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Snake envenomation – systemic — RACP Paediatrics MCQ

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ModerateEmergencySnake envenomation – systemicRACP Paediatrics

The same child arrives at hospital with the pressure bandage in situ. Two hours after the bite, he develops drooping eyelids, difficulty swallowing, and generalised weakness. Coagulation studies show a markedly elevated INR and undetectable fibrinogen. What is the most appropriate treatment?

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Correct answer: A — IV antivenom

Neurotoxic features (ptosis, bulbar weakness) and coagulopathy (venom-induced consumptive coagulopathy - VICC) indicate systemic envenomation requiring IV antivenom. Brown snake antivenom should be administered. The pressure bandage should not be removed until antivenom has been given and the patient is in a monitored setting prepared for potential anaphylaxis.

Reference: Australian Therapeutic Guidelines – 2024 – Toxicology; RCH Melbourne – 2023 – Snake Bite CPG