Materiały źródłowe

• #1 Snakebite Envenoming Diagnosis and Diagnostics

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8113877/

  Snakebite envenoming is predominantly an occupational disease of the rural tropics, causing death or permanent disability to hundreds of thousands of victims annually. The diagnosis of snakebite envenoming is commonly based on a combination of patient history and a syndromic approach. […] Achieving timely diagnosis, and thus treatment, is a challenge faced by treating personnel around the globe. For years, much effort has gone into developing novel diagnostics to support diagnosis of snakebite victims, especially in rural areas of the tropics. Gaining access to affordable and rapid diagnostics could potentially facilitate more favorable patient outcomes due to early and appropriate treatment. […] A basic diagnosis of snakebite envenoming requires a thorough patient history, targeted examination, and appropriate laboratory investigations.

• #2 Diagnosis of Snakebite and the Importance of Immunological Tests in Venom Research

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4052258/

  In many cases of envenoming following snake bite, the snake responsible for the accident remains unidentified; this frequently results in difficulty deciding which antivenom to administer to the systemically-envenomed victim, especially when only monospecific antivenoms are available. […] Normally the specific diagnosis of snake bite can be conveniently made using clinical and laboratory methods. […] Where clinical diagnosis depends upon the recognition of specific signs of envenoming in the patient, laboratory diagnosis is based on the changes which occur in envenomed victims including the detection of abnormalities in blood parameters, presence/absence of myoglobinuria, changes in certain enzyme levels, presence/absence of neurotoxic signs and the detection in the blood of specific venom antigens using immunologically-based techniques, such as enzyme immunoassay.

• #3 Snake Bites | Doctor

  https://patient.info/doctor/snake-bites

  Snake bites can be life-threatening injuries that can require intensive care. […] The majority of people who are bitten by snakes in the UK, and indeed in countries where venomous snakes are more common, will have been bitten by a non-venomous snake. […] However, unless the identity of the snake is known with certainty, it is advisable to administer first aid with the assumption that the snake may have been venomous. […] It is important to obtain an accurate history if possible. […] Ideally this should incorporate details of the snake. […] Identification is then according to accurate description of size, colour, patterning and other characteristics (’rattle’, habitat). […] This should be thorough. […] Check vital signs according to the airway, breathing and circulation routine.

• #4 Diagnosis of Snakebite and the Importance of Immunological Tests in Venom Research

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4052258/

  The identification of the biting species by both lay and many medical personnel is notoriously inaccurate. […] EIA enables the reliable and objective determination of the species causing envenoming. […] A rapid, sensitive, simple and affordable test is still required to enable the clinician to treat the patient with the correct monospecific (or polyspecific) antivenom at the bedside as soon as possible after admission to hospital. […] The main application of the EIA is in retrospective identification of the biting species. […] The value of EIA in the study of new and existing antivenoms is that it provides an important objective assessment of antivenom efficacy. […] EIA has proved to be a very useful method for the objective assessment of antivenom efficacy and dosage. […] The assay is carried out against the venoms from all species of venomous snakes known to be present in the study region.

• #5 Snakebite – Wikipedia

  https://en.wikipedia.org/wiki/Snakebite

  Determining the type of snake that caused a bite is often not possible. […] Treatment partly depends on the type of snake. Washing the wound with soap and water and holding the limb still is recommended. Antivenom is effective at preventing death from bites; however, antivenoms frequently have side effects. […] The number of venomous snakebites that occur each year may be as high as five million. They result in about 2.5 million envenomations and 20,000 to 125,000 deaths. […] The three types of venomous snakes that cause the majority of major clinical problems are vipers, kraits, and cobras. Knowledge of what species are present locally can be crucial, as is knowledge of typical signs and symptoms of envenomation by each type of snake.

• #6 Snake Bites – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/pediatrics/snake-bites/

  In considering the diagnosis of a venomous snake bite, it is important to exclude bites by other animals, for example, spider bites and nonvenomous snake bites. It is also important to rule out other causes of puncture wounds. Identification of the snake as well as clinical manifestations are the mainstays of diagnosis. […] Nonvenomous snakes typically have a round head, no heat-sensing pit, round pupils, and a double row of plates caudal to the anal plate. In contrast, venomous snakes have triangular heads, elliptical eyes, and a heat-sensing pit between each eye and nostril. […] The physical exam should focus particularly on the cardiovascular, pulmonary, and neurologic systems. […] Pit viper envenomation is typically described as minimal, moderate, or severe. Mild envenomation consists of purely local effects without systemic signs or symptoms or abnormal laboratory values. Moderate envenomation reveals local effects that do not include the entire extremity, mild systemic signs or symptoms, or mild laboratory abnormalities. Severe envenomation includes progression of local effects (swelling, erythema, edema, and ecchymoses) of the entire extremity or concern for airway compromise, life-threatening systemic signs or symptoms, or significantly abnormal coagulation studies.

• #7 Snakebite Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/168828-workup

  Ultrasonography of the affected extremity should be obtained when the diagnosis is uncertain and there is clinical concern about deep vein thrombosis (DVT). […] Clinicians should examine the affected extremity for swelling, tenderness, hemorrhagic blebs, and the presence of strong distal pulses. […] Serial dynamometry and negative inspiratory force assessments should be performed in patients at risk for respiratory or skeletal weakness or paralysis (eg, from coral snake envenomations or bites from neurotoxic rattlesnakes). […] However, compartmental pressures should be measured in patients with disproportionate pain and significant tissue swelling.

• #8 Snakebites – Injuries and Poisoning – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/injuries-and-poisoning/bites-and-stings/snakebites

  The bite marks sometimes suggest whether the snake was venomous. The fangs of a venomous snake usually produce 1 or 2 large punctures, whereas the teeth of nonvenomous snakes usually leave multiple small rows of scratches. […] Envenomation is recognized by the development of characteristic symptoms. People who are bitten by a venomous snake are generally kept in the hospital for observation for 6 to 8 hours to see if any symptoms develop. Doctors do various tests to assess the effects of the venom. […] A doctor’s evaluation […] Hospitalization for observation for bites with envenomation.

• #9 Snake bites – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/945?locale=ko

  Key diagnostic factors include identification of the snake, local redness, swelling, tenderness, and pain at wound site, blurred or double vision, shortness of breath, difficulty swallowing, hypotension, tachypnea, tachycardia, puncture marks, fang marks, bulbar weakness/paralysis, stridor, hemorrhage, and quadriplegia/locked-in syndrome. […] Other diagnostic factors include nausea and vomiting, malaise, generalized weakness or dizziness, perioral tingling or numbness, urticaria, and tremors. […] 1st tests to order include prothrombin time, PTT, fibrinogen, and D-dimer, CBC, electrolytes, BUN, and creatinine, arterial blood gas, creatine kinase (CK), lactate, urinalysis, ECG, chest x-ray, wound x-ray, and negative inspiratory force (NIF) test. […] Tests to consider include CT/MRI, compartment pressure, central venous line with central venous pressure (CVP) transduction, and arterial line with pressure transduction.

• #10 Snake bites – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/945?locale=ko

  Snakebites in the US usually occur during intentional snake exposures, such as snake handling, snake hunts, and aggravating snakes in the wild. […] Few physicians have experience treating snakebites, and a poison center should be consulted in all cases. […] All snakebites should be copiously irrigated and inspected for foreign bodies or tendon damage. […] Crotalinae (pit viper) envenomation may cause significant local and systemic effects including rhabdomyolysis, compartment syndrome, coagulopathy, pulmonary edema, and hypotension. […] Crotalinae antivenom (Crotalidae polyvalent immune Fab) should be administered in Crotalinae envenomations with worsening local toxicity or systemic symptoms. […] The first sign of Elapidae (coral snake) envenomation is frequently ptosis. […] Elapidae antivenom (antivenin, North American coral snake) should be administered in all confirmed Eastern coral snake envenomations to arrest progression of toxicity.

• #11 Snakebite Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/168828-workup

  In cases of possible snakebite envenomation, the following laboratory tests should be performed: […] For patients with systemic toxicity, additional testing may be warranted, including liver function tests (LFTs), urinalysis, blood typing and crossmatching, and venous blood gas analysis. […] Hematologic toxicity is frequently observed after pit viper envenomation. It may be present on arrival, or it may develop after several days. Specific laboratory abnormalities may include the following: […] In general, copperhead envenomations are associated with the least hematotoxicity. […] In a multicenter study of cottonmouth envenomations, coagulopathy was observed in 19% of patients. […] Hematologic toxicity was seen in 76% of patients with rattlesnake envenomations. […] Routine imaging is not required following snake envenomation.

• #12 Snakebite Envenoming Diagnosis and Diagnostics

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8113877/

  Diagnostic algorithms can aid clinicians in determining the snake species most likely to have caused the bite. […] The SVDK is a non-laboratory, rapid, freeze-dried, immunoassay kit, developed for Australian and some Papua New Guinea snake venoms, that uses bite site swabs, or alternatively a urine sample, to detect the venom immunotype. […] In the United States (US) and Canada, around 6,500 people suffer from snakebites annually, resulting in 5-6 deaths. […] The US has about 26 indigenous venomous snake species, where rattlesnakes (Crotalus spp.), moccasins (Agkistrodon spp.), and pygmy rattlesnakes (Sistrurus spp.), all of which belong to the pit viper (Crotalinae) subfamily, are the main genera implicated in snakebites. […] In Latin America and the Caribbean islands, 80,000-129,000 snakebite envenomings occur each year, leading to an estimated 540-2,300 deaths.

• #13 Snakebite in Australia: a practical approach to diagnosis and treatment | The Medical Journal of Australia

  https://www.mja.com.au/journal/2013/199/11/snakebite-australia-practical-approach-diagnosis-and-treatment

  Laboratory measurement of the international normalised ratio (INR) and aPTT is imperative. […] Thrombocytopenia and red cell fragmentation on a blood film indicate a diagnosis of thrombotic microangiopathy. […] Serial measurements of electrolyte, urea and creatinine levels may assist in assessing renal function. […] The Snake Venom Detection Kit (SVDK; CSL Ltd) is designed to assist in determining the appropriate antivenom to use in envenomed patients. […] Most patients present with a report of a definite or suspected snakebite, but it is often unclear whether a patient is envenomed and what type of snake is involved. […] Investigation and treatment should follow a logical process to ensure envenoming is correctly diagnosed and the correct antivenom is used. […] Evidence of envenoming exists if neurotoxicity develops or the INR, aPTT or CK level becomes abnormal, and antivenom treatment should be considered based on the timing, severity and specific abnormality.

• #14

  https://www.who.int/teams/control-of-neglected-tropical-diseases/snakebite-envenoming/treatment

  Diagnosis is aided by a test known as the 20 Minute Whole Blood Clotting Test (20WBCT). […] Diagnostic tools also have considerable potential to better inform the surveillance of snakebite envenoming by enabling retrospective identification in pathology samples of venom immunotypes from various species of snakes.

• #15 Forensic Diagnosis of Snake Bites – Legal Desire Media and Insights

  https://legaldesire.com/forensic-diagnosis-of-snake-bites/

  Laboratory methods: […] The most common effects of snake bite venoming is hematologic abnormalities. […] Immunological detection of venom antigens in body fluids can be adept by ELISA technique. […] Diagnosis is aided by a test known as the 20 minutes Whole Blood Clotting Test {20WBCT}. […] If the blood clot is present it indicates the negative result of the test, and the absence of clot formation in the blood indicates the positive result, indicating presence of a coagulopathy and the need for antivenom treatment. […] Diagnostic tools also have substantial potential to better inform the observation of snake bite poison by enabling backdated identification in pathology samples of venom immunotypes the various species of snakes. […] Signs of envenomation may not be readily appear in every snake bite fatality and the chemical analysis is usually unsuccessful in confirming a snake bites. […] A snake bite should be suspected in patients with a history of bite and a local swelling with local signs of inflammation, even if the biting animal has not been seen.

• #16 This simple blood test can tell if a snakebite was dry or full of venom – Scimex

  https://www.scimex.org/newsfeed/this-simple-blood-test-can-tell-if-a-snakebite-was-dry-or-full-of-venom

  A simple blood test can tell if a snakebite was dry or full of venom, according to Aussie researchers, who say that within 2 – 3 hours of being bitten, the test can clearly distinguish between envenomed and non-envenomed patients. […] The authors say that rapid diagnosis can facilitate earlier antivenom treatment and potentially reduce the risk of later complications in people bitten by snakes. […] The increased availability of D-Dimer testing — a blood test that checks for, or monitors, blood-clotting problems may be a vital aid to the early diagnosis of venom-induced consumption coagulopathy (VICC), the most frequent systemic effect of snakebite in Australia, according to research published today by the Medical Journal of Australia. […] D-dimer values exceeded 2.5 mg/L from three hours after the bite for 95% of patients who developed VICC, and were lower than 2.5 mg/L for 95% of non-envenomed patients up to six hours after the bite, Isbister and colleagues reported.

• #17 Diagnosis of Snakebite and the Importance of Immunological Tests in Venom Research

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4052258/

  In order to be able to depend on the results of venom immunoassay, it is vital first to validate the test. […] The sensitivity of the venom assay is in the region of 1 ng/mL serum, but using a modification of the EIA using a biotin/avidin combination the sensitivity can be even further increased. […] The use of enzyme immunoassay in epidemiological studies of snake bite is potentially extremely useful although the requirement for a powerful control (non-bitten) group of the same socio-economic background is stressed.

• #18 Diagnosis of Snakebite and the Importance of Immunological Tests in Venom Research

  https://www.mdpi.com/2072-6651/6/5/1667

  Theakston and colleagues first reported the use of enzyme-linked immunosorbent assay (ELISA) or EIA (enzyme immunoassay), using the double sandwich technique performed in 96 well Microtitre plates for the detection of specific venom and the indirect method for detection of specific antibody (including antivenom) in the blood of envenomed victims. […] The sensitivity of the venom assay is in the region of 1 ng/mL serum, but using a modification of the EIA using a biotin/avidin combination the sensitivity can be even further increased. […] EIA enables the testing of both accepted and traditional methods of first aid therapy. Many of these methods, used both in the past and currently, are of potential danger to the patient. […] EIA can contribute to the outcome of more accurate and meaningful epidemiological surveys.

• #19 Quick Diagnosis of Venomous Snake Bites 毒蛇咬傷的快速診斷 | 衛教單張 – China Medical University Hospital

  https://www.cmuh.org.tw/HealthEdus/Detail_EN?no=9685

  For early diagnosis and early administration of correct serum, we have invented the quick-test diagnosis film just like the pregnancy test film. You can drop the serum of the patient on the specimen pool (S) and verify the type of snake in few minutes. The red line on T indicates positive, meaning the limb redness and welling caused by Naja Atra. C is the control line and this line must appear for each test to indicate that this test agent is still active. If the patient is bitten by unknown venomous snakes in wildness, home kitchen, or even in bed, use this diagnosis film for doctors to assist with the diagnosis and even identify as bites by Naja Atra, so we could quickly inject the correct antivenin. This diagnosis film can also be used to trace the changes in the local injury and conditions of patients, so that doctors can be reminded for further treatment. Currently, this diagnosis test agent is expanded eventually for scope of application and increased types of snakes for diagnosis. Our intention is to use one drop of patients serum to help the doctor determine which type of the six major venomous snakes in Taiwan bites the patient. This diagnosis film has been tested in Vietnam, and the identification and diagnosis capacities are excellent. Since the product has not been commercialized, if you were bitten by a venomous snake, please use the right product for identification of snake type. You may be transferred to our ER or conduct us directly (CMUH Emergency Room or Division of Toxicology).

• #20 Diagnosis of snake envenomation using a simple phospholipase A2 assay | Scientific Reports

  https://www.nature.com/articles/srep04827

  The PLA2 assay was positive in both coagulopathic snakes (Russell’s viper and Hump-nosed viper) and neurotoxic snakes (kraits and cobras) in our sample of bites by Australian and Asian snakes. A simple bedside version of the PLA2 assay would therefore be a useful test in resource poor areas with limited access to medical care. […] The PLA2 assay may also be particularly useful in neurotoxic envenomation to diagnose systemic envenomation early, before irreversible neurotoxicity develops. […] It is therefore likely that PLA2 activity can be measured in patient serum within 30 to 60 minutes of the bite as venom enters the circulation. This would then allow patients with systemic envenomation to be identified rapidly and given antivenom prior to the development of neurotoxicity. […] There would be huge benefits for a PLA2 test because it would allow for fast, simple and easy identification of systemic envenomation, so that antivenom can be given.

• #21 Approach to the diagnosis and management of snakebite envenomation in South Africa in humans: The hospital phase – emergency unit general principles

  http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742023000700003

  The management of a patient with a snakebite from an undefined snake is best accomplished using the syndromic approach. […] A balance should be struck between snake identification and the syndromic approach. If the snake is positively identified as one of the 10 snakes covered by polyvalent antivenom, or a boomslang is suspected, then antivenom should strongly be considered. […] All patients with systemic signs and symptoms or severe spreading local tissue damage should receive antivenom. […] The South African Vaccine Producers (SAVP) have produced two types of antivenom using equine serum: polyvalent antivenom (PAV) and monovalent antivenom (MAV). […] The practice of testing for equine protein sensitivity is no longer considered useful. Such testing is unreliable and unnecessarily delays antivenom therapy.

• #22 Snakebite Envenoming Diagnosis and Diagnostics

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8113877/

  Laboratory investigations almost always include an evaluation of the blood clotting profile to screen for venom-induced coagulopathies. […] Based on the patient history and laboratory tests, trained toxinologists may be able to infer the offending snake species, and this can in turn guide the choice of treatment. […] Diagnostic algorithms summarize much of the knowledge required to diagnose snakebites. […] The purpose of such diagnostic algorithms is to synthesize and distill the knowledge and experience of experts in clinical toxinology into a readily and rapidly accessible format to guide less experienced health professionals toward optimal care of bitten and envenomed patients. […] In Australia, snakebites are diagnosed based on patient history and laboratory investigations, as described above.

• #23 Venomous snake bites: clinical diagnosis and treatment | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-015-0081-8

  Because mamushi hide in the grass and fallen leaves, identification is difficult, even in the daytime. Patients usually feel only a pain similar to that of a splinter because the fangs are about 5 mm long and very thin. […] The mamushi bite usually leaves two very small wounds that are 1 cm apart. […] In many cases, blood test data do not change for several hours after the bite. If symptoms such as swelling are seen, it is necessary to perform frequent blood tests. […] In cases where venom was injected into the blood vessel directly, platelet counts rapidly decrease to 10,000/mm3 but fibrinogen levels do not decrease. […] Grade classification for mamushi bites is clinically used to determine the severity of injuries as follows: Grade I, redness and swelling around the bitten area; Grade II, redness and swelling of the wrist or foot joint; Grade III, redness and swelling of the elbow or knee joint; Grade IV, redness and swelling of the whole extremity; and Grade V, redness and swelling in parts beyond the extremity or exhibiting systemic symptoms.

• #24 Snakebite Differential Diagnoses

  https://emedicine.medscape.com/article/168828-differential

  Anaphylaxis […] Deep Venous Thrombosis (DVT) […] Extremity Vascular Trauma […] Scorpion Envenomation […] Septic Shock […] Serum Sickness […] Wasp Stings […] Wound Care […] Wound Infection.

• #25 Urgent Care Evaluation for Snakebite Envenomation – Journal of Urgent Care Medicine

  https://www.jucm.com/urgent-care-evaluation-snakebite-envenomation/

  Snakebite envenomation is relatively rare, but immediate action upon presentation to the urgent care center including quick and accurate identification, appropriate care, and sound decisions regarding transfer to the ED maximize the chance for optimal outcomes. […] The following discussion will focus on appropriately identifying snakebites from indigenous venomous species in North America, Crotalid and Elapid snakes; initiating urgent management; and indications for transfer. […] The first step in evaluation is to establish whether a bite is from a snake, another animal, or is not a bite at all (often patients with a MRSA infection will state that they have a skin lesion from a bite wound). […] The confirmation of a snakebite is based on the presence of fang marks and a consistent history. The first step will be differentiating a venomous snakebite from a nonvenomous snakebite.

• #26 Snakebite Envenoming Diagnosis and Diagnostics

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8113877/

  The majority of physicians in South- and Southeast Asia rely on the circumstances of the bite and clinical manifestations to diagnose the victim. […] The continuing absence of Hypnale spp. from the immunizing mix for Indian polyvalent antivenoms can be mentioned as an example of this. […] Studies find that early treatment of Australian and North American snakebite victims is linked to faster recovery and shorter time to hospital discharge. […] Novel diagnostics will likely have the greatest impact in areas where transportation to the treatment facility and antivenom availability are not limiting factors, areas with many different indigenous snake species that are visually difficult to discern, areas where monovalent antivenoms are available, and areas with medical or paramedical personnel with limited training in clinical management of snakebite envenoming.

• #27 Research on Snake Venom Detection Methods – Creative Diagnostics

  https://www.creative-diagnostics.com/blog/index.php/research-on-snake-venom-detection-methods/

  Snake bites seriously threaten public health security in tropical and subtropical countries and regions. Rapid identification of the type of venomous snake bite is very important to obtain the best clinical treatment as early as possible. Before the use of antivenom, there is still a general lack of feasible experimental methods for snake venom detection. At present, the clinical identification of snake bites mainly relies on the patients description of the snakes morphology, the manifestations of the bite site and systemic symptoms, and simple tests such as coagulation, blood routine, and urine routine. […] Therefore, identification of the species of the injuring snake is crucial to the effectiveness of early use of monovalent antivenom in the treatment of venomous snake bites. For a long time, researchers have been committed to developing a stable, reliable, fast, simple, and specific snake venom identification method. Currently, there are radioimmunoassay, agglutination assay, enzyme-linked immunosorbent assay (ELISA), fluorescent immunoassay, and proteomics techniques have been used to detect various snake venoms and toxins.

• #28 Snake Bites: Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/15647-snake-bites

  Treatment for a venomous snake bite is antivenom (antivenin). […] You should treat every snake bite as a medical emergency, as some snakes are venomous and their bite can be life-threatening. […] Your outlook after a snake bite varies based on what type of snake bit you and the amount of venom it injected into your body. […] Treat every snake bite as a medical emergency unless you know for certain that the snake is nonvenomous.

• #29 Snakebites – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/bites-and-stings/snakebites

  The effectiveness of this antivenom is time and dose related; it is most effective in preventing venom-induced tissue damage when given as soon as possible. […] Crotalidae polyvalent immune FAb is very safe, although it can still cause acute (cutaneous or anaphylactic) reactions and delayed hypersensitivity reactions. […] Antivenom should not be withheld based on the species of snake and should be given based on envenomation grading regardless of the species.

• #30 Venomous snake bites: clinical diagnosis and treatment | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-015-0081-8

  Snake bites are life-threatening injuries that can require intensive care. The diagnosis and treatment of venomous snake bites is sometimes difficult for clinicians because sufficient information has not been provided in clinical practice. […] No definite diagnostic markers or kits are available for clinical practice; therefore, definitive diagnosis of snake-venom poisoning requires positive identification of the snake and observation of the clinical manifestations of envenomation. […] The diagnosis and treatment of venomous snake bites is sometimes difficult for clinicians because sufficient information, including the administration of antivenom therapy, has not been provided in clinical practice. […] There are no definite diagnostic markers or kits available in clinical practice; therefore, definitive diagnosis of snake-venom poisoning requires positive identification of the snake and observation of the clinical manifestations of envenomation.

• #31 DNA Test Identifies Snake Bites

  https://www.voanews.com/a/snake-bite-test-4nov14/2507290.html

  There may soon be a rapid diagnostic test to determine whether a person was bitten by a venomous snake. […] A DNA test has been developed that takes a swab from the fang marks on people bitten by snakes. Researchers say the test correctly identified the species of the biting snake 100-percent of the time in a first of its kind clinical study. […] The current test would not be used for rapid diagnosis and treatment. But it is expected to lead to that. […] He said, We use this genetic test as the gold standard in addition to any dead snake brought to the hospital by the patient to determine the species identity of the snake involved in the bite. […] This type of test detects venom. And venom can be detected in the blood of the patient or in urine or from the bite site, as well. […] Kuch describes snake bites as a disease of poverty. […] The challenge, he said, is to connect snake bite diagnostics to primary health care in the most affected countries. […] The tests could lead to the stockpiling of anti-venom in strategic locations.

• #32 The Urgent Need to Develop Novel Strategies for the Diagnosis and Treatment of Snakebites

  https://www.mdpi.com/2072-6651/11/6/363

  The Urgent Need to Develop Novel Strategies for the Diagnosis and Treatment of Snakebites […] Snakebite envenoming (SBE) is a priority neglected tropical disease, which kills in excess of 100,000 people per year. […] Administration of antivenom is too frequently based on symptomatology, which results in wasting crucial time. […] The development of reliable diagnostical tools could therefore initiate a paradigm shift in the treatment of SBE. […] Improvements to snakebite diagnostics would not only rule out administration of antivenom in cases of dry bites and bites from species not covered by the antivenom or non-venomous but may also begin to quantify the scale of envenoming and quantity of antivenom required, as well as paving the way to more case-specific treatments. […] A simple device may enable victims to confirm SBE and seek prompt hospital treatment instead of resorting to traditional healers. […] However, choosing the correct antivenom is frequently not an option, as there is often only one choice. […] A point of care test would prevent unwarranted and wasteful administration of this life-saving medicine, which despite new antivenoms being produced is still in very short supply (~2.5% of projected needs). […] Hence, simple diagnostics would boost the production of more specific treatments.

• #33 Snakebite in Australia: a practical approach to diagnosis and treatment | The Medical Journal of Australia

  https://www.mja.com.au/journal/2013/199/11/snakebite-australia-practical-approach-diagnosis-and-treatment

  Snakebite is a potential medical emergency and must receive high-priority assessment and treatment, even in patients who initially appear well. […] All patients with suspected snakebite should be admitted to a suitable clinical unit, such as an emergency short-stay unit, for at least 12 hours after the bite. Serial blood testing (activated partial thromboplastin time, international normalised ratio and creatine kinase level) and neurological examinations should be done for all patients. […] Antivenom should be administered as soon as there is evidence of envenoming. Evidence of systemic envenoming includes venom-induced consumption coagulopathy, sudden collapse, myotoxicity, neurotoxicity, thrombotic microangiopathy and renal impairment. […] Investigations for diagnosis and treatment of snake envenoming (as well as excluding envenoming in suspected snakebites) include coagulation studies, a full blood count and biochemical tests.

• #34 Snakebite in Australia: a practical approach to diagnosis and treatment | The Medical Journal of Australia

  https://www.mja.com.au/journal/2013/199/11/snakebite-australia-practical-approach-diagnosis-and-treatment

  Accumulating data suggest that antivenom might prevent certain envenoming syndromes if used early, but may have little, if any, effect once major envenoming syndromes are established. […] Determination of the snake (or snake group) involved and therefore the appropriate antivenom to be administered requires local knowledge of snakes found where the patient was bitten. […] One vial of relevant snake monovalent antivenom is required to treat both children and adults for all snake types. […] Antivenom must be given in a critical care area, and staff must be prepared to treat anaphylaxis. […] Patients who are given antivenom must be admitted for repeat laboratory testing and observation to determine when envenoming has resolved and to identify complications.

• #35 A snake bite case: The value of timely diagnosis and treatment

  https://www.oatext.com/a-snake-bite-case-the-value-of-timely-diagnosis-and-treatment.php

  The treatment of toxic snake bites depends upon reassurance, supportive measures, and the definitive treatment of toxic bites by the snake antivenin. […] The regression of the manifestations in the described case above, after administration of the antivenin, together with symptomatic care and appropriate consultations, confirms the diagnosis of a vasculo-toxic snake bite despite the lack of history of any snake exposure. […] The successful outcome of the case presented in this report signifies the value of the timely diagnosis of snake bite cases, the importance of the consultations of other specialties for a proper treatment of the existing and possible complications in such cases, the necessity of timely and proper administration of the snake antivenin for the diagnosed cases of toxic snake bites and the importance of the sense of suspicion to diagnose such cases if the history is lacking an exposure to a snake.

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