Snakebite in children: Texts

Text A

Background

Snakebite is uncommon in Victoria and envenomation (systemic poisoning from the bite) is rare. The bite site
may be evidenced by fang marks, one or multiple scratches. The bite site may be painful, swollen or bruised,
but usually is not for snakes in Victoria.

There are no sea snakes in Victoria, but land-based snakes can swim.

Major venomous snakes in Victoria and effects of envenomation:

Systematic Cardiovascular
Snake Coagulopathy Neurotoxicity Myotoxicity TMA
symptoms effects

- Collapse (35%)
Brown VICC Rare and mild 50% 10%
Cardiac arrest (5%)

Tiger VICC 30% 20% Common Rare 5%

Red- Mild increase - Uncommon Common - -

bellied
Text C in aPITT and Often
black INR with significant
normal bite site pain
fibrinogen, and limb
usually no swelling
significant
bleeding

VICC: Venom-induced consumptive coagulopathy (abnormal INR, high aPTT, fibrinogen very low, D-dimer
high).

Myotoxicity muscle pain, tenderness, rhabdomyolysis

Systemic Symptoms see history and examination.

TMA: thrombotic microangiography. Haemolysis with fragmented red blood cells on blood film,
thrombocytopenia and a rising creatinine.

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 Text B

Assessment

Focus on evidence of envenomation.

• Once the possibility of snakebite has been raised, it is important to determine whether a child
has been envenomed to establish the need for antivenom.
• This is usually done taking into consideration the combination of circumstances, symptoms,
examination and laboratory test results.
• Most people bitten by snakes in Australia do not become significantly envenomed.

History and Examination

Circumstances Symptoms Examinations

- Confirmed or witnessed - Headache - Evidence of a bite/ multiple

bite versus suspicion that - Diaphoresis bites
bite might have occurred - Evidence of venom movement
Text C - Nausea or vomiting
- Abdominal pain (e.g. sowllen or tender draining
- Were there multiple bites?
- Diarrhoea lymph nodes)
- When?
- Where? - Blurred or double vision - Neurotix paralysis (ptosis,
- First aid? - Slurring of speech ophthalmoplegia, diplopia,
- Past history? - Muscle weakness dysarthria, limb weakness,
- Medications? - Respiratory distress respiratory muscle weakness)
- Allergies? - Bleeding from the bite site or - Coagulopathy (bleeding gums,
elsewhere prolongued bleeding from
- Passing dark or red urine venepuncture sites or other
- Local pain or swelling at bite wounds, including bite site)
site - Muscle damage (muscle
- Muscle pain tenderness, pain on movement
- Pain in lymph nodes draining weakness, dark or red urine
the bite area indicating myoglobinuria)
- Loss of consciousness/collapse
and/or convulsions

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Text C

Snakebite Management Flowchart

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 Text D

Giving Antivenom

• Antivenom is indicated in all children where there is evidence of envenomation.

• Giving antivenom should occur in consultation with a clinical toxicologist.
• Dilute one vial in 100mls of 0.9% saline and give IV over 15-30 min.
• If the child is in cardiac arrest and this is thought to be due to envenomation, then give undiluted
antivenom via rapid IV push.
• There is no weight based calculation for antivenom (the snake delivers the same amount of venom
regardless of the size of the child). One vial of antivenom is enough to neutralise the venom that can be
delivered by one snake. Clinical recovery takes time after antivenom administration and multiple vials do
not speed recovery.

At discharge, ensure that the family is given advice on how to recognise serum sickness:

• Occurs in about 30% of children given antivenom.

• Tends to occur 4 – 14 days following antivenom administration.
• Consists of flu-like symptoms, fever, myalgia, arthralgia and rash.
• A letter should also be written to the child’s GP regarding this.

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OET ONLINE – READING
TEST 3
A3
TIME: 15 minutes
Look at the four texts, A – D, in the separate Text Booklet.
For each question, 1 – 20, look through the texts, A – D, to find the relevant information.
Write your answers on the spaces provided in this Question Paper.
Answer all the questions within the 15-minute time limit.
Your answers should be correctly spelt.
Questions 1 – 7
For each of the questions, 1 – 7, decide which text (A, B, C or D) the information comes from. You may use any letter more than
once.
1. the factors to consider when evaluating snakebite?________
2. what a snakebite can look like? ________
3. possible types of snakebite and their reactions? ________
4. signs that a child may be bitten by a poisonous snake? ________
5. when to release a pressure immobilisation bandage? ________
6. knowing when it is safe to discharge a child who has not been envenomed? ________
7. to tell parents to look for in a child having a response to serum? ________

Answer each of the questions, 8-12, with a word or short phrase from one of the texts. Each
answer may include words, numbers or both.

8- If you suspect a snakebite has occurred, you must decide whether or not the child has

been ___________________ .

9- Substantial pain and swelling is a likely sign that the child has been bitten by a ___________________ snake.

10- If clinical evidence warrants administration of antivenom, you should ensure it is done in conjunction with a

___________________ .

11- You will need to affix a ___________________ if it hasn't been done.

12- When deciding how much antivenom to administer, ___________________ is considered sufficient for each

child irrespective of their body weight.

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Questions 13 – 20
Answer each of the questions, 13 – 20, with a word or short phrase from one of the texts. Each
answer may include words, numbers or both.

13- What TWO signs should you look for if snakebite is suspected?

_________________________________________________________

14- When assessing a child, what might indicate the presence of venom movement?

_________________________________________________________

15- In cases where neurotoxicity is rare or not severe, what type of snakebite could it indicate?

_________________________________________________________

16- After removing the PIB, when should you conduct another blood test if there is no evidence of poisoning from a
snakebite?

_________________________________________________________

17- What TWO anti-venoms should you give to a child with signs of envenomation?

_________________________________________________________

18- What quantity and strength of saline should each vial of anti-venom be diluted in?

_________________________________________________________

19- What time of day should discharge occur?

_________________________________________________________

20 - After anti-venom is administered, how long does it usually take for serum sickness to develop?

_________________________________________________________

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 B3
The purpose of the email to hospitals about prescribing of antibiotics is to
Select one:
A. encourage them to implement appropriate procedures.
B. remind them of the seriousness of the issue.
C. advise them of upcoming changes.

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According to the memo, when keeping records staff should ensure
Select one:
A. they reflect everything that occurred.
B. important information is written down first.
C. their colleagues will be able to understand them.

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Why is the Queensland Bedside Audit conducted each year?
Select one:
A. to improve the quality of health service supply.
B. to find out how parties feel about their treatment.
C. to allow facilities to make advancements in technology.

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The policy extract tells us that
Select one:
A. all haemophilia patients must be treated in a registered HTC.
B. only haemophilia patients with a factor level above 30% need to be treated in a HTC.
C. the risks of being treated in a non-HTC facility have to be conveyed to relevant haemophilia patients.

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 C3.1

The writer uses the percentages in the first paragraph to highlight

A. the size of the study.

B. the illnesses identified by the study.

C. the significance of the results of the study.

D. the differences between certain groups who took part in the study.
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What does Max Griswold, the lead author of the study, say concerns him?

A. the fact that alcohol is consumed in larger quantities now than in the past.

B. the misconception that in some instances alcohol may be good for you.

C. the lack of education available about the effects of alcohol.

D. the amount of ways alcohol has to make people sick.

What does the word ‘they’ in the second paragraph refer to?

A. Types of threats.

B. New discoveries.

C. Number of drinks.

D. Previous outcomes.

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The writer uses the expression ‘went further’ to indicate EmmanuelaGakidou

A. would have liked the study to look at more cases.

B. wants more people to reduce the amount they are drinking.
C. believes the suggestions made by Max Griswold aren't enough.
D. isn't happy about the lack of action since the 2014 World Cancer Report.

Study co-author Emmanuela Gakidou suggests alcohol consumption

A. should not be if concern if current levels are monitored.

B. must be addressed by governments immediately.
C. has been increasing at an alarming rate.
D. is an excellent source of revenue.
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 C3.2
.

What concern does the writer express in the second paragraph?

A. Empathy isn't fully understood by some health professionals.

B. Sympathy can impede on professionalism in a clinical setting.
C. Health professionals don't equally display empathy and sympathy.
D. Empathy and sympathy are often confused by health professionals.

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What does the word ‘it’ in the fourth paragraph refer to?

A. Touch.

B. Oxytocin.

C. The work of a nurse.

D. Non-verbal communication.

The writer suggests technology has led to reduced levels of empathy because

A. it means people don't always need to be in the same room.

B. it sometimes results in people becoming preoccupied.

C. it causes an extra level of stress for some people.

D. it can create greater distance between people.

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In the final paragraph, the writer suggests the best way to improve empathy is to
Select one:
A. fund research into the issue.
B. utilise new lab-focussed initiatives.
C. pay greater attention to the patient.
D. undertake communication-based study.

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