Toxicology

Snakebite — Paediatric male at community event

Intermediate

Pediatric · 8yr · male

Patient Information

Dispatch	You are called to a patient (Liam Nguyen, 8-year-old male) at the Whiteman Park Community Fair FAP. Bystanders say he was playing in the grass near the picnic area and is now crying and holding his lower leg.
Patient	Liam Nguyen — 8yr (26kg)
Incident History	Pt was running through long grass near the oval boundary when he felt a sharp sting on his lower right leg. A bystander saw what appeared to be a snake in the grass. Pt walked to the FAP with his father approximately 5 minutes ago.
Emergency Contact	Thanh Nguyen (Father) — 0412 783 456

Initial Rapid Assessment

Response	Alert
Airway	Patent. No airway obstruction, no stridor, no swelling.
Breathing	Spontaneous. Rate 22/min. No increased work of breathing. No wheeze.
Circulation	Radial pulse present, regular, normal rate. Skin warm. Two small puncture marks visible on right medial ankle — minimal redness, no significant swelling. No external bleeding.
Disability	GCS 15 (E4V5M6). Orientated to time, place and person. Anxious but co-operative.
Exposure	Two small puncture marks approximately 8mm apart on right medial ankle. Mild redness localised to bite site. No urticaria, no angioedema.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	99% (RA)	Nil	22	108	102/68	<2s	15	4 4 ++	36.8	5.4 mmol/L	4
10 mins	99% (RA)	Nil	20	102	104/70	<2s	15	4 4 ++	36.8	5.4 mmol/L	3

History Taking

Treatment Response

Diagnosis

This patient is suffering from a suspected venomous snakebite to the right medial ankle with no current signs of systemic envenomation.

Facilitator Triggers — if trainees miss a critical step

! (If trainee allows or encourages Liam to walk or stand at any point — father states Liam looks pale and suddenly says his eyes feel heavy and he feels dizzy. GCS drops to 13.)
! (If Pressure Immobilisation Technique is NOT applied within 5 minutes of assessment — Liam begins to complain of tingling spreading up his right calf toward the knee at the 8-minute mark.)
! (If trainee attempts to wash, incise, or suck the bite site — facilitator reminds trainee this is contraindicated per CPG and prompts them to reconsider their management.)
! (If trainee fails to splint the limb after applying PIT bandage — father asks 'shouldn't we stop him moving his leg somehow?' as Liam continues to bend his knee.)
! (If trainee does not call for ambulance transport early — at 12 minutes Liam develops mild ptosis and says 'my eyelids feel heavy'. Escalate to Priority 1 transport with pre-notification.)

Treatment Objectives

1. Ensure scene safety — confirm snake is no longer present in the FAP or immediate area before proceeding.
2. Don appropriate PPE — gloves minimum.
3. Perform Primary Survey — airway patent, breathing adequate, circulation intact, GCS 15.
4. Instruct Liam to stop walking immediately and assist him to sit or lie down — DO NOT allow the patient to walk or stand.
5. Perform Vital Sign Survey — HR, RR, BP, SpO2, GCS, BGL, temperature, pain score.
6. Expose right lower leg — identify and document two puncture marks on right medial ankle, note location and appearance.
7. Apply Pressure Immobilisation Technique (PIT) to the right lower limb as per clinical skill — commence at the toes/foot and bandage firmly upward covering as much of the limb as possible, ensuring 1.5cm x 1.5cm square indicator on snakebite bandage.
8. Mark the bite site on the PIT bandage with a marker pen.
9. Apply a splint to the right lower limb to further minimise movement.
10. Keep Liam calm and still — continuously reassure patient and father throughout.
11. Do NOT wash, cut, incise, suck, or apply an artery tourniquet to the bite site.
12. Do NOT attempt to identify, trap, catch, or kill the snake.
13. Do NOT remove PIT bandage or splint prior to arrival at hospital.
14. Assess distal neurovascular observations of right foot — capillary refill, colour, warmth, movement, sensation — confirm arterial flow is maintained distal to PIT; if CRT exceeds 3 seconds, contact CSPSOC/ASMA before adjusting bandage.
15. Activate ambulance transport — all suspected snakebite patients require transport to hospital for assessment and observation. Contact State Operations Centre.
16. Monitor patient persistently — record full observations every 10 minutes, closely monitoring for respiratory depression, ptosis, weakness, drooling, slurred speech, or visual disturbances.
17. If signs of envenomation develop (ptosis, weakness, respiratory depression, altered GCS): escalate to Priority 1 transport with pre-notification of receiving facility.
18. Continue to monitor and reassure until ambulance arrival.
19. Scenario ends on arrival of ambulance and IMISTAMBO handover.
20. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Snakebite · Pressure Immobilisation Technique (P.I.T) · Primary Survey · Pulse Oximetry · Blood Glucose Monitor · Blood Pressure · Fractures & Dislocations — Splinting

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Signs/Symptoms	Pain and mild redness at right medial ankle bite site. Mild headache developing. Feeling anxious. No weakness, no visual changes, no drooling, no difficulty swallowing or speaking.
Allergies	Nil known drug allergies.
Medications	Nil regular medications.
Pertinent History	Fit and well. No significant past medical history. Father confirms Liam walked to the FAP — approximately 20 metres from where he was bitten.
Last Oral Intake	Ate a sausage sizzle and drank water approximately 45 minutes ago.
Events Leading	Pt was running barefoot through long grass at the boundary of the oval during the community fair when he felt a sudden sharp pain in his right ankle. A bystander reported seeing a brown snake moving away in the grass.
Treatment Prior	Father applied firm pressure with a cloth to the bite site for approximately 2 minutes prior to walking to FAP. No bandage applied.

Onset	Approximately 10–15 minutes ago while running through long grass near the oval boundary.
Pain	Localised pain at right medial ankle bite site.
Quality	Sharp initial sting, now a dull ache at site.
Radiates	Nil radiation of pain.
Severity	4/10