastern Brown Snake (Also known as Common Brown Snake - Found throughout the eastern half of mainland Australia)
Western Brown Snake (Found widespread over most of mainland Australia)
Mainland Tiger Snake (Found along the south-eastern coast of Australia, from New South Wales and Victoria to Tasmania and the far corner of South Australia)
Inland Taipan (Found in Queensland, South Australia, New South Wales and Northern Territory borders)
Coastal Taipan (Found in an arc along the east coast from northern New South Wales to Brisbane and northern Western Australia. They are fond of sugarcane fields)
Mulga Snake (Found throughout Australia, except in Victoria, Tasmania and the most southern parts of Western Australia)
Lowland Copperhead ( Found in south-eastern Australia, southern Victoria, Tasmania and the islands of Bass Strait)
Small-Eyed Snake (Found in widely distributed along the east coast, from Victoria to Cape York)
Common Death Adder (Found in eastern Australia (except the far north and south), southern South Australia and Western Australia)
Red- Bellied Black Snake (Found in east coast (though not to Tasmania) and slightly into south-eastern South Australia)
References..