Emergency Medicine Book

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Snake Antivenom

Aka: Snake Antivenom, Snake Anti-Venom, Snake Antivenin, Antivenin Crotalidae Polyvalent, CroFab
  1. Indications: Venomous Snake Bite
    1. Unstable SnakeBite patient
    2. All eastern Coral Snake bites
    3. Clinical worsening in SnakeBite patient
      1. Progressive local swelling and Ecchymosis at bite
      2. Coagulopathy
      3. Hypotension
      4. Mental status changes
  2. Efficacy: Effective if given within 24 hours of bite
    1. Most beneficial if given within 4 hours of bite
  3. Contraindications
    1. Positive Skin Test for Horse Serum Sensitivity
    2. Mild pit viper bite
  4. Preparations
    1. Pit vipers (Rattlesnake, Cottonmouth, Copperhead)
      1. Equine-derived Snake Antivenin (horse derived)
        1. Antivenin Crotalidae Polyvalent (ACP)
      2. Ovine-derived Snake Antivenin (CroFab)
    2. Eastern coral Snake Antivenin (Micrurus fulvius)
      1. Required in all Coral Snake bite cases
  5. Protocol
    1. Start reconstituting antivenin on patients ER arrival
      1. Requires 60 minutes to prepare
    2. Consider Skin Test for Horse Serum Sensitivity
      1. Controversial due to lack of efficacy
      2. Only advantage may be a medicolegal one
    3. Consider Premedication for Allergy Prevention
    4. Be prepared for Anaphylaxis
    5. Administer antivenin
      1. Depending on severity may require more than 25 vials (typically 12 vials)
      2. Protocols vary for ACP, CroFab, and Coral antivenin
      3. Antivenin doses are the same for children and adults
      4. Give 4-6 vials over 1 hour for any of the following findings
        1. Advancing swelling (mark margins, and repeat hourly until stops advancing)
        2. Platelet Count <100
        3. Fibrinogen <100
      5. Maintenance dosing
        1. Consult with poison control
        2. Typically not recommended by toxicologists (despite package inserts)
      6. References
        1. Swadron and Nordt in Herbert (2016) EM:Rap 16(5): 15
    6. Rattlesnake hand bites are associated with risk of hand dysfunction
      1. CroFab 6 vials (based on expert opinion)
    7. Most protocols follow antivenom with Prednisone 40-60 mg orally daily for 5 days
      1. Consult with poison control
  6. Adverse effects
    1. Serum Sickness
    2. Severe allergy or Anaphylaxis
      1. ACP: 23 to 56% Allergic Reaction rate
      2. CroFab: 14.3% Allergic Reaction and none severe
  7. Disadvantages
    1. CroFab is very expensive
      1. Cost to hospital is over $1,000 per vial
      2. Typical 12 vial course with hospital mark-up pricing is over $100,000
  8. Resources (Antivenin sources)
    1. Arizona Poison and Drug Information Center
      1. Exotic Snake Antivenins
      2. Phone: 520-626-6016
    2. American Zoo and Aquarium Association
      1. Antivenin indexes
      2. Phone: 301-562-0777
  9. References
    1. Dart (2001) Ann Emerg Med 37:181-8 [PubMed]
    2. Juckett (2002) Am Fam Physician 65(7):1367-74 [PubMed]
    3. McKinney (2001) Ann Emerg Med 37(2):168-74 [PubMed]

Snake antivenin (C0305047)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129)
SnomedCT 71289008
English snake antivenin, antivenom snake, snake antivenom, antivenom snakes, antivenoms snake, Snake antivenom, Snake antivenin (product), Snake antivenin, Snake antivenin, NOS, Snake antivenin (substance)
Spanish antisuero de ofidio, antisuero de serpiente, antisuero de víbora, antiveneno de víbora, suero antiofídico (producto), suero antiofídico (sustancia), suero antiofídico
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Polyvalent crotalidae antivenin (C0305048)

Concepts Amino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129) , Pharmacologic Substance (T121)
SnomedCT 425117000, 17859000
English Polyvalent crotalidae antivenin, Polyvalent crotalidae antivenin (substance), antivenin (crotalidae) polyvalent, polyvalent crotalidae antivenin (medication), polyvalent crotalidae antivenin, North and South American antisnake serum, Pit-viper antivenin, Polyvalent crotaline antivenin, Polyvalent crotalidae antivenin (product), ANTIVENIN,CROTALIDAE POLYVALENT, antivenin (Crotalidae) polyvalent
Spanish antiveneno polivalente crotalidae (sustancia), antiveneno polivalente crotalidae, suero anticrotálido polivalente (producto), suero anticrotálido polivalente (sustancia), suero anticrotálido polivalente, suero antiofídico de América del Norte y América del Sur
Sources
Derived from the NIH UMLS (Unified Medical Language System)


CroFab (C1145755)

Concepts Pharmacologic Substance (T121) , Immunologic Factor (T129) , Amino Acid, Peptide, or Protein (T116)
MSH C431183
English CroFab, crofab
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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