Snakebite is a potential medical emergency and must receive high-priority assessment and treatment, even in patients who initially appear well. Patients should be treated in hospitals with onsite laboratory facilities, appropriate
antivenom stocks and a clinician capable of treating complications such as
anaphylaxis. All patients with suspected
snakebite should be admitted to a suitable clinical unit, such as an emergency short-stay unit, for at least 12 hours after the
bite. Serial blood testing (activated partial thromboplastin time, international normalised ratio and
creatine kinase level) and neurological examinations should be done for all patients. Most
snakebites will not result in significant envenoming and do not require
antivenom.
Antivenom should be administered as soon as there is evidence of envenoming. Evidence of systemic envenoming includes
venom-induced
consumption coagulopathy, sudden collapse,
myotoxicity, neurotoxicity,
thrombotic microangiopathy and renal impairment. Venomous snake groups each cause a characteristic clinical syndrome, which can be used in combination with local geographical distribution information to determine the probable snake involved and appropriate
antivenom to use. The
Snake Venom Detection Kit may assist in regions where the range of possible snakes is too broad to allow the use of monovalent
antivenoms. When the snake identification remains unclear, two monovalent
antivenoms (eg, brown snake and tiger snake
antivenom) that cover possible snakes, or a polyvalent
antivenom, can be used. One vial of the relevant
antivenom is sufficient to bind all circulating
venom. However, recovery may be delayed as many clinical and laboratory effects of
venom are not immediately reversible. For expert advice on envenoming, contact the National
Poisons Information Centre on 13 11 26.