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B. Elapidae: Immediate local symptoms and signs from these bites may be minimal. The
degree and rapidity of the onset of systemic symptoms will vary according to the species,
bite site and effectiveness of the bite. Systemic symptoms such as nausea, vomiting,
sweating, myalgias and general malaise are common. Signs of paralysis such as
generalized weakness, blurred vision and respiratory difficulties may become obvious.
There may be no signs of overwhelming coagulopathy until a catastrophe such as an
intracerebral bleed occurs. In all cases of suspected bite assume envenomation and treat
accordingly. There is strong evidence that in elapid bites appropriate first aid may be life
saving (Category 1A) Suthurland SK, Coulter AR, Harris RD. Rationalisation of first-aid
measures for Elapid snakebite. Lancet 1979; 1: 183-186. A bandage applied at a similar
tension to that for a sprained ankle should commence at the bite site and extend along the
length of the limb and back again to the bite. Splint the limb and keep the patient still.
The patient must not self evacuate under any circumstances as activity will enhance
movement of the venom centrally. With well-conducted first aid, venom will be trapped
and broken down locally and the risk of life threatening envenomation will be minimized.
With the acknowledged problems in elapid species identification and of anti venom
storage the field use of anti-venom is not recommended.
C. Gila Monsters: Gila monsters have no injection mechanism for their venom, but they
have very powerful jaws and they chew and tear at their victims, drooling venom and
producing a substantial amount of pain. Envenomation produces pain, swelling, vomiting,
increased heart rate, vertigo, shortness of breath, and loss of consciousness. Follow the
recommendations for pit viper envenomation. Fatal Gila monster encounters are
extremely rare.
