Paramedic Bitten By Highly Venomous Brown Snake Emergency

Emergency doctor Scott Taylor is getting ready for an unusual case about to arrive on another air ambulance. Snakebite. Snakebite? Yeah, snakebite. Vomiting and dizzy. She was winched out of somewhere. Okay, how far off are they? Coming in the chopper. We're expecting a young female in her early 30s who's apparently been bitten by a snake and she's reporting a headache with some vomiting and feeling generally unwell which might be a sign that she's been poisoned. Dr. Scott has treated snakebite victims in country hospitals but it's rare in the city so he's preparing the team for all possibilities. I've got the brown snake antivenom. Do we have tiger as well? Yeah. We probably won't know and in all likelihood we'll probably have to give one brown one tiger. Both brown and tiger snakes are potentially fatal. They're amongst the most poisonous snakes in the world. Both of those can cause a patient to bleed and bleed very quickly and in places where we can't stop the bleeding. 30-year-old Rhi, a paramedic, was rescued from bushland and rushed to the Royal Melbourne. Rhi, I'm Scott, one of the emergency doctors. How are you feeling at the moment? Not feeling great. Have you vomited? Twice. Okay. Tummy pain? Headache? A bit of a headache. Okay. So Rhi's out running today. She ran about 6km. She was looking at her phone and has stepped onto a brown snake and it's bitten her on the back of her right leg. She has had considerable pain in her right calf and has required 250 mics of IV fentanyl. Nobody's visualized the wounds but Rhi herself says there's two obvious bite marks in that spot. Great, great. Thank you. No worries. You've wrapped it with a singlet. Yeah, so I took my singlet off. That's where the bite is and then I grabbed a jumper out of my bag and wrapped that as well. Okay. Calling on her paramedic skills, Rhi used her running gear as a bandage to slow down the venom seeping into her bloodstream. And we're assuming it was a brown snake just on visualization. Yeah, just a big fat, light brown. If it is a brown snake, the thing we worry about is bleeding. It basically chews up all your clotting factors and you can bleed and obviously we don't want that. No. Want to cut a little window and see what that bite site looks like. Where this X is I'm guessing. Yeah. What we're looking for is to see what that bite site looks like, particularly whether there's any ongoing oozing from that site. The venom from the snake bites can chew up all the proteins in your blood that helps your blood clot. So without those patients can bleed uncontrollably because there's nothing to actually help that blood clot. It just seems to be an endless layer here. It's amazing. It's like it's so good. Dr. Scott Taylor's patient, paramedic Rhi, was jogging when she was bitten by a suspected and potentially deadly brown snake. We're gonna need to put some of this back on. Rhi is complaining of a headache. She's had some nausea and a couple of vomits and feeling a bit dizzy and she probably has absorbed a significant amount of venom. It's a little bit tricky. It's kind of folded over on itself. Dr. Scott's looking for the snake bite by cutting through the bandaging Rhi made with her singlet and jumper. There's even more layers under here. I'm looking at Rhi's improvised bandage but I'm thinking, oh my god, this is the most amazing thing that I've ever seen. I think this is the last one. It's so thick and so effective. I still can't find it. I think so. There's a little bit of bruising there but I can't see any obvious puncture marks there. Hang on, hang on. No, that's a tattoo. I might come back to this I think. Can we just put another bandage just over the foot? Yeah. The tight bandage is delaying the spread of poison and Dr. Scott doesn't want to risk loosening it. The priority now is to give Rhi the anti-venom. Do you have any questions before I duck off? I don't think so. Okay, alright, I won't be long. My impression is that she has not only been bitten by a snake but potentially has been envenomed by the snake and it's important that we get some advice from our on-call toxicology service about the best way forward. Both of the anti-venoms in one bag. Okay. They're stuck in the tissues. That's the whole point of pressure immobilisation is to keep the venom bound up in the tissues. Deputy Director of Emergency Steve Pincus has a lot of experience in treating snake bites. While I was finishing my emergency medicine training I did a research registrar post for 12 months at the Australian Venom Research Unit so I developed an ongoing interest in envenomation in its many forms. He said the longer you wait the less likely it is to to work. Cut a window about this big and I still can't find an actual bite. When a snake's biting a person it's a defence bite and so they don't classically produce the two beautiful pin marks. Most of the time it looks like a scratch. Once you start the anti-venom you can actually take the pressure immobilisation down. Okay, easy, thank you. Dr. Scott explains that the anti-venoms can have side effects. So the toxicologist said we should crack on and give one vial of each. The longer we leave it the less likely it is to be effective. With the anti-venom itself there's a risk of something called serum sickness. So fevers, joint aches, pains, rashes which can happen up to a couple of weeks down the track or any sort of immediate allergic reactions ranging from rash to anaphylaxis. I think being a paramedic and having almost certainly seen her fair share of anaphylactic reactions in the past I'm sure this information is quite unsettling to read and if I was in her shoes I'd be terrified. There's the anti-venom for tiger snake and there's an anti-venom for brown snake mixed in the same bag and we run that over 30 minutes and that should neutralise any of the toxin that's been absorbed into the bloodstream. We try and be very selective in who we administer anti-venom to because there's a high risk of patients having allergic reactions to the medication and that can be anywhere from as little as a rash to something as severe as a life-threatening anaphylaxis. We're about 20% of the way through it. In Royal Melbourne emergency snake bite victim Rhi has been given anti-venom for both the dangerous brown and tiger snakes. Dr. Scott Taylor is on alert for any sign of serious side effects. You're still feeling okay? Yeah. Yep. How's the headache going? Still there. Nausea? Yeah. Okay. It's a light-headed fuzzy feeling. Yeah. It's an anxious half-hour wait to see if 30-year-old Rhi has a bad reaction. Rhi was planning on going out for a run and the next minute she's being chopped into a hospital in the middle of Melbourne and being given anti-venom and being told that she's high risk of having an anaphylactic reaction. It must be mind-blowing and something I'm sure she didn't anticipate waking up with in the morning. Howdy. Antivenom is finished. And she's still good? Yep. Excellent. All right we should hopefully have some bloods to check now. Yes they're all back. Her D-dime is negative and her coag are normal. Good. So the bandage can come off. I'll come help you cut it off. Yeah. I've got some good news for you. Blood test all normal so no signs of any bleeding disorder. We'll need to repeat your blood test. We don't know what's going to happen over the next hour, six hours, 12 hours, which is why we need to keep Rhi in hospital for that period of time and repeat the blood tests a couple of times to make sure nothing's changing. Should be a bit easier to cut off now that we can just cut the whole thing. I guess we can have a proper look at that bite site too. So if any symptoms get worse or you get new symptoms then definitely let us know. This is the most amazing bandage I've ever seen. I'm a poor jumper. So what was it? It was a footie jumper? Like a rugby top. Oh okay. Yeah it's 30, 40 bucks but considering what it's done for me today, I think it's worth it. She's potentially saved her own life by cutting up her $40 wind cheater and using it as a makeshift bandage. All right, there we go. Oh there it is. It's certainly not oozy and you can still wiggle your toes all right. Yeah beautiful. All right, straight in the bin. Get comfy. Have a light stroll around. There's no snakes inside as far as I know. Might be other things but as far as I know there's no snakes. That's awesome, thank you. She'll certainly need a longer period of observation before we can give her the all clear but it's better than I thought it was going to be. We've seen a few of these go pretty badly. Paramedic Rhi was bitten by a suspected deadly brown snake while out jogging. Have you vomited? Twice. Okay. She was flown into the Royal Melbourne Hospital and given anti-venom. You still feeling okay? Yeah. It's that light-headed fuzzy feeling. Yeah. Rhi was kept overnight for observation. It seems like the anti-venom worked and yeah it's just it's insane. I'm still getting over the fact I stepped on a snake yesterday. Just that, that's where it bit me. That's it. If it had been a decent biter that would have probably killed me so I was lucky. Could have been a lot worse.