Snakes produce venom in modified salivary glands, administering this through fangs which pierce the skin. Many snakes in Australia (including sea snakes) are capable of delivering doses of toxin lethal to humans. In reality true envenomation is rare.
Life-threatening effects of toxins include:
- Neurotoxic muscle paralysis leading to respiratory arrest;
- Coagulation failure leading to excessive bleeding;
- Muscle damage which leads to kidney failure.
- Several snake species in WA pose a threat to humans. Tiger, Coastal Taipan, King Brown, Dugite and Death Adder snakes are all highly venomous.
- Puncture mark(s) or scratch
- Bite may be painless, without any visible marks (localized bruising or redness is uncommon in Australian snake bites).
- Headache, nausea/vomiting, abdominal pain.
- Swollen or tender lymphatic glands at groin/axilla of bitten limb.
Symptoms can resemble dysfunction of the CNS:
- Confusion
- Collapse
- Visual disturbances
- Drooping eyelids
- Difficulty speaking
- Swallowing or breathing
- Weakness/paralysis
- Respiratory weakness/arrest
- Seizure
- The size of the patient in relation to the volume of venom will be determinants in predicting the rate of envenomation. For infants and paediatric patients the rate of envenomation would be faster than that of larger adults.
- It is advisable that all potential snake bite victims be transported to a medical facility for assessment.
- Most venom reaches the blood stream via the lymphatic system. Research by the ARC indicates little venom reaches the circulation, even after several hours, if a Pressure Immobilization Technique is applied immediately, and maintained[1]. These patients are NOT considered time critical, unless signs of envenomation is evident.
- Venom identification kits are used to detect type of venom on patient skin or clothing.
- Anti-venom is available for all venomous Australian snake bites.
- Paralysis may be long lasting and where possible treatment for respiratory or cardiac arrest should continue until arrival at an appropriate medical facility.
- Primary Survey
- Assist ventilations as required
- Manage cardiac arrest as per guidelines
- Keep patient at rest and prevent movement
- Continually reassure
- Do not:
- Walk the patient
- Apply a Pressure Immobilization Technique if the bite did not occur on a limb.
- Cut/incise, wash or suck the site of the bite.
- Utilise an artery tourniquet, this should be replaced with PIT if encountered in the field.
- Trap/catch or kill the snake. Medical services do not rely on visual identification for anti-venom selection.
- Apply Pressure Immobilization Technique to bitten limb as per clinical skill.
- If applied correctly, and in a timely fashion, the PIT should slow the progression of venom
- If a PIT has been applied prior to St John WA arrival, assess and determine if there is a requirement for replacement. This may be necessary when a PIT bandage is loose or deemed ineffective.
- Application of a PIT bandage greater than four hours post bite is unlikely to be effective.
- Apply splint to further minimize movement
- Conduct Vital Sign Survey, monitoring closely for respiratory depression (assist ventilations as required)
- DO NOT remove bandages or splint prior to arrival at a suitable hospital for treatment
- Apply cardiac monitor if trained and authorised
- Consider pain relief
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if signs and symptoms of envenomation is evident; pre-notify receiving facility
- Apply cardiac monitoring
- Consider establishing vascular access; obtain pre-hospital blood sample
- Consider pain relief
- Consider use of anti-emetic
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if signs and symptoms of envenomation is evident; pre-notify receiving facility
- As per Advanced Care guidelines
Additional Information
Avau, B., Borra, V., Vandekerckhove, P., & De Buck, E. (2016). The treatment of snake bites in a first aid setting: a systematic review. PLoS neglected tropical diseases 10(10), e0005079.
Sutherland, S. K., Coulter, A. R., & Harris, R. D. (1979). Rationalisation of first-aid measures for elapid snakebite. The Lancet, 313(8109), 183-186.
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