VAPAGuide - Flowcharts

Emergency & clinical flowcharts

Autopharmacological
effects

Local
effects

Haemostatic
effects

Neurological
effects

Muscular
effects

Cardiac
effects

Renal
effects

Pseudonaja sp.

Hours to days

Flank pain, renal bed sensitive to percussion

Urinary output <400 ml/24 h

Renal failure

Acanthophis sp.
Micropechis sp.
Notechis scutatus
Oxyuranus sp.
Tropidechis carinatus
(Pseudonaja sp.)

Minutes to hours

Cranial nerve deficits (ptosis, ophthalmoplegia, dysphagia, dysarthria)

Paralysis of the skeletal musculature including the respiratory musculature

Respiratory failure

All Australian elapids
Minutes (to hours)

Nausea, vomiting, abdominal pain, diarrhoea (urticaria, angio-oedema) (bronchospasm) arterial hypotension






Cardiovascular failure

Pseudechis sp.
(in particular Pseudechis australis)

Minutes (to hours)

Local pain and swelling

Painful swelling of the regional lymph nodes

(Necrosis)

Notechis scutatus Oxyuranus sp. (Pseudechis sp.) Pseudonaja sp. (Tropidechis carinatus)
Hours

Clotting time¹ abnormal ^{1 or more complex clotting tests}

Gingival bleeding

Bleeding from wounds remote from the site of the bite

Haematemesis, bleeding per rectum, haematuria

Systemic bleeding		Focal neurological deficits, meningismus, coma

Hypovolaemia/haemorrhagic shock

Cardiovascular failure	Renal failure	CNS failure

Notechis scutatus
Oxyuranus sp.
Pseudechis sp.
Tropidechis carinatus

Hours

Myalgia (at rest, with active/passive movement, upon pressure), dark urine, ECG changes

Signs of paralysis

Skeletal muscle necrosis