Snakebite in tropical Australia, Papua New Guinea and Irian Jaya

Abstract

AbstractWhile snakebite numbers are decreasing in temperate Australia, snakebite remains an important cause of morbidity in tropical Australia and of mortality in Papua New Guinea and Irian Jaya. The Australasian elapid snakes have complex mixtures of venom components, with distinct clinical syndromes defined for the potentially lethal species. Life‐threatening scenarios are progressive neuromuscular paralysis with taipan (Oxyuranus spp.) and death adder (Acanthophis spp.) envenoming and early hypotensive collapse and severe coagulopathy with fibrinogen depletion and major bleeding (especially intracranial haemorrhage) with brown snake (Pseudonaja spp.) bites. The ‘brown snake paradox’ is that textilotoxin is one of the most potent neurotoxins known, yet neurotoxicity is uncommon in brown snake envenoming. Prospective studies using assays of serial patient serum venom levels will provide better evidence for efficacy or otherwise of various first‐aid methods used and help define appropriate doses of antivenoms for specific clinical scenarios. Financial and distribution constraints have resulted in antivenoms being unavailable for use in most regions of Papua New Guinea and Irian Jaya.