Tests for snake bite victums

Tests for snake bites
CSL venom detection kit
• Locate the bite site. Alternatively, if there is clearly systemic envenoming and the bite site is of poor quality, test urine.
• Take one of the cotton bud swab sticks provided in the kit and an unused "Yellow Sample Diluent" bottle. Put the swab stick into the sample diluent fluid to thoroughly moisten it.
• Rotate and rub the moistened swab stick vigorously over the bite site and adjacent skin.
• Place the swab stick back in the "Sample Diluent" bottle and twirl it around, to get any venom off into solution, then remove the swab stick and replace the dropper cap.
• Open a pack containing test wells, remove the enclosed set of 8 joined wells and place them in the holder.
• Place 2 drops of the sample diluent you have prepared into each well.
• Leave to stand for 10 minutes.
• Gently wash all wells under gently running water then invert and gently shake out excess water
• Now add the 2 substrate reagents, one drop to each well of the "Peroxide" and the "Chromogen".
• Allow to incubate for 10 minutes, watching the whole time, against a white background, for colour change. It is vital to observe the kit throughout this final phase, as the time sequence of colour change may be crucial.
• There should be a blue colour develop in well 7 (positive control), usually within 2-3 minutes. There should be no colour change in well 6 (negative control). A colour change in any of wells 1 to 5 indicates the presence of snake venom. The number of the well changing colour first indicates the type of snake venom and corresponding CSL snake antivenom. If there is no snake venom detected, then wells 1 to 5 will not change colour.

Meanings of colour changes:
• Only well 7 positive: No snake venom detected. This result does not exclude snakebite.
• If well 1 changes to blue first, then the patient has been bitten by either a tiger snake or rough scaled snake, or possibly a copperhead, broad-headed snake or Stephen's banded snake. Envenoming from all these snakes respond to CSL Tiger Snake Antivenom.
• If well 2 changes to blue first, then the patient has been bitten by a brown snake. CSL Brown Snake Antivenom will then be the right choice.
• If well 3 changes to blue first, then the patient has been bitten by a mulga snake (king brown), red bellied black snake, spotted black snake or Collett's snake. All these respond to CSL Black Snake Antivenom, but this is best reserved for bites by the mulga snake and Collett's snake, as all the others respond well to CSL Tiger Snake Antivenom (which is lower volume and cost effective).
• If well 4 changes to blue first, then the patient has been bitten by a death adder
• If well 5 changes to blue first, then the patient has been bitten by a taipan or inland taipan
• If wells 1 and 3 change to blue at the same time, then the patient has been bitten by either a copperhead, a red bellied black snake, a spotted black snake or possibly a Collett's snake.
• If some other combination occurs please ring CSL for advice
www.toxinology.com/generic_static_files/cslavh_svdk.html

Other tests for patients suspected of being bitten by a snake include:
• Coagulation screen
• Full blood count
• Electrolytes and calcium
• Creatinine kinase levels
• Arterial blood gases
• ECG
aerg.canberra.edu.au/staff/georges/snakebite.pdf

-Ben