[Clinical and biological surveillance of envenomed patients].

Faced with an envenomation, the problem is to take sufficiently rapidly the decision to administer the only effective treatment--immunotherapy--, to know which antivenom to choose and how long to administrate it. If the snake is not identified, symptoms and initial development give information on the type of venom. It is convenient to classify the symptoms according to four clinical types: i) the cobra syndrome with a potentially fatal evolution within two to ten hours and which resembles an Elapid bite, ii) the viper syndrome associating bleeding and inflammation, which can be due either to a viper, pit viper or, in Australia, to Elapids, iii) disturbance of blood circulating functions and iv) disturbance of other live functions. Between the third to the half of snakebite victims present no envenomation. Severe envenomations must be monitored in an intensive care unit, with experience in emergency management and monitoring of patients with major life-threatening conditions. Throughout the world, snakebites induce more than 100,000 deaths every year. Schematically, the emergency may be considered in terms of seconds for blood circulation disorders, minutes for respiratory paralysis, and hours for the coagulopathy.