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A Clinician's Guide to Australian Venomous Bites and Stings

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A Clinician's Guide to Australian Venomous Bites and Stings Incorporating the updated CSL Antivenom Handbook Bites and Stings Australian Venomous Guide to A Clinician’s A Clinician’s Guide to DC-3234 Australian Venomous Bites and Stings Incorporating the updated CSL Antivenom Handbook Associate Professor Julian White Associate Professor Principal author Principal author Principal author Associate Professor Julian White The opinions expressed are not necessarily those of bioCSL Pty Ltd. Before administering or prescribing any prescription product mentioned in this publication please refer to the relevant Product Information. Product Information leafl ets for bioCSL’s antivenoms are available at www.biocsl.com.au/PI. This handbook is not for sale. Date of preparation: February 2013. National Library of Australia Cataloguing-in-Publication entry. Author: White, Julian. Title: A clinician’s guide to Australian venomous bites and stings: incorporating the updated CSL antivenom handbook / Professor Julian White. ISBN: 9780646579986 (pbk.) Subjects: Bites and stings – Australia. Antivenins. Bites and stings – Treatment – Australia. Other Authors/ Contributors: CSL Limited (Australia). Dewey Number: 615.942 Medical writing and project management services for this handbook provided by Dr Nalini Swaminathan, Nalini Ink Pty Ltd; +61 416 560 258; [email protected]. Design by Spaghetti Arts; +61 410 357 140; [email protected]. © Copyright 2013 bioCSL Pty Ltd, ABN 26 160 735 035; 63 Poplar Road, Parkville, Victoria 3052 Australia. bioCSL is a trademark of CSL Limited. bioCSL understands that clinicians may need to reproduce forms and fl owcharts in this handbook for the clinical management of cases of envenoming and permits such reproduction for these purposes. However, except for the purpose of clinical management of cases of envenoming from bites/stings from Australian venomous fauna, no part of this publication may be reproduced by any process in any language without the prior written consent of bioCSL Pty Ltd. Where applicable, copyright of photos, illustrations and fl owcharts included in this handbook that have been reproduced with permission, is attributed to the appropriate person/authority. Maps regarding the distribution of various venomous fauna in Australia obtained courtesy A/Prof Julian White. Cover photos: Box jellyfi sh photo copyright Dr Lisa-ann Gershwin, Australian Marine Stinger Advisory Services; all other cover photos copyright bioCSL Pty Ltd. Editorial content: Although great care has been taken in compiling and checking the information provided in this publication to ensure that it is accurate, bioCSL Pty Ltd shall not be responsible for the continued currency of the information, or for any errors, omissions or inaccuracies in this publication. Before using this handbook This handbook is sponsored as a service to the healthcare profession by bioCSL Pty Ltd (bioCSL), and is provided for educational purposes only. Associate Professor Julian White is the principal author of this handbook. The contents represent a compilation of A/Prof White’s clinical experience and that of his peers alongside research evidence (published and unpublished, including discussions with colleagues at scientifi c meetings). Any clinical information and recommendations in this handbook are relevant to Australian venomous fauna only and should not be applied to envenoming by non-Australian organisms. Specifi cally, although the venomous fauna in Papua New Guinea are similar to that of Australia, there are important differences, particularly with regards to snake fauna. Please note: The purpose of this handbook is to educate and assist clinicians in the emergency management of cases of envenoming and in the appropriate use 1 of antivenom therapy when clinically indicated. The primary intention is to guide the clinician towards current understanding of clinical best practice. The handbook does not purport to be an exhaustive review of the literature. Unreferenced material can be attributed to A/Prof Julian White personal communication. Envenoming from venomous bites/stings can be life threatening and represents a potential medical emergency. When managing patients with signifi cant systemic envenoming, always seek expert advice. Access to expert advice is available from relevant contacts listed on page 3 of this handbook. Healthcare professionals should be made aware that the contents of this handbook are based on published evidence, as well as clinical and research experience of the authors. Sometimes the instructions from the authors for use are different from the instructions described in the current respective Antivenom Product Information (PI). bioCSL does not support and is not responsible for the use of its antivenom products outside of that specifi ed in the PI. 2 Contact Information Emergency (Police/Ambulance/Fire Services) 000 Women and Children’s Hospital, Adelaide (08) 8161 7000 (ask to speak to the Duty Clinical Toxinologist) bioCSL Medical Information Department 1 800 642 865 National Poisons Information Centre 13 11 26 Australian Venom Research Unit 1 300 760 451 3 Contents How to use this handbook in Snakebite: General treatment ..........107 an emergency ......................................6 Specifi c treatment of snakebite: Acknowledgments ...............................8 Antivenom Foreword ...........................................11 Antivenom therapy for snakebite ...................................111 Section 1 Indications, timing, choice Management of venomous bites of antivenom, dosing, and stings: General information complications, etc ......................112 Management of venomous bites and stings ..................................15 Administering I.V. antivenom Envenoming: (fl owchart) .......................................134 Envenoming overview ..................20 Treating snakebite: Managing Diagnosis of systemic venom-induced toxicity ....................135 envenoming ................................24 Management of envenoming Australian venomous snakes with antivenoms ..........................26 overview: Brown snake group ...................143 Tiger snake group ......................149 4 Section 2 First aid Black snake group .....................156 Basic (critical care) fi rst aid .................31 Death adder group ....................160 Basic fi rst aid: DRS ABCD ...................32 Taipans ......................................163 Specifi c fi rst aid for venomous Sea snakes ................................166 bites and stings: Snake identifi cation .........................168 Appropriate fi rst aid for bites/stings ..................................37 Section 4 Pressure Bandaging & Spiders Immobilisation (PBI) ............................38 Spiderbite: Vinegar ..............................................44 Background ...............................177 Hot water ..........................................47 Clinical presentation ..................178 First aid .....................................184 Section 3 Diagnosis ...................................186 Snakes Spiderbite decision tree based on Snakebite: clinical presentation (fl owchart) ........192 Clinical presentation ....................51 Spider identifi cation .........................193 First aid .......................................56 Management of envenoming Diagnosis ....................................58 due to spiderbite: Treating snakebite: Basic principles ..........................195 Fundamentals ..............................97 Urgent treatment ......................196 Urgent treatment ........................99 Management of suspected Snakebite management chart 1 .......102 or confi rmed funnel web Snakebite management chart 2 .......104 spider bite (fl owchart) ......................197 Snakebite management chart 3 .......106 Management of suspected Management of Irukandji syndrome: or confi rmed red back spider Urgent management .................268 bite (fl owchart) ................................198 General management: Specifi c treatment for funnel analgesia; hypertension; web spider bite: Antivenom .............199 & other issues ............................269 Specifi c treatment for red back Irukandji syndrome management spider bite: Antivenom .....................203 guidelines (fl owchart) .......................273 Spider antivenoms: Preparation, administration and complications .....207 Other jellyfi sh stings .........................274 Necrotic arachnidism ........................217 Section 7 Necrotic skin lesions: Approach to Stinging fi sh investigations (fl owchart) .................220 Stinging fi sh: Australian spiders overview: Background & clinical Funnel web spider group ...........221 presentation ..............................281 Red back spiders ........................223 First aid & diagnosis ...................282 Mouse spiders ...........................226 Fish stings: General treatment ..........283 Other spiders .............................227 5 Specifi c treatment for stonefi sh stings: Stonefi sh antivenom .............284 Section 5 Stonefi sh: Overview .........................295 Other arthropods Insects, centipedes and scorpions .....233 Section 8 Paralysis ticks ...................................235 Other marine animals Stingray stings .................................299 Section 6 Blue ringed octopus, Jellyfi sh Hapalochlaena spp ...........................301 Jellyfi sh stings: Overview ..................243 Cone snails, Conus spp ....................302 Jellyfi sh triage algorithm (fl owchart) .......................................244 Section 9 Box
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