Admissions for suspected snake bite to the Perth adult teaching hospitals, 1979 to 1988

Jelinek, George A; Hamilton, Thomas E.; Hirsch, Ronald L.

doi:10.5694/j.1326-5377.1991.tb94030.x

Cited by 40 publications

(59 citation statements)

References 6 publications

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“…[14] Major haemorrhage causing death has received widespread publicity, and early collapse and cardiac arrest also appear to be an important cause of death from brown snake envenoming. [15], [16].…”

Section: Introductionmentioning

confidence: 99%

Clinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja spp.) Envenoming — Australian Snakebite Project (ASP-14)

et al. 2012

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BackgroundSnakebite is a global health issue and treatment with antivenom continues to be problematic. Brown snakes (genus Pseudonaja) are the most medically important group of Australian snakes and there is controversy over the dose of brown snake antivenom. We aimed to investigate the clinical and laboratory features of definite brown snake (Pseudonaja spp.) envenoming, and determine the dose of antivenom required.Methods and FindingThis was a prospective observational study of definite brown snake envenoming from the Australian Snakebite Project (ASP) based on snake identification or specific enzyme immunoassay for Pseudonaja venom. From January 2004 to January 2012 there were 149 definite brown snake bites [median age 42y (2–81y); 100 males]. Systemic envenoming occurred in 136 (88%) cases. All envenomed patients developed venom induced consumption coagulopathy (VICC), with complete VICC in 109 (80%) and partial VICC in 27 (20%). Systemic symptoms occurred in 61 (45%) and mild neurotoxicity in 2 (1%). Myotoxicity did not occur. Severe envenoming occurred in 51 patients (38%) and was characterised by collapse or hypotension (37), thrombotic microangiopathy (15), major haemorrhage (5), cardiac arrest (7) and death (6). The median peak venom concentration in 118 envenomed patients was 1.6 ng/mL (Range: 0.15–210 ng/mL). The median initial antivenom dose was 2 vials (Range: 1–40) in 128 patients receiving antivenom. There was no difference in INR recovery or clinical outcome between patients receiving one or more than one vial of antivenom. Free venom was not detected in 112/115 patients post-antivenom with only low concentrations (0.4 to 0.9 ng/ml) in three patients.ConclusionsEnvenoming by brown snakes causes VICC and over a third of patients had serious complications including major haemorrhage, collapse and microangiopathy. The results of this study support accumulating evidence that giving more than one vial of antivenom is unnecessary in brown snake envenoming.

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Section: Introductionmentioning

confidence: 99%

Clinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja spp.) Envenoming — Australian Snakebite Project (ASP-14)

et al. 2012

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“…Despite Australia being host to a large number of venomous animals and having some of the best antivenoms in the world, clinical research into snakebite and envenoming has been fragmented. There have been a few case‐series of snakebite, 3–10 the majority being retrospective and few placing emphasis on attempting to identify caught snakes. There have been far more small case‐series and case reports 11–20 .…”

Section: Introductionmentioning

confidence: 99%

“…Although the majority of previous case‐series have included suspected and definite snakebites 3–10 none has developed specific guidelines for the diagnosis and differentiation of envenoming that are applicable to most EDs or smaller regional or rural hospitals. One study examined the diagnostic value of clinical evidence and coagulopathy in identifying envenomed patients, but this study was of children admitted to a paediatric intensive care unit, so not generalisable to EDs 3 …”

Section: Introductionmentioning

confidence: 99%

Suspected snakebite: One year prospective study of emergency department presentations

Currie

2003

Emergency Medicine

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Aim: Snakebite is an uncommon, but potentially life‐threatening condition. The more common clinical scenario is suspected snake‐bite. Our aim was to characterise the epidemiology, diagnosis and management of patients with suspected snakebites. Methods: Prospective cohort study of patients presenting with suspected snakebites to a tertiary referral hospital serving a large rural region in tropical northern Australia where a standard admission protocol for suspected snakebites is used. Results: Of 70 suspected snakebite cases, there were 45 definite bites: three severe envenomings (two western brown snakes [Pseudonaja nuchalis] and one mulga snake [Pseudechis australis]); seven mild/moderate envenomings by other snakes, two non‐envenomings by identified P. nuchalis, five bites by identified non‐venomous snakes and 28 definite bites without envenoming. The remaining 25 cases were either suspected bites (8), unlikely bites (15) and two people hit by snakes. Definite snake‐bites occurred throughout the year, peaking in May and December. There were three severe envenomings (mainly coagulopathy), requiring antivenom treatment, but no deaths or major complications. Most patients had appropriate investigations. Of 47 venom detection kit swabs collected, 34 were not tested, venom was not detected in nine and was positive in the three envenomings with one false‐positive tiger snake. Whole blood clotting time was highly sensitive for procoagulant coagulopathy and envenoming in this study. Median length of time from the bite to discharge was 20 h (interquartile range: 12–27). Conclusions: The study shows that although suspected snakebite was common, severe envenoming occurred in less than 5% of cases. The study supports the proposition that a structured approach and admission policy of suspected snakebites leads to the appropriate management of severe envenoming, with no cases discharged early and no cases of non‐envenoming treated with antivenom.

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“…Evidence from a recently published prospective study over 12 months from the Royal Darwin Hospital (RDH) demonstrated that the rate of presentation of snakebite in tropical Australia was far greater than more southern capital cities 15 . The 70 suspected snakebite cases from RDH in one year were a greater case load than the 99 snakebite cases from the three major metropolitan teaching hospitals in Perth over a 10 year period 1 …”

Section: Introductionmentioning

confidence: 99%

Five years of snake envenoming in far north Queensland

Barrett

Little

2003

Emergency Medicine

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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.

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Admissions for suspected snake bite to the Perth adult teaching hospitals, 1979 to 1988

Cited by 40 publications

References 6 publications

Clinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja spp.) Envenoming — Australian Snakebite Project (ASP-14)

Clinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja spp.) Envenoming — Australian Snakebite Project (ASP-14)

Suspected snakebite: One year prospective study of emergency department presentations

Five years of snake envenoming in far north Queensland

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