Exclusion of envenoming
The initial presentation and admission bloods diagnosemost cases of envenoming. If laboratory studies onadmission are normal and there is no clinical evidence ofenvenoming, the pressure bandage can be removed in acritical care area (where antivenom is available) and thepatient observed carefully. Evidence of envenoming willusually develop rapidly within an hour post- removal ofthe bandage; if it is going to occur. If there is no evidenceof envenoming after an hour the patient should beobserved for 12 hours after the time of the bite with thefollowing laboratory tests and a careful neurologicalexamination (ptosis, bulbar, respiratory or distal paralysis).n 1 hour after removal of the bandage:INR, aPTT, CK and neurological examinationn 6 hours post-bite: INR, aPTT, CK andneurological examinationn 12 hours post-bite: INR, aPTT, CK andneurological examination
@mikey_mike Why would a SVDK be used only once the decision has been made that envenomation occurred?? That doesn't make sense. If a patient is initially asymptomatic surely it would be advantageous to do the test to determine what anti venom should be used in case systemic symptoms ensue? If you wait till the patient begins to show symptoms before doing the test then there is a long time delay before you can administer the correct anti venom!
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Bite site swabs and urine samples should be taken as soon as possible, but will not normally be processed until there are signs or symptoms of envenomation. Venom detection kits should never be used to rule in or rule out envenomation. Their only use should be to identify the snake so that the appropriate monovalent antivenom can be used instead of polyvalent. There's not usually any problem with using polyvalent antivenom instead of monovalent, it just means that the patient receives a larger protein load & is therefore more likely to develop an allergic reaction (which should be treatable). The risk of this allergic reaction would anyway need to be balanced against the risk of giving the wrong antivenom if the VDK was wrong (which is possible) so regardless the VDK result would only be applied if was consistent with the observed envenomation syndrome & with local snakes.
If I were to speculate at this stage I would say that unfortunately Wayne may have died partly because his first aid was so effective
Question for you even arfter removing bandage would tipan venom relly kill that quickly i all ways been under the impression that it takes a few hours for symptoms to apper that would be deadly. If so he being a snake relocater would have knowen the symptom even miner ones at that. One other thing will ortopsy resalts tell as if was the venom of a alergic rraction to the venom its self
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