Episode 163. Snake Bite Envenomation in Australia with Dr Tim Jackson 

Block 6
Written By Andrew Ford

Australia is home to many of the world’s most dangerous snake species so familiarity with snake bite management and understanding the clinical effects of snake bite is vital for Australian doctors, especially those with a rural practice. Each year in Australia there are about 1000 recorded snake bites but fortunately only 2-3 deaths, most of these relate to bites from the brown snake. This contrasts with a vastly higher number of reported deaths from snake bites in India and Africa contributing to a recorded 100,000 deaths from envenomation globally.

Australian snakes, also known as elapids, deliver venom through their bites, which predominantly exert systemic effects. There are five major venom types for Australian snakes. Depending on the snake genera, minor to moderate local effects may also be experienced.

Snake venom is a complex mixture of many components including peptides, enzymes, phospholipases, proteases, and others. The venoms may have a potent pro-coagulant effect leading to venom-induced consumptive coagulopathy which may ultimately lead to defective coagulation through the consumption of clotting factors. D- Dimer levels will be high in such instances. A primary anticoagulant effect may occur without significant D-Dimer production but significant bleeding. Other effects include neurotoxicity where toxins have either pre or post-synaptic targets. Early signs of developing paralysis such as ptosis need to be watched for closely in the hope of avoiding a neurotoxic flaccid paralysis that may require ventilation. Myotoxicity predominantly affects skeletal muscle and may lead to profound rhabdomyolysis with renal injury and intravascular haemolysis as associated sequelae.

Clinical diagnosis of envenomation may be based on a definite history of observed snake bite however more cryptic presentations where definite snake bite has not been observed may result in baffling systemic effects with minimal local evidence of a bite. It’s important to be aware of envenomation as a potential diagnosis in such cases.

Detecting coagulopathy is the most urgent investigation to consider after an Australian snake bite. A complete coagulation panel including a D-Dimer assessment is essential, electrolyte, renal function and creatinine phosphokinase levels should also be checked. For a well patient these tests should be ordered at presentation, after removal of the first aid pressure bandage and then again at 6 and 12 hours post bite, assuming preceding tests have been normal. Evidence of envenomation requires stabilisation of the patient and administration of antivenom. 

Australia is the only country with commercially available snake venom detection kits that may assist in the identification of venom that has been inoculated and provide a very helpful guide to the appropriate antivenom to administer. A polyvalent vaccine is also available for administration although larger in volume and associated with more side effects than the ‘monovalent ‘antivenoms correctly chosen from the kits mentioned above. Doses are the same for adults, children and the pregnant. 

Expert assistance from a toxicologist and intensivist should be sought early if troubling signs and symptoms of envenomation are observed.

In this episode, we have a conversation with Dr Tim Jackson who is co-head of the Australian Venom Research Unit at Melbourne University and an evolutionary biologist. Tim brings a huge and enthusiastic wealth of knowledge to this discussion, and it was a real honour to invite him as an expert guest. Please welcome Tim to the podcast.

References:

Dr Tim Jackson - AVRU - Australian Venom Research Unit - Melbourne University

White, J.A Clinician’s Guide to Australian Venomous Bites and Stings, BioCSL, Melbourne 2013.

Preventing and managing snake bites. (PDF). Qld Govt. May 2018

Andrew Ford
Marketing expert Andrew Ford, the founder of Social Star, has discovered the secret of ‘Powerful Branding’. With a fire for unleashing people’s inner brand and developing business models to generate profit from an individual’s passions, Andrew leverages ground-breaking digital and social media marketing techniques to create digital strategies for clients to attract maximum opportunities. Having established a strong name for himself in the field, Andrew blends traditional business techniques with now-necessary tools for entrepreneurs to achieve scale, quality, and influence in their niche. Andrew’s comprehensive business background and qualifications consist of a Bachelor of Business (Marketing) (RMIT 2003), a Graduate Certificate in Management (MBA Executive Program, University of Sydney 2005), and a Masters of Entrepreneurship and Innovation (Swinburne University 2011). Continually on the cutting edge of his own education, Andrew has tested his marketing theories in forums such as the BCG Business Strategy Competition, which he won in 2005 against all Victorian MBA schools, and the Venture Cup Business Plan Competition (Swinburne University 2003), which he won in the Masters category. With experience working at Hewlett-Packard, Sensis (Telstra) and IBM, Andrew also has mentored dozens of junior staffs to help them achieve their professional goals. Meeting and influencing high-profile public figures helped Andrew to realise just how many professionals require more understanding and control of their public brands or appearance, and need help with the skills to use the many amazing free tools at their disposal to generate success. At Social Star, Andrew consults with clients to uncover their personal brand – both where it is today and where it can be tomorrow – and refine and define how that should be displayed in social media in order to attract their perfect target audience. Andrew mentors his clients to rapidly grow their business’ audiences, resulting in larger potential client bases and higher revenue. Applying formulas that integrate over twenty years of Andrew’s business experience and fifteen years of formal business education, Social Star specialises in building clarity and velocity for clients’ brands using the ‘Understand, Build and Leverage’ methodology. ‘Having a Personal Business enables people to have an authentic, congruent connection with their valued clients and partners, using their brand as the bridge,’ says Andrew. ‘I’m highly driven to work with the new breed of entrepreneurs and small business owners – people who have a passion for making the world a better place. Traditional business models are stepping aside as people follow their innermost dreams and my role is to see them operate within their values while creating wealth. Some people think you have to sacrifice what you love to be successful in your business, yet it is actually the opposite. Follow your passion and success will come.’ Lecturing at Swinburne University from 2009 to 2011 on brand dynamics and digital marketing, presenting at numerous conferences, and consulting to hundreds of clients, Andrew has seen his philosophy work that if you follow your unique path, based on your skills, experience, values and goals, you will automatically attract the opportunities you desire and achieve the success you deserve. Living his mantra, Andrew has created a successful business and attracts high-profile clients including musicians, athletes, authors, models, entrepreneurs, professionals and small business owners, helping them find their ‘why’ in their business and fulfilment in their lives. Business for Andrew is more than work, it’s personal. Running a personal business means that he is able to fulfil all of his values rather than separating his life from work. It supports his two boys while providing social opportunities, educational development, fitness opportunities, spiritual fulfilment and many valuable friendships. Social Star has now become the vehicle for Andrew to crystallise his mission in the world, to help people love what they do, supporting his ‘why’, that if more people loved what they did, the world would be a better place.
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