On arrival check clinical status;

Insert IV line; Take blood for FBE, PT, PTT, Fibrinogen, FDPs

Possible bite
Patient completely
asymptomatic with
normal coagulation
tests

Yes

Remove pressure bandage

Observe at least 4 hours in
Emergency
Discharge if remains well to
return if any symptoms develop

If signs develop

Define bite
Patient
asymptomatic with
normal coagulation
tests

Yes

Remove pressure bandage

If remains asymptomatic
admit to HDU (5th floor)
Discharge after 12 hours if
remains well

If signs develop

Define bite
Patient mildly
symptomatic or
abnormal
coagulation test

Patient very sick

Hypotension
Bleeding
Paralysis

Yes

Yes

Admit ICU
Swab bite site (cut bandage over site)
Use Venom Detection Kit
Give antivenom if significant systemic
symptoms or coagulopathy
Discuss with ICU consultant first
Remove pressure bandage once stable

Admit ICU
Full ABC
Leave bandage in place (or apply one)
Empirical use of both
Brown & Tiger antivenom
Use Venom Detection Kit