Objective: To describe the epidemiology, clinical features, treatment and outcomes of patients with elapid snake envenoming in far north Queensland. Methods: Review of patients admitted with snake envenoming to Cairns Base Hospital, Queensland, from 1 January 1996–31 December 2000. Results: A total of 264 patients presented to the hospital with a diagnosis of snakebite. Of these, 27 (10%) had clinical evidence of envenoming, including seven children. All envenomed patients had been bitten on a limb. Two patients had correct initial first aid applied. Commercially available venom detection kits were used in 23 patients; 14 (61%) bite site swabs were positive, but only four (23%) of 17 urine Venom Detection Kits were positive. Antivenom was administered to 20 envenomed patients. The five brown snake envenomed patients required a median of 9 ampoules of antivenom to treat their coagulopathy. Sixteen patients were admitted to the ICU, with six requiring ventilation. Six patients were successfully managed in the ED observation ward. Three patients envenomed by a taipan, and one by a death adder were discharged with ongoing neurological symptoms. There was one death from brown snake envenoming. Conclusions: The incidence of snakebite and envenoming in far north Queensland is higher than reported from hospitals in capital cities and is a significant health issue.