Once bitten, twice shy: How consistent is the management of snake bite victims in Australian emergency departments?

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Kain, Victoria
Jesberg, Andrew
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Background: There are approximately 3000 snakebite presentations to emergency departments in Australia each year; of these, almost 500 patients will require anti-venom treatment. The complexities of clinical symptoms can provide a difficult and challenging clinical presentation in the emergency room. Clinical judgement and laboratory testing, in conjunction with geographic location and a description of the snake, are essential in identifying the correct species. Specific antivenom is required for the treatment of severe snake envenomation, but carries the risk of a hypersensitivity reaction to the treatment.

Aim: The aim of this study was to determine whether clinical protocols for the management of snake envenomated patients are consistent and informed by the best available evidence.

Method: This study utilised a non-experimental, retrospective design to develop a clinical audit tool to extrapolate data from clinical protocols with a purposive sample of tertiary healthcare facilities in eastern border states of Australia.

Results: Clinical protocols were analysed from six tertiary hospitals. The data from the audit tool were organised into six domains: First aid; symptom identification; clinical assessment; clinical management; antivenom therapy; and management of an anaphylactic reaction. There were inconsistencies across all domains; only two of the protocols were informed by evidence in the form of a reference list.

Conclusion: The significance of the inconsistencies in these clinical protocols need to be determined, and furthermore, whether there is an association with adverse patient outcomes. In order to guide clinicians in best practice to treat snake envenomated patients, standardised policies and protocols, informed by evidence, may be required in Australian healthcare facilities.

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Australasian Emergency Nursing Journal
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Kain, V; Jesberg, A, Once bitten, twice shy: How consistent is the management of snake bite victims in Australian emergency departments?, Australasian Emergency Nursing Journal, 2011, 14 (Supplement 1), pp. S1-S2