Emergency Flowchart

Signs and symptoms^1,2	Emergency medical treatment	Identification of the culprit	Antivenom

	Possible culprit³


Nausea, vomiting, abdominal pain, diarrhoea, arterial hypotension, collapse, cardial arrest, seizures (autopharmacological / cardial effects of the venom; anaphylaxis)	Treatment of arterial hypotension, cardiac arrest, anaphylactic/anaphylactoid reactions	Narrowing down the cause with the aid of indirect criteria (if the snake is unavailable or could not be unequivocally identified) Which snake species are present in the country where the snake bite took place? Syndromic approach: How does the clinical picture of snakebite envenoming develop? Comparative observations of the various species responsible in the region. Follow also links to species- and family-specific 'clinical entries' in the column `possible culprit' of this flowchart.	WHO Snakebite Information and Data Platform Check for nationally / regionally available antivenoms (assure safety and effectiveness) Antivenom indications and antivenom therapy: go to 'clinical management' Check for updates in case of an accident

	Australian elapids

Systemic bleeding (haemostatic effects of the venom) → hypovolaemia → haemorrhagic shock Intracranial bleeding (haemostatic effects of the venom) → focal neurological deficits, coma, meningismus	Treatment of blood loss Treatment of intracranial bleeding

	Hoplocephalus sp. Notechis scutatus ssp. Oxyuranus sp. (Pseudechis sp.) Pseudonaja sp. Tropidechis carinatus

Severe anaemia (haemolysis - TMA) - delayed	Treatment of severe anaemia (blood transfusion)

	Hoplocephalus sp. Notechis scutatus ssp. Oxyuranus sp. Pseudonaja sp. Tropidechis carinatus

Cranial nerve deficits, paralysis of the skeletal musculature including the respiratory musculature (neurological effects of the venom) → respiratory insufficiency, respiratory failure	Treatment of the respiratory insufficiency/respiratory Endotracheal intubation and artificial respiration

	Acanthophis sp. (Notechis scutatus ssp.) Oxyuranus sp. Pseudechis papuanus (Pseudonaja sp.) (Tropidechis carinatus)

Myalgia, pain on active/passive movement, upon pressure (muscular effect of the venom: rhabdomyolysis) → ECG changes (hyperkalaemia), signs of paralysis, urine colour (differential diagnosis haemoglobinuria), renal failure.	Treatment of the hyperkalaemia and hypercalcaemia, prevention / treatment of the acute renal failure, treatment of the respiratory insufficiency/respiratory failure

	Notechis scutatus ssp. (Oxyuranus sp.) Pseudechis sp. (Tropidechis carinatus)

Myocardial symptoms, arterial hypotension, collapse, cardial arrest, seizures, cardiac dysrhythmias, ischaemia (ECG), cardiac insufficiency, heart failure	Treatment of the cardiac disturbance

	Australian elapids


Acute renal failure (secondary - TMA, rhabdomyolysis, hypotensive shock, etc.), rarely primary renal effects of the venom)	Treatment of the acute renal failure

	see footnote 4

This section contains genera and species for which clinical data is either sparse or entirely missing. In this case, the link will lead you to the biological file. Under 'Risk', you will find what is known about the potential harm to humans which are well described for adjacent regions but not for the region you are currently looking at. The link will take you to the biological file and from there to the clinical file. When using the clinical information, however, you must consider that it is not from your region and therefore may not be applicable to your situation.
	Follow ABCDE approch


	See Distribution table

1	See also Clinical flowchart as a guide to the dynamics of envenoming.
2	Local effects are uncommon in Australian snakebite and are minimal for bites by brown snakes. More significant local signs can occur in bits from black snakes, tiger snakes and rough-scaled snakes.
3	Taxonomic name without parentheses/(in parentheses)/((in double parentheses)): these signs and symptoms are regularly/(rarely)/((questionably)) observed following bites by these species.
4	Direct venom nephrotoxicity, renal ischaemia secondary to shock, disseminated intravascular coagulation with thrombotic microangiopathy (TMA), haemoglobinuria, myoglobinuria, and hyperkalaemia contribute to acute tubular necrosis.” (Warrell and Williams 2023). The contribution of direct venom nephrotoxicty in Australian elapid envenoming is unclear. In Australian elapid envenoming, AKI mostly occurs in the context of thrombotic microangiopathy and rhadomyolysis (Johnston et al. 2017a, Isbister and Berling 2025). Species causing muscle injury/rhabdomyolysis: Notechis scutatus ssp., (Oxyuranus sp.), Pseudechis sp., (Tropidechis carinatus).