Emergency Care Institute – Clinical tools

Snake and spider bite

Published: June 2024. Printed on 17 Jul 2024.

Venomous bites and stings

For all venomous and unfamiliar insect bites and marine stings, or if clinically concerned, consult with the Poisons Information Centre 13 11 26 or a local clinical toxicologist.

Monitor for signs of envenomation or shock.

Snake and spider bite guideline

The clinical management of snake bites is primarily focused on determining whether the patient experiences any signs of envenomation, requiring early administration of the appropriate antivenom.

Snake and Spider Bites Clinical Management (GL2024_007)

Snake bite

Information for clinicians on the assessment, decision making and clinical management of patients presenting with suspected or confirmed snake bite, for those species normally found in NSW.

Key principles of management

Consult early with a clinical toxicologist or the NSW Poisons Information Centre 13 11 26 before blood results are available to make a clinical decision regarding antivenom administration.
Early antivenom treatment for those with clinical signs or symptoms of envenomation.
Geographical location of where the bite occurred (or likely snake responsible for the bite) is a factor in determining the choice of antivenom or antivenoms. Make antivenom choice in consultation with the NSW Poison Information Centre or a clinical toxicologist. Note: this does not apply to snake handlers.
It is recommended that each local health district has an escalation pathway to enable expert toxicology advice where available and a distribution pathway to all district sites.
In the rural and regional setting, follow existing admission, virtual care and retrieval processes.
In the out-of-hospital setting, transport any suspected snake bite patient to the emergency department for ongoing assessment and monitoring. For any collapse secondary to snake bite or any suspected envenomation, the priorities are resuscitation, application of pressure bandage with immobilisation and rapid transport to a facility that can administer antivenom. As soon as possible, consult the NSW Poisons Information Centre, particularly in rural and remote locations where transport times may be extended.
All patients, regardless of whether there are signs of envenomation, require a facility with on-site pathology and the ability to manage ongoing clinical monitoring, antivenom administration and anaphylaxis management.
Patients and their carers must be informed and kept updated regarding factors that contribute to any treatment decision. This includes risks and benefits of the treatment plan and any consultation with experts.

Clinical pathway

This flowchart outlines each step in the management of patients who have presented with a suspected snake bite. It provides a quick reference and should be used in conjunction with the more detailed information provided in the guideline (GL_2024_007).

For treatment of anaphylaxis, refer to the Australasian Society of Clinical Immunology and Allergy anaphylaxis guideline.

Geographical location of snake bite and antivenom selection

This map uses green and grey shading to show how the location of the patient displaying signs of envenomation influences the treatment.

In green-shaded area (east of the Darling River) and exhibiting clinical features of envenomation, give one vial of brown and one vial tiger antivenom.
In grey-shaded area and exhibiting clinical features of envenomation, give one vial of polyvalent antivenom.
Recently, there have been rare sightings of taipans in Northern NSW outside of their previously known geographical regions. This may necessitate the administration of polyvalent antivenom in rare cases in this region. This should be discussed with a clinical toxicologist or the NSW Poisons Information Centre.

Map shows location of key hospitals in two areas, east of the Darling River and west.

Spider bite

Information for clinicians in relation to the assessment, decision making and clinical management of patients presenting with suspected or confirmed spider bite, for those species normally found in NSW.

Key principles of management

Funnel-web spider antivenom should be given to patients exhibiting symptoms. The dose is two vials of antivenom given intravenously (children receive the same dose as adults). Early contact with a clinical toxicologist or the NSW Poisons Information Centre is recommended if advice is required.
Pressure bandage with immobilisation should be used for funnel-web spider bites.
Symptomatic management is the mainstay of redback spider bite. A pressure bandage will make the pain worse and is not recommended.
All other spider bites only cause minor effects and only require symptomatic treatment.

Pressure bandage with immobilisation

Apply a broad 10-15cm elasticised bandage (preferred rather than crepe) directly over the bite site. Do not remove clothing.

Wrap the bandage distally and then proximally to cover the whole affected limb. The bandage should be firm and tight. You should be unable to easily slide a finger between the bandage and the skin.

Extend the bandage as high as it can go on the limb, covering as much of the limb as possible.

Splint the limb, including joints on either side of the bite site. This can be done with an additional bandage starting distally in combination with step 3.