VAPAGuide - Flowcharts

Emergency & clinical flowcharts

Autopharmacological
effects

Local
effects

Haemostatic
effects

Neurological
effects

Muscular
effects

Cardiac
effects

Renal
effects

Colubridae¹ Bitis gabonica Echis sp.		Naja nigricollis Bitis arietans
Hours

CT↑		Tc↓

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

¹ Dispholidus typus, Thelothornis sp.

CT↑: abnormal clotting time (or more complex clotting test).

Tc↓: thrombopaenia, impaired platelet function.

Causus sp. Hemachatus haemachatus¹ Naja mossambica¹ Naja nigricollis¹ Naja pallida¹ Bitis arietans Bitis gabonica Echis sp.
Minutes (to hours)

Local pain and swelling

Painful swelling of the regional lymph nodes

Naja mossambica¹ Naja nigricollis¹ Naja pallida¹ Bitis arietans Bitis gabonica
Days		Hours

		Extensive swelling

		Hypovolaemia

Necrosis Loss of function of extremities Loss of extremities

¹ Can also cause local signs of envenoming in the eyes (spitting cobras).

Bitis sp. Echis sp.
Minutes (to hours)

Nausea, vomiting, abdominal pain, diarrhoea (urticaria, angio-oedema) (bronchospasm) arterial hypotension	Bitis arietans Bitis gabonica
	Hours

	Non-cardiogenic pulmonary oedema, cerebral oedema	Generalised oedema

		Hypovolaemia/hypovolaemic shock

Cardiovascular failure

Aspidelaps scutatus
Dendroaspis sp.
Hemachatus haemachatus
Naja haje

Naja anchietae
Naja melanoleuca
Naja nivea

Minutes to hours

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

Paralysis of the skeletal musculature including the respiratory musculature

Respiratory failure

Bitis arietans
Bitis gabonica

Cardiac dysrhythmias, ischaemia (ECG)

Arterial hypotension, pulmonary oedema

Heart failure

Bitis arietans

Hours to days

Flank pain, renal bed sensitive to percussion

Urinary output <400 ml/24 h

Renal failure