Envenomation — Snake, Spider & Marine (ANZ)

Also known as Snake bite · Venom-induced consumption coagulopathy · VICC · Pressure-immobilisation · Funnel-web spider · Redback spider · Box jellyfish · Snake antivenom

The Australian envenomation — the snake (the elapid — the brown, the tiger, the taipan, the death adder; the venom-induced consumption coagulopathy / the VICC, the neurotoxicity, the myotoxicity, the sudden collapse), the spider (the funnel-web — the robustoxin, the life-threatening; the redback — the latrotoxin, the painful), and the marine (the box jellyfish — the cardiotoxic; the blue-ringed octopus — the tetrodotoxin paralysis). The pressure-immobilisation, the venom detection kit, the antivenom. The ANZ (the CICM) emphasis.

high24 referencesUpdated 20 Aug 202611 min readVerification in progress

Practise this topic

8 MCQs

The one-paragraph exam answer

Australian envenomation splits three ways — snake (the elapids: brown, tiger, taipan, death adder, mulga), spider (the funnel-web and the redback), and marine (the box jellyfish and the blue-ringed octopus). The snake syndromes are venom-induced consumption coagulopathy (an unmeasurable INR with consumed clotting factors and a HIGH D-dimer — the factors resynthesise over the days that follow), neurotoxicity (ptosis descending to respiratory paralysis), myotoxicity, and the sudden collapse of the brown snake. First aid is PRESSURE-IMMOBILISATION for the snake and funnel-web (it delays lymphatic spread), the venom detection kit identifies the genus, and the monovalent antivenom is the cure. Pressure-immobilisation is WRONG for the redback (latrotoxin is local) and the box jellyfish (use vinegar).^[1]

Meet the patient

A 9-year-old boy is bitten on the finger by a Sydney funnel-web while lifting a log. Within twenty minutes he is salivating, lacrimating, sweating profusely, fasciculating, hypertensive (160/100) and progressively bradycardic. Across the country, a stockman bitten on the ankle by an unseen snake has a normal first blood count at one hour — and an unrecordable INR by the third.^[1]

The two questions that govern every Australian bite are the ones these vignettes turn on: which animal, and has venom actually been injected? Roughly half of snakebites are dry. The pressure-immobilisation bandage, the venom detection kit, and the antivenom answer the rest — but only if you observe long enough to let the venom declare itself.^[1]

References24Show

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