# So Sad..



## Firepac (Apr 11, 2016)

http://www.themorningbulletin.com.au/news/rocky-snake-handler-killed-taipan/2992642/


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## butters (Apr 11, 2016)

Very sad. Makes you wonder what went wrong when someone administers correct first aid, gets themselves safely to hospital and this happens? 
If it panned out as the article suggests then it shows up major issues with the testing procedure and what happens after a possible negative test is returned.

I'm sure everyone that has regular contact with vens and has emergency plans in place would expect that once they got to the hospital safely you would survive. 

Very sad for all involved particularly the family.


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## geckoman1985 (Apr 11, 2016)

I am wondering if a venom dection kit was uesd or blood test as thay seem to have moved away from venom kits as its cheeper to test blood then the kits i know for fact rocky hospital dose carry anti venom for tiapan 

'


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## Stuart (Apr 12, 2016)

Very sad for all involved.


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## Murph_BTK (Apr 12, 2016)

First mistake with such a snake can ultimately be the only mistake.. very sad news and feel for the family..


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## BrownHash (Apr 12, 2016)

Horrible news. 

Unfortunately their doesn't appear to be a standard procedure for dealing with snake bite at hospitals. I've heard several catchers with snake bite experience tell me which hospitals to stay away from.

- - - Updated - - -

Just found this - NSW Snakebite and Spiderbite Clinical Management Guidelines 2013 -Third Edition

Interesting read on how snake and spider bites are dealt with within the hospital system in NSW. Page 15/16 outlines the procedure to follow in cases similar to Wayne Cameron.

> *Exclusion of envenoming
> *The initial presentation and admission bloods diagnosemost cases of envenoming. If laboratory studies onadmission are normal and there is no clinical evidence ofenvenoming, the pressure bandage can be removed in acritical care area (where antivenom is available) and thepatient observed carefully. Evidence of envenoming willusually develop rapidly within an hour post- removal ofthe bandage; if it is going to occur. If there is no evidenceof envenoming after an hour the patient should beobserved for 12 hours after the time of the bite with thefollowing laboratory tests and a careful neurologicalexamination (ptosis, bulbar, respiratory or distal paralysis).n 1 hour after removal of the bandage:INR, aPTT, CK and neurological examinationn 6 hours post-bite: INR, aPTT, CK andneurological examinationn 12 hours post-bite: INR, aPTT, CK andneurological examination


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## Firepac (Apr 12, 2016)

I know of several instances of incorrect protocol being followed at local hospitals fortunately without any serious consequences which is why I always carry a laminated sheet with first aid on one side and correct medical treatment on the other side when relocating snakes.


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## butters (Apr 12, 2016)

That's a very good idea.


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## Stuart (Apr 16, 2016)

Here is the version of the story from Waynes wife..

http://m.themorningbulletin.com.au/news/snake-victims-wife-sets-the-record-straight/2998307/


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## andynic07 (Apr 16, 2016)

Queensland protocol. 

https://www.health.qld.gov.au/poisonsinformationcentre/docs/Snake-bite-cp.pdf


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## Firepac (Apr 16, 2016)

@andynic97 That's a clinical pathway rather than a protocol and lacks a lot of detail. Somewhere I have the Mackay Health District Protocol as well as the recommended medical treatment fron the AVRU. I'll see if I can find them tomorrow.


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## mikey_mike (Apr 16, 2016)

A venom detection kit result should only be used once the decision has been made that envenomation occurred. The VDK shouldn't have had any role in what happened. I've got to head off now, but I'm happy to explain in further detail tomorrow. I'm surprised that anyone would have removed the bandage after only 2 hours in the ED - doesn't sound to me like correct protocol was followed, but I've never worked in a Qld ED.


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## geckoman1985 (Apr 16, 2016)

I thought thay took sample from the bite aira straight away . Any way besides that could a tipan relly kill that quick arfter bandige removed


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## Firepac (Apr 17, 2016)

This is basically the information I carry on the laminated card and is the basis for hospital protcols.

http://www.anaesthesia.med.usyd.edu.au/resources/venom/snakebite.html#medical


*@*mikey_mike Why would a SVDK be used only once the decision has been made that envenomation occurred?? That doesn't make sense. If a patient is initially asymptomatic surely it would be advantageous to do the test to determine what anti venom should be used in case systemic symptoms ensue? If you wait till the patient begins to show symptoms before doing the test then there is a long time delay before you can administer the correct anti venom!

Its easy to be critical without complete knowledge of the events, especially from media articles, but even the wife's explanation raises several questions to me.

First aid was applied and he then removed the snake from the bag to verify its ID. Why? After first aid is applied you should move as little as possible as any muscle movement helps to push the venom through the compressed lymphatic system. He was a nurse so he should know you do NOT need to know what has bitten you, the SVDK will determine what immunotype the venom belongs to and therefore what antivenom should be used.

"..but for crying out loud you've got to take the bandage off some bloody time" - yes you do but it should be done slowly and progressively to allow a slow release of any venom and if systemic symptoms ensue the bandages should be reapplied.


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## andynic07 (Apr 17, 2016)

After the wife's account of the story a lot less seems to have gone wrong at the hospital than first thought. I think you are right [MENTION=19694]Firepac[/MENTION] about the removal of the bandage , maybe their interpretation of slowly and progressively was either faster than needed or possibly influenced by the patient (former nurse) thinking there was no bite. Either way it lead to the poor mans death and needs to be addressed. I also think his underlying medical issues may have played a big part in this accident as well. Not exactly sure what issues he currently had.


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## mikey_mike (Apr 17, 2016)

Firepac said:


> *@*mikey_mike Why would a SVDK be used only once the decision has been made that envenomation occurred?? That doesn't make sense. If a patient is initially asymptomatic surely it would be advantageous to do the test to determine what anti venom should be used in case systemic symptoms ensue? If you wait till the patient begins to show symptoms before doing the test then there is a long time delay before you can administer the correct anti venom!
> .



OK I need to place an appropriate disclaimer - always discuss local protocols with your local ED / toxicology service. Please don't rely on social media for treatment of life threatening illnesses.

Bite site swabs and urine samples should be taken as soon as possible, but will not normally be processed until there are signs or symptoms of envenomation. Venom detection kits should never be used to rule in or rule out envenomation. Their only use should be to identify the snake so that the appropriate monovalent antivenom can be used instead of polyvalent. There's not usually any problem with using polyvalent antivenom instead of monovalent, it just means that the patient receives a larger protein load & is therefore more likely to develop an allergic reaction (which should be treatable). The risk of this allergic reaction would anyway need to be balanced against the risk of giving the wrong antivenom if the VDK was wrong (which is possible) so regardless the VDK result would only be applied if was consistent with the observed envenomation syndrome & with local snakes. 

Andynic thanks for that flow chart. I think I can see what happened. Please note the coroner will certainly review this case & it's possible protocols will change as a result.

If I were to speculate at this stage I would say that unfortunately Wayne may have died partly because his first aid was so effective. It seems that after about 2 hrs in ED he remained asymptomatic, all blood tests and clinical exam were normal and at that point the bandage was removed. Taipans are known to cause a very rapid collapse (1-2 min after bite) and shortly after the bandage was removed Wayne arrested and died.

I guess it's possible that had the ED staff not been so efficient & processed all tests so rapidly, or had Wayne been a bit less competent with the pressure immobilisation bandage there would have been some sign of envenomation, antivenom could have been administered and he could have survived.

My condolences to Waynes family & to all of those who treated him in ED. I and everyone who treats snakebite in Australia will be waiting for the coroners review. To my knowledge this is the first Australian case where someone has died after proper effective first aid & prompt hospital attendance.


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## Firepac (Apr 17, 2016)

mikey_mike said:


> Bite site swabs and urine samples should be taken as soon as possible, but will not normally be processed until there are signs or symptoms of envenomation. Venom detection kits should never be used to rule in or rule out envenomation. Their only use should be to identify the snake so that the appropriate monovalent antivenom can be used instead of polyvalent. There's not usually any problem with using polyvalent antivenom instead of monovalent, it just means that the patient receives a larger protein load & is therefore more likely to develop an allergic reaction (which should be treatable). The risk of this allergic reaction would anyway need to be balanced against the risk of giving the wrong antivenom if the VDK was wrong (which is possible) so regardless the VDK result would only be applied if was consistent with the observed envenomation syndrome & with local snakes.



Okay that makes more sense than the way i originally interpreted your previous post.



mikey_mike said:


> If I were to speculate at this stage I would say that unfortunately Wayne may have died partly because his first aid was so effective



Completely agree, in fact a posted something similar elsewhere using this as an example of just how effective a PIB can be if applied correctly and quickly.


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## geckoman1985 (Apr 17, 2016)

Question for you even arfter removing bandage would tipan venom relly kill that quickly i all ways been under the impression that it takes a few hours for symptoms to apper that would be deadly. If so he being a snake relocater would have knowen the symptom even miner ones at that. One other thing will ortopsy resalts tell as if was the venom of a alergic rraction to the venom its self


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## mikey_mike (Apr 17, 2016)

geckoman1985 said:


> Question for you even arfter removing bandage would tipan venom relly kill that quickly i all ways been under the impression that it takes a few hours for symptoms to apper that would be deadly. If so he being a snake relocater would have knowen the symptom even miner ones at that. One other thing will ortopsy resalts tell as if was the venom of a alergic rraction to the venom its self



I guess he was just unlucky / had pre-existing illnesses / received an unusually large amount of venom. There's no reason to speculate that he had an allergic reaction to the venom. Anaphylaxis (systemic allergic reaction) would be easier to treat than envenomation.

Wait for the coroners report. This will be examined in great detail.


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