Snake Bite (part 2): management pearls

21 Oct

ED Management:anklebite

  • Limb Elevation
    • Avoid pressure immobilization (tourniquets)
  • Wound Demarcation
    • Assess every 15-30 min
  • Pain Control
    • IV Opioids
  • Toxicology C/S
  • Tetanus ppx

 

Note:  No indication for FFP and platelets.  Both are inactivated by Crotalinae venom. 

 

Antivenom (Crofab):

Tx for significant Crotalinae envenomation in the U.S.anklebite3

 

  • Dosing
    • Mix 4-6 vials of crotalinae Fab antivenom (Crofab) in 250 mL NS.
    • Infuse IV over 1 hr.
    • Pediatric antivenom dose = Adult dose

 

Anaphylaxis to Antivenom:

  • Epinephrine3 – 0.5 mg IM (1 mg/mL preparation):
    • Repeat q5-15min PRN.
  • Steroids
    • Methylprednisolone 125 mg IV.
  • Antihistamine
    • 25 to 50 mg IV
  • Oxygen
    • 8-10 L/min via facemask

 

 

ED Disposition:

  • Treated with antivenom
    • Hospital admission for further observation and supportive care.
  • No antivenom administration
    • Discharge home if:
      • No clinical signs of toxicity
      • 8-10 hours c/ normal coagulation panel

 

Submitted by Christina Brown.

 

References: 

  • Walter FG, Chase PB, Fernandez MC, McNally J. Venomous snakes. In: Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose, 4th, Shannon MW, Borron SW, Burns MJ (Eds), Saunders, Philadelphia 2007. p.399.
  • Lavonas EJ, Ruha AM, Banner W, et al. Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop. BMC Emerg Med 2011; 11:2.
  • American College of Medical Toxicology, American Academy of Clinical Toxicology, American Association of Poison Control Centers, et al. Pressure immobilization after North American Crotalinae snake envenomation. J Med Toxicol 2011; 7:322.
  • American College of Medical Toxicology, American Academy of Clinical Toxicology, American Association of Poison Control Centers, et al. Pressure immobilization after North American Crotalinae snake envenomation. Clin Toxicol (Phila) 2011; 49:881.
  • Yip L. Rational use of crotalidae polyvalent immune Fab (ovine) in the management of crotaline bite. Ann Emerg Med 2002; 39:648.
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: