IMMEDIATE FIRST AID
for bites by
In the event of an actual or probable bite from an Inland Taipan, execute
the following first aid measures without delay.
- Make sure that the responsible snake or snakes have been appropriately
and safely contained, and are out of danger of inflicting any additional bites.
- Immediately call for transportation.
- Keep the victim calm and reassured. Allow him or her to lie flat and
avoid as much movement as possible. If possible, allow the bitten limb to rest
at a level lower than the victim's heart.
- Immediately wrap a large crepe bandage snugly around the bitten limb
starting at the site of the bite and working proximally up the limb (the full
length if possible). The bandage should be as tight as one might bind a
sprained ankle. (See attached copy from "First Aid for Snakebite" by Dr. S.K.
- Secure the splint to the bandaged limb to keep the limb as rigid and
unmoving as possible. Avoid bending or moving the limb excessively while
applying the splint.
- DO NOT remove the splint or bandages until the victim has reached the
hospital and is receiving Antivenom.
- Have the TAIPAN ANTIVENOM (Commonwealth Serum Laboratories) ready for
the emergency crew to take with the victim to the hospital. Give them the
- the available antivenom (at least 10 vials)
- the accompanying instruction (Protocol) packet
- the victim's medical packet (if available)
DO NOT cut or incise the bite site
DO NOT apply ice to the bite site
Summary for Human Bite
The bite of the Inland Taipan with envenomation can be rapidly fatal (as
early as 30 minutes). Please read the attached Medical Management Protocol and
- First Aid:
- Bandage and Immobilize the bitten limb with crepe bandages and splint
as described in the Immediate First Aid section. Rest this extremity below the
level of the patient's heart (if practical).
- Transport to a medical center emergency or trauma service.
- Medical Management:
- Call your local Poison Control Center or the San Diego Regional Poison
Control Center (800 876-4766). They should locate a consultant to help you
treat this patient.
- Observe for Signs and Symptoms of Envenomation.
- If signs or symptoms are present, perform the following:
- Administer Lactated Ringers Solution at 200 to 250 mls per hour.
- Draw samples and collect initial laboratory data.
- Dilute the contents of 1 vial (12000 units) of Commonwealth Serum
Laboratories Taipan Antivenom 1:10 in Lactated Ringers Solution. Administer
the antivenom I.V. piggyback over 30 minutes at a rate of 400 units per
- Remove the splints and crepe bandage slowly over a period of 10
minutes. If symptoms progress rapidly, reapply the bandage, and administer an
additional vial of antivenom. Again attempt to remove the bandage.
- Allergic or untoward reactions to the antivenom should be treated with
Corticosteroids, Epinephrine, Benadryl, Atarax and/or Antihistamines as
- Monitor Signs, Symptoms, and Laboratory data, and administer additional
antivenom in 1 vial (12000 units) increments at a rate of 400 units per
minute as necessary to control the progression of symptoms.
- The required amount of antivenom will vary with the severity of
envenomation. One should anticipate using (including the initial
1-3 vials total for a minor bite with envenomation.
4-10 vials or more may be necessary for moderate or severe bites.
for bites by
This person has received a bite and probable envenomation from an Inland
Taipan (Oxyuranus microlepidotus). Also referred to as the Fierce Snake or
Small-scaled Snake, this extremely venomous and dangerous snake occupies a
remote region of central Australia including the southwest corner of Queensland
and adjacent areas of New South Wales, South Australia and the Northern
Territories; The Taipans as a group have been responsible for a large number of
human deaths. The Inland Taipan is the most venomous terrestrial snake known
to man; perhaps the most toxic of all snakes in the world. Envenomation
signifies a true medical emergency. The venom can cause neurotoxic, hemolytic,
and coagulopathic reactions; paralysis or death could ensue rapidly.
Please read and execute the following procedures without delay.
- A crepe bandage and splint have been applied as immediate first aid
adjuncts to retard the absorption of the venom. DO NOT remove until the
patient has arrived at the hospital and is receiving the antivenom.
- Make sure that at least 10 vials of Taipan Antivenom are present with
the patient. This antivenom contains the appropriate fractions necessary to
neutralize the components of Taipan venom.
- If the patient has been envenomated, the treatment is 3 to 10 vials
of intravenous antivenom. Envenomation is diagnosed by the presence of
characteristic signs and symptoms. Necessary information follows and is
organized in sections:
- Signs and Symptoms of Envenomation
- Medical Management
- General Considerations
- Special Considerations
Signs and Symptoms of Envenomation:
- Neurological and Neuromuscular: These signs and symptoms have a high
degree of variability from case to case, and may come on subtly and progress
rapidly. Early recognition is extremely important.
- Eyelid drooping (Ptosis)
- Blurred vision or difficulty seeing
- Difficulty with Speaking or Swallowing
- Convulsions or Epileptoid Seizures
- Sudden loss of consciousness
- Flaccid paralysis
- Stumbling gait (Ataxia)
- Respiratory arrest or Dyspnea
- Hematological and Vascular:
- Profuse bleeding from bite site
- Spitting or vomiting blood (Hematemesis)
- Coagulation defects
- Circulatory collapse
- Renal and Urinary:
- Acute Renal Failure
- General: These symptoms may manifest very early (usually within 15 -
60 minutes following the bite) presenting as vague complaints; again prompt
recognition as indication of clinical envenomation is critical.
- Abdominal Pain
- Regional lymph node tenderness
- Profuse sweating
- Swelling, Edema
- Fang Marks: Fang marks may be present as one or more well defined
punctures, as a series of small lacerations or scratches, or there may not be
any noticable or obvious markings where the
bite occurred. The absence of fang marks does not preclude the possibility
of a bite (especially if a juvenile snake is involved). The Taipans have the
longest fangs of the venomous Australian and Papuan snakes reaching 13 mm or
more in some specimens. The snake strikes with extraordinary speed and
accuracy, often snapping its jaws fiercely several times which can result in
multiple punctures in the same attack. Multiple bites inflicted by a single
snake or by more than one snake are possible, and should be noted if present
(See Special Considerations below). The presence of fang marks does not always
imply that the injection or deposition of venom into the bite wound
(envenomation) actually occurred.
- Admit patient to an emergency or trauma service and call the consultant
identified by the Poison Control Center.
- Begin a peripheral intravenous infusion (16 gauge catheter) of Lactated
Ringers Solution at a rate of 250 cc/hour.
- Draw blood from the contralateral arm, and collect urine for the
following laboratory tests. Mark STAT.
- Type and Cross Match TWO units of Whole blood.
- CBC with differential and platelets.
- Coagulation Parameters:
- Prothrombin Time (PT)
- Partial Thromboplastin Time (PTT)
- Fibrinogen levels
- Fibrin Degredation Products
- Serum Electrolytes, BUN/Creatinine, Calcium, Phosphorus.
- Lactate Dehydrogenase (with Isoenzyme analysis). Isoenzyme analysis may
indicate multiple targets of the venom components which may dictate further
- Urinalysis (Macroscopic and Microscopic Analysis). Must include
- Free Protein
- Electrocardiogram (Sinus Tachycardia would be expected).
- Continuous Urine Output Monitoring (Indwelling Foley Catheter if
unconscious). Watch for possible oliguria or anuria.
- Additional Tests as needed or indicated by patient's hospital
- It may be necessary or practical to repeat some of the above serum and
urine tests periodically over the hospital course to monitor the effects of
antivenom therapy or to detect late changes in laboratory values previously
normal or slightly abnormal.
- OBSERVE PATIENT CLOSELY for signs and symptoms of envenomation which
usually manifest between 15 minutes and two hours after the bite
- If NONE of the signs or symptoms have been noted after TWO hours, there
is the possibility that the patient received a dry bite (no venom
- VERY SLOWLY begin to remove the bandages and splint watching carefully for any changes in the patient's status. If any changes occur, assume the
patient has been envenomed and prepare to give antivenom immediately (as
- If signs and symptoms still fail to manifest, continue CLOSE observation
of the patient for an additional 12 to 24 hours.
- IF ANY SIGN OR SYMPTOM becomes apparent or has been noted during the
course of treatment, begin Antivenom Therapy as follows:
- Dilute the contents of ONE vial of Taipan Antivenom (12000 units) in
Lactated Ringers Solution (Hartmann's Solution) to a total volume of 400
- Administer the diluted Antivenom intravenously over a period of 30
minutes at a rate of 13 -14 mls per minute (i.e., 1 vial per 30 minutes or 400
units per minute).
- Should any signs of ALLERGY/ANAPHYLAXIS (e.g., coughing, dyspnea,
urticaria, itching, increased oral secretions, etc.) develop, immediately
discontinue the administration of antivenom, and treat symptoms with
Epinephrine, Steroids and Antihistamines. As soon as the patient is
stabilized, continue the antivenom infusion at a slower rate.
- After 15 minutes of antivenom administration, the splint and the
bandages may be removed. This should be done VERY SLOWLY over a period of FIVE
minutes to prevent a bolus release of venom. If the patient's condition
worsens, reapply the crepe bandage, wait 10 minutes and release the bandage
again slowly over 10 minutes while antivenom administration is
- Antivenom Therapy is the mainstay of treatment for Taipan envenomation.
Many of the symptoms are ameliorated or entirely eliminated by the antivenom
alone. Other symptoms will require additional modalities of therapy to
- Neurological Symptoms (especially respiratory obstruction or failure)
are usually the most immediate cause of dangerous problems. Many may be
improved by the antivenom. If breathing becomes impaired, provide respiratory
assistance. Secretions may become copious, necessitating suctioning.
- Hematological symptoms may present as Desseminated Intravascular
Coagulopathy, and are treated as are other DICs.
- Renal symptoms may complicate the situation, and if severe (Acute Renal
Failure) may necessiate Peritoneal Dialysis.
- It is important to keep venom neutralization current and continuous.
The best method to accomplish this is to keep a close watch on the patient's
status. If the present condition does not improve, or should it worsen for any
reason, additional antivenom should be administered. Give all additional
antivenom in 1 vial (12000 unit) doses. Dilute one vial in Lactated Ringers
Solution to a total volume of 400 mls and deliver I.V piggyback over 30 minutes
at a rate of 13-14 mls per minute (i.e., 1 vial per 30 minutes or 400 units per
minute). One should anticipate using (including the Initial dose):
1-3 vials for a minor bite with envenomation.
4-10 or more vials may be necessary for moderate or severe bites.
- It is advisable to perform periodic serum and urine analyses during
therapy (as outlined above).
- It is always best to keep the patient in an Intensive Care setting
until free of major symptoms for 24 hours. The patient should be observed in
the hospital for at least 24 hours after all symptoms abate.
- It is important that the patient be placed at rest, kept warm, and
avoid unnecessary movement.
- The onset of dangerous Neurotoxic symptoms can be rapid and
subtle. In addition, they are more rapidly reversed in their early stages than
when fully developed. It may be necessay to wake the patient and perform a
brief neurologic check every hour or so to assure that breathing and other
vital functions are not impaired. Carefully note the progress of any paralysis
which may be present.
- Respiratory obstruction and failure are the greatest immediate
concerns. Should the patient develop difficulties in breathing or airway
impairment, respiratory support will be required. If the tongue, jaw or
pharynx become paralyzed, insert an oral airway. Make sure adequate suction
equipment is available and operative.
- Fluid management is very important in snake bite cases. The
patient should be well hydrated, and a brisk urine output maintained. Blood
replacement SHOULD NOT be started until the circulating venom anticoagulants
have been fully neutralized.
- If any signs of Oropharyngeal paralysis or impaired
swallowing exist, give NOTHING BY MOUTH, and keep patient on his side with
head down. Watch for airway compromise and aspiration.
- Morphine is CONTRAINDICATED because of its tendancy to suppress
respiration. Alcohol should also be avoided. Diazepam (Valium) may be given,
but not in large quantities.
- In cases in which Circulatory Shock remains uncorrected by
antivenom therapy, Plasma volume expanders and/or vasopressor agents may be
given with appropriate considerations.
- Tetanus prophylaxis should be current.
- Antibiotics are NOT recommended prophylactically.
- Multiple Bites:
- The Inland Taipan is an extremely fast and agile snake which can strike
instantly with extreme accuracy. It is possible for a Taipan to deliver more
than one bite in a single attack. If there is evidence that such an attack
occurred (i.e., history or multiple bite sites), twice (2X) the INITIAL dose of
antivenom should be given: TWO vials (24000 units) diluted in Lactated Ringers
Solution to a total volume of 800 mls, and delivered over 30 minutes at a rate
of 26 - 28 mls per minute (i.e., 2 vials per 30 minutes or 800 units per
- Severe Envenomation:
- If the patient shows severe signs of envenomation, particularly if early
after the bite, increase the INITIAL dose of antivenom 2X or 3X. Dilute this
volume 1:10 in Lactated Ringers Solution, and deliver over a period of 30
minutes. If the patient is in extreme fluid load, the further antivenom may be
delivered at more concentrated (i.e., 1:5) volumes until the patient is in
appropriate fluid balance.
- Testing for Equine Protein Sensitivity:
- It is NOT ADVISABLE to utilize subcutaneous or intradermal testing for
sensitivity to equine products in that such testing may be unreliable, and may
unnecessarily delay antivenom therapy which must be used if any signs of Taipan
envenomation are present.
- If there is reason to believe that the patient may be sensitive to
equine protein products (e.g., previous snake bite treated with antivenom in
which a senstivity reaction was noted, multiple previous snake bites):
- Administer 1 gram of Solumedrol I.V. Push.
- Wait 15 minutes.
- Administer the antivenom at a rate as tolerated by the patient, and
beginning at a rate of 10 mls/ minute (i.e., 300 units/min).
- Monitor Pulse and Blood Pressure carefully. Be prepared to treat for
- Clinical Experience with Oxyuranus microlepidotus :
- The venom of the Inland Taipan is by far the most toxic land snake venom
known to science with strong coagulopathic and neurotoxic effects. Due to its
nervous agitated demeanor, the blinding speed of its strike, its ability to
bite multiple times in one attack, the extreme toxicity of its venom, and the
number of fatalities attributed to it, the Taipan is perhaps the most feared of
all the venomous Australian snakes; it is also one of the most dangerous and
difficult to handle in captivity. Prior to the introduction of specific
antivenom, the envenomation fatality rate was essentually 100%.
- There have been two documented cases of envenomation by Oxyuranus
microlepidotus. Clinically, evenomation may represent a complex scenario of
multiple organ system poisoning with neurotoxic symptoms typically
dominating. Acute renal failure, Rhabdomyolysis, and Disseminated Coagulopathy
may also complicate the setting, and are controlled with adjuvant support as
- The development of general and/or respiratory paralysis is of paramount
concern in that these are often difficult to reverse once established, even
with large amounts of antivenom. Prolonged intubation and ventilatory support
(perhaps up to 1 week or longer) may be required. Early diagnosis of
neurotoxic symptoms with prompt and adequate dosages of antivenom is critical
to avoid these complications.
- Although the signs and symptoms of Taipan envenomation may resemble
those of other Australian elapid snakes, especially Tiger Snakes (Genus
Notechis) and Brown Snakes (Genus Pseudonaja), the antivenoms for these other
snakes offer little cross-protection and vice versa -- the Antivenom must be
specific for Taipans (Genus Oxyuranus).
The following references are recommended for further indepth reading. This
material includes case histories, guidelines and recent findings in Australian
elapid literature. These should be read only after treatment has begun, and
the patient is in stable status.
- COMMONWEALTH SERUM LABORATORIES: Treatment of Snake Bite in Australia
and Papua New Guinea using Antivenom (Package Insert with Antivenom). CSL,
- SUTHERLAND, S.K. et al.: Rapid Death of a Child after a Taipan Bite.
Med. J. Aust., 1:136, 1980.
- BRIGDEN, M.C.: Taipan Bite with Myoglobinuria. Med. J. Aust., 2:42,
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