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wikitox:2.3.5.3.2_australian_venomous_snakes [2025/02/18 19:52] – kharriswikitox:2.3.5.3.2_australian_venomous_snakes [2025/07/06 19:13] (current) – [Other Resources] kharris
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 ==== Laboratory Tests ==== ==== Laboratory Tests ====
  
-These should be done as per the snakebite pathway and should include :+These should be done as per the [[https://www.poisonsinfo.health.qld.gov.au/_media/for-health-professionals/clinical-pathway-for-non-envenomed-snake-bite.pdf|snakebite pathway]] and should include :
  
   * Full blood count   * Full blood count
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   * To be able to treat anaphylaxis if it occurs   * To be able to treat anaphylaxis if it occurs
  
-If there is no requirement for AV administration on clinical grounds then the patient will require to be transferred to a facility with 24/7 laboratory testing capability. This will enable all suspected or confirmed snakebites to be managed with the use of the snakebite pathway. This pathway commences at the time of bite and involves clinical observation and serial laboratory testing until 12 hours post bite. Thus in practice a patient cannot be declared to be unenvenomed until 13 to 14 hours post bite. (The latter one or two hours due to the time taken for 12 hours post lab test results to be available).+If there is no requirement for AV administration on clinical grounds then the patient will require to be transferred to a facility with 24/7 laboratory testing capability. This will enable all suspected or confirmed snakebites to be managed with the use of the [[https://www.poisonsinfo.health.qld.gov.au/_media/for-health-professionals/clinical-pathway-for-non-envenomed-snake-bite.pdf|snakebite pathway]]. This pathway commences at the time of bite and involves clinical observation and serial laboratory testing until 12 hours post bite. Thus in practice a patient cannot be declared to be unenvenomed until 13 to 14 hours post bite. (The latter one or two hours due to the time taken for 12 hours post lab test results to be available).
  
  \\ Envenomed patients may require AV but this depends on the picture of envenoming and several other factors. A clinical toxicologist should always be contacted for expert input in this context.  \\ Envenomed patients may require AV but this depends on the picture of envenoming and several other factors. A clinical toxicologist should always be contacted for expert input in this context.
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 Intracranial haemorrhage is relatively rare but documented to occur with haemorrhagic envenomation syndromes. These tend to occur around 12 hours or more following a snake bite. Intracranial haemorrhage is relatively rare but documented to occur with haemorrhagic envenomation syndromes. These tend to occur around 12 hours or more following a snake bite.
  
-===== Further Reading =====+===== Educational Resources =====
  
-**Fulltext**+[[https://player.vimeo.com/video/344443374?h=91c7a8e203|Video: Does post-synaptic neurotoxicity occur in snakebite - Dr Anjana Silva - TAPNA ASM 2019]]
  
-  - Yeung JM, Little M, Murray LM, Jelinek GA, Daly FFS. Antivenom dosing in 35 patients with severe brown snake (Pseudonaja) envenoming in Western Australia over 10 years. [[http://www.mja.com.au/public/issues/181_11_061204/yeu10307_fm.html|Med. J. Aust. 2004 Dec 6;181(11-12):703-705.]] +[[https://player.vimeo.com/video/476108386?h=47ebc98a8b|Video: D-dimer in snakebite - Dr Geoff Isbister - TAPNA ASM 2020]] 
-  - Isbister GK. Antivenom, anecdotes and evidence. [[http://www.mja.com.au/public/issues/181_11_061204/isb10726_fm.html|Med. J. Aust. 2004 Dec 6;181(11-12):685-686]]. + 
-  - Isbister GK, Brown SG, MacDonald E, White J, Currie BJ. Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis. [[http://www.mja.com.au/public/issues/188_08_210408/isb11096_fm.html|Med. J. Aust. 2008 Apr 21;188(8):473-476]]. +[[https://player.vimeo.com/video/553858377?h=4588a2e66c|Video: The golden hours for snake antivenom - Prof Geoff Isbister - TAPNA ASM 2021]] 
-  - Isbister GK, Tankel AS, White J, Little M, Brown SGA, Spain DJ, et al. High rate of immediate systemic hypersensitivity reactions to tiger snake antivenom. [[http://www.mja.com.au/public/issues/184_08_170406/letters_170406_fm-1.html|Med. J. Aust. 2006 Apr 17;184(8):419-420]]. + 
-  - Isbister GK, Duffull SB, Brown SGA. Failure of antivenom to improve recovery in Australian snakebite coagulopathy. [[http://qjmed.oxfordjournals.org/content/102/8/563.full.pdf+html|QJM. 2009 Aug;102(8):563-568. ]] +[[https://player.vimeo.com/video/553859027?h=c861dc6bdc|Video: Thrombotic microangiopathy in snakebite: What’s new - Dr Tina Noutsos - TAPNA ASM 2021]] 
-  - Currie BJ. Snakebite in tropical Australia: a prospective study in the "Top End" of the Northern Territory. [[http://www.mja.com.au/public/issues/181_11_061204/cur10911_fm.html|Med. J. Aust. 2004 Dec 6;181(11-12):693-697. ]]+ 
 +[[https://player.vimeo.com/video/729490036?h=dad25031c5|Video: Snakebite Quiz - Prof Geoff Isbister - TAPNA ASM 2022]] 
 + 
 +[[https://player.vimeo.com/video/729491228?h=eb6ba5fbb5|Video: Snake Venom Proteomics - Dr Theo Tasoulis - TAPNA ASM 2022]] 
 + 
 +[[https://player.vimeo.com/video/916335482?h=ff3734ca51|Video: Real word delays in antivenom administration: Patient, snake or hospital factors - Prof Geoff Isbister - TAPNA Regional Meeting 2023]] 
 + 
 + 
 +===== Further Reading =====
  
-**ADVICE on Australian venomous snakebite is available from the Poisons Information Service, telephone 131126 in Australia.** \\ [[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=524395&dopt=Abstract|Broad AJ, Sutherland SK, Coulter AR.]] The lethality in mice of dangerous Australian and other snake venom. Toxicon 1979;17(6):661-4. 3. \\ +  - Allen GE, Brown SG, Buckley NA, O’Leary MA, Page CB, Currie BJ, et al. Clinical effects and antivenom dosing in brown snake (Pseudonaja spp.) envenoming–Australian snakebite project (ASP-14). PLoS One 2012;7(12). {{:wikitox:clinical_effects_and_antivenom.pdf|PDF}} 
-[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8326906&dopt=Abstract|Buckley N, Dawson AH.]] Unusual results of brown snake envenomation. Med.J.Aust. 1993;158(12):866, 868. \\ +  - Churchman A, O’Leary MA, Buckley NA, Page CB, Tankel A, Gavaghan C, et al. Clinical effects of red-bellied black snake (Pseudechis porphyriacus) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP-11). Med J Aust 2010;193(11–12):696–700. {{:wikitox:medical_journal_of_australia_-_2010_-_churchman_-_clinical_effects_of_red‐bellied_black_snake_pseudechis_porphyriacus_.pdf|PDF}} 
-[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10688264&dopt=Abstract|Currie BJ]]. Clinical toxicology: A tropical Australian perspective. Ther.Drug Monit. 2000;22(1):73-8. \\ +  - Currie BJ. Snakebite in tropical Australia: a prospective study in the “Top End” of the Northern Territory. Med J Aust 2004;181(11–12):693–7. {{:wikitox:medical_journal_of_australia_-_2004_-_currie_-_snakebite_in_tropical_australia_a_prospective_study_in_the_top_end_of_the.pdf|PDF}} 
-Currie BJ. Snakebite in tropical Australia, Papua New Guinea and Irian Jaya. Emerg.Med. 2000;12:285-94. \\ +  - Ireland G, Brown SG, Buckley NA, Stormer J, Currie BJ, White J, et al. Changes in serial laboratory test results in snakebite patients: when can we safely exclude envenoming? Med J Aust 2010;193(5):285–90. {{:wikitox:medical_journal_of_australia_-_2010_-_ireland_-_changes_in_serial_laboratory_test_results_in_snakebite_patients_when_can.pdf|PDF}} 
-[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9043799&dopt=Abstract|Hodgson WC.]] Pharmacological action of Australian animal venoms. Clin.Exp.Pharmacol.Physiol. 1997;24(1):10-7. \\ +  - Isbister GK, Brown SG, MacDonald E, White J, Currie BJ, Australian Snakebite Project I. Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis. Med J Aust 2008;188(8):473–6. {{:wikitox:medical_journal_of_australia_-_2008_-_isbister_-_current_use_of_australian_snake_antivenoms_and_frequency_of_immediate‐type.pdf|PDF}} 
-[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7830641&dopt=Abstract|Howarth DM, Southee AE, Whyte IM.]] Lymphatic flow rates and first-aid in simulated peripheral snake or spider envenomation. Med.J.Aust. 1994;161(11-12):695-700. \\ +  - Isbister GK, Brown SG, Page CB, McCoubrie DL, Greene SL, Buckley NA. Snakebite in Australia: a practical approach to diagnosis and treatment. Med J Aust 2013;199(11):763–8. {{:wikitox:medical_journal_of_australia_-_2013_-_isbister_-_snakebite_in_australia_a_practical_approach_to_diagnosis_and_treatment.pdf|PDF}} 
-[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11711130&dopt=Abstract|Isbister GK, Dawson AH, Whyte IM.]] Two cases of bites by the black-bellied swamp snake (Hemiaspis signata). Toxicon 2002;40(3):317-9. \\ +  - Isbister GK, Buckley NA, Page CB, Scorgie FE, Lincz LF, Seldon M, et al. A randomized controlled trial of fresh frozen plasma for treating venom-induced consumption coagulopathy in cases of Australian snakebite (ASP-18). J Thromb Haemost 2013;11(7):1310–8. {{:wikitox:randomisedffpinsnakebite.pdf|PDF}} 
-[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2246987&dopt=Abstract|Jelinek GA, Breheny FX.]] Ten years of snake bites at Fremantle Hospital. Med.J.Aust. 1990;153(11-12):658-61. \\ +  - Isbister GK, Noutsos T, Jenkins S, Isoardi KZ, Soderstrom J, Buckley NA. D-dimer testing for early detection of venom-induced consumption coagulopathy after snakebite in Australia (ASP-29). Med J Aust 2022. {{:wikitox:medical_journal_of_australia_-_2022_-_isbister_-_d‐dimer_testing_for_early_detection_of_venom‐induced_consumption.pdf|PDF}} 
-[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8614336&dopt=Abstract|Mead HJ, Jelinek GA.]] Suspected snakebite in children: a study of 156 patients over 10 years. Med.J.Aust. 1996;164(8):467-70. \\ +  - Isbister GK, O’Leary MA, Elliott M, Brown SG. Tiger snake (Notechis spp) envenoming: Australian Snakebite Project (ASP-13). Med J Aust 2012;197(3):173–7. {{:wikitox:medical_journal_of_australia_-_2012_-_isbister_-_tiger_snake_notechis_spp_envenoming_australian_snakebite_project_.pdf|PDF}} 
-[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6503793&dopt=Abstract|Mirtschin PJ, Crowe GR, Thomas MW.]] Envenomation by the inland taipan, Oxyuranus microlepidotus. Med.J.Aust. 1984;141(12-13):850-1. \\ +  - Isbister GK, Scorgie FE, O’Leary MA, Seldon M, Brown SG, Lincz LF, et al. Factor deficiencies in venom-induced consumption coagulopathy resulting from Australian elapid envenomation: Australian Snakebite Project (ASP-10). J Thromb Haemost 2010;8(11):2504–13. {{:wikitox:factordeficienciesvicc.pdf|PDF}} 
-[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6098054&dopt=Abstract|Morrison JJ, Tesseraux I, Pearn JH, Harris J, Masci PP.]] Venom of the Australian rough-scaled snake, Tropidechis carinatus: lethal potency and electrophysiological actions. Toxicon 1984;22(5):759-65. \\ +  - Johnston CI, Brown SG, O’Leary MA, Currie BJ, Greenberg R, Taylor M, et al. Mulga snake (Pseudechis australis) envenoming: a spectrum of myotoxicity, anticoagulant coagulopathy, haemolysis and the role of early antivenom therapy - Australian Snakebite Project (ASP-19). Clin Toxicol (Phila) 2013;51(5):417–24. {{:wikitox:mulga_snake_pseudechis_australis_envenoming_a_spectrum_of_myotoxicity_anticoagulant_coagulopathy_haemolysis_and_the_role_of_early_antivenom_thera.pdf|PDF}} 
-[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10858512&dopt=Abstract|Pearn J, McGuire B, McGuire L, Richardson P.]] The envenomation syndrome caused by the Australian red-bellied Black Snake Pseudechis porphyriacus. Toxicon 2000;38:1715-29. \\ +  - Johnston CI, Ryan NM, O’Leary MA, Brown SG, Isbister GK. Australian taipan (Oxyuranus spp.) envenoming: clinical effects and potential benefits of early antivenom therapy - Australian Snakebite Project (ASP-25). Clin Toxicol (Phila) 2017;55(2):115–22. {{:wikitox:australian_taipan_oxyuranus_spp._envenoming_clinical_effects_and_potential_benefits_of_early_antivenom_therapy_australian_snakebite_project_asp-.pdf|PDF}} 
-[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10685181&dopt=Abstract|Shea GM]]. The distribution and identification of dangerously venomous Australian terrestrial snakes. Aust.Vet.J. 1999;77(12):791-8. \\ +  - Johnston CI, Ryan NM, Page CB, Buckley NA, Brown SG, O’Leary MA, et al. The Australian Snakebite Project, 2005–2015 (ASP-20). Med J Aust 2017;207(3):119–25. {{:wikitox:medical_journal_of_australia_-_2017_-_johnston_-_the_australian_snakebite_project_2005_2015_asp‐20.pdf|PDF}} 
-Sutherland SK, Tibballs J. Treatment of snake bite in Australia. In: Sutherland SK, Tibballs J, editors. Australian Animal Toxins. 2nd ed. Melbourne: Oxford University Press; 2001. p. 286-342. \\ +  - Kulawickrama S, O’Leary MA, Hodgson WC, Brown SG, Jacoby T, Davern K, et al. Development of a sensitive enzyme immunoassay for measuring taipan venom in serum. Toxicon 2010;55(8):1510–8. {{:wikitox:developmentimmunoasseytaipan.pdf|PDF}} 
-[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8538559&dopt=Abstract|Sutherland SK, Leonard RL.]] Snakebite deaths in Australia 1992-1994 and a management update. Med.J.Aust. 1995;163(11-12):616-8. \\ +  - Ryan NM, Kearney RT, Brown SG, Isbister GK. Incidence of serum sickness after the administration of Australian snake antivenom (ASP-22). Clin Toxicol (Phila) 2016;54(1):27–33. {{:wikitox:incidence_of_serum_sickness_after_the_administration_of_australian_snake_antivenom_asp-22_.pdf|PDF}}
-[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9792162&dopt=Abstract|White J]]. Envenoming and antivenom use in Australia. Toxicon 1998;36(11):1483-92.+