Nick Buckley and Ian Whyte, the authors of the article, comment:
Management of snakebite in remote areas, particularly those without 24-hour laboratory facilities, presents many challenges. Point-of-care tests (for example iSTAT INR and d-dimer) do not substitute for laboratory studies and should not be used under any circumstances. The ‘20 minute whole blood clotting test’ may detect coagulopathy, but requires small clean glass tubes. Even if these are available, in practice the test often will not detect envenomation. Most patients with suspected or confirmed snakebite should therefore be transferred to a larger hospital (with a pressure bandage on the bite and immobilisation) for diagnosis and monitoring.
Most remote hospitals will still be recommended to keep a minimal stock of antivenom. For symptomatic patients, a decision may be made to administer antivenom before or during transfer without laboratory confirmation. Weak evidence suggests early antivenom may reduce the incidence of some complications such as myotoxicity, but at the cost of potential adverse effects from the antivenom (if the patient is not envenomed). This should only be done if the doctor is prepared to treat anaphylaxis.
The NSW Health’s snakebite guidelines recommend stocking of antivenom in Trundle (and the NSW Therapeutic Advisory Group lifesaving drugs register recommends that it is available). It is concerning if it is not, for it follows there is no current quick and reliable means of determining where the nearest hospital is with antivenom stocks.
This is another example of the urgent need for a national policy on stocking antidotes and a regularly audited antidote register with a search tool to locate them in an emergency.
