Five years of snake envenoming in far north Queensland

Abstract

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.

Terrestrial Snakes (Suborder: Serpentes)

“…The presence of obvious redness and bruising along with marked swelling within 3 hours suggests the mulga, red -bellied black, or yellowfaced whip snakes, whereas the lack of swelling in the presence of obvious bite marks suggests the tiger or the rough -scaled snakes. 334 In another case series, 90% of severe brown snake envenomations as defi ned by nondetectable fi brinogen concentrations ( < 30 mg/dL) responded to between 1 -10 ampules with a range up to 23 ampules. The administration of antivenom should be guided by the clinical presentation and laboratory data (i.e., swab of bite site for venom detection kit).…”

Snakebite in Australia: Moving from anecdotes to prospective studies

“…Hence the recommendation to usually restrict VDK testing to envenomed patients to assist with antivenom choice. Third, as also noted by Barrett and Little, 3 the amount of antivenom to use remains contentious, especially for brown snake ( Pseudonaja spp.) coagulopathy, where the time required for fibrinogen reconstitution makes assessment of response to given antivenom doses problematic.…”

“…Three important papers in this edition of Emergency Medicine add useful information to the expanding evidence‐base on the management of snakebite in Australia 1–3 . The papers also highlight some major gaps in our knowledge of clinical and best practice issues.…”

“…for which clinical syndromes are poorly elucidated. Second, the issue of false Venom Detection Kit (VDK) results remains of concern, as noted by Barrett and Little 3 . It is important to remember that VDK does not determine whether antivenom should be given — this is entirely a clinical decision.…”

232. Death Adder Envenoming Causes Neurotoxicity not Reversed by Antivenom - Australian Snakebite Project (ASP-16)

“…In a prospective series of 21 cases from tropical northern Australia, eight (38%) developed neurotoxicity [20]. There is controversy regarding the dose and effectiveness of antivenom and whether adjunctive therapy with anticholinesterases such as neostigmine play a role in treatment [2,[20][21][22][23][24][25][26][27]. The aim of this study is to describe the clinical syndrome of death adder envenoming in Australia and evaluate the response of death adder envenoming to antivenom therapy.…”