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Admissions for suspected snake bite to the Perth adult teaching hospitals, 1979 to 1988
G A Jelinek1, T Hamilton, R L Hirsch
1Department of Emergency Medicine, Fremantle Hospital, WA.
Objective:
To describe the epidemiology of snake bite in Perth, and the likelihood of envenomation.
Design:
Information from case notes was retrospectively analysed.
Setting:
Emergency medicine, teaching hospitals.
Patients:
All patients admitted to the three adult teaching hospitals in Perth for suspected snake bite from 1979 to 1988.
Main Outcome Measure:
Systemic envenomation, was accepted as present if there were definite symptoms, signs or laboratory evidence (vomiting, abdominal pain, ptosis, convulsions, difficulty with breathing or swallowing, coagulopathy, haemolysis, rhabdomyolysis or renal failure).
Results:
Ninety-nine patients were definitely bitten, with 53 envenomed, including three snake handlers. Thirty others may have been envenomed. Nearly half (44%) of the 82 patients with witnessed snake bite were envenomed. The dugite (Pseudonaja affinis) caused most cases of envenomation, most often producing coagulopathy only. The remainder were probably due to bites by the tiger snake (Notechis after occidentalis) and gwardar (Pseudonaja nuchalis), with one by a sea snake. The Commonwealth Serum Laboratories Snake Venom Detection Kit (VDK) enabled identification of the genus in 36% of definite cases of snake bite, and in 51% of cases of envenomation. It may occasionally produce false-positive results. The VDK is of greatest value in establishing the genus of snake in envenomed patients.
Conclusions:
It is suggested that a mixture of brown and tiger snake antivenom be used to treat patients envenomed by an unidentified snake in the Perth metropolitan area. This does not apply to patients bitten elsewhere in Western Australia or transferred to Perth from country regions where other snakes are more prevalent.