Mrs Z, a 70-year-old woman, died from tiger snake envenomation after being bitten on the left foot while sleeping. She received two vials of antivenom within 2.5–4 hours of the bite at Royal Melbourne Hospital, consistent with national guidelines. Despite appropriate antivenom administration, she developed severe consumptive coagulopathy and life-threatening intra-abdominal haemorrhage, dying in ICU. The coroner accepted expert opinion that medical management was reasonable and timely. However, the finding highlights an ongoing clinical debate regarding whether higher antivenom doses (more than one vial) might benefit cases with severe envenoming and massive venom loads, and recommends this case and another similar death be published to inform clinical practice.
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pressure immobilising bandagingcentral venous line insertionblood product transfusionintubationresuscitation
Contributing factors
severe venom-induced consumptive coagulopathy (VICC)
intra-abdominal haemorrhage
very high venom load (697 ng/mL)
possibly delayed or inadequate antivenom dosing in context of severe envenoming
Coroner's recommendations
Recommend that the Australasian College for Emergency Medicine (ACEM) circulate this Finding to ACEM fellows to highlight the evidence, guidelines and potential issues in the management of snake bite
Support publication of clinical details of this case and the similar death of Shane Tatti in medical literature (subject to family consent) to inform clinicians
Implied recommendation for further research and modification of guidelines when sufficient evidence accumulates regarding dosing in severe envenoming cases
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