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Practice Guideline
. 2011 Feb 3:11:2.
doi: 10.1186/1471-227X-11-2.

Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop

Eric J Lavonas  1 , Anne-Michelle Ruha, William Banner, Vikhyat Bebarta, Jeffrey N Bernstein, Sean P Bush, William P Kerns 2nd, William H Richardson, Steven A Seifert, David A Tanen, Steve C Curry, Richard C Dart; Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority
Affiliations
Practice Guideline

Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop

Eric J Lavonas et al. BMC Emerg Med. .

Abstract

Background: Envenomation by crotaline snakes (rattlesnake, cottonmouth, copperhead) is a complex, potentially lethal condition affecting thousands of people in the United States each year. Treatment of crotaline envenomation is not standardized, and significant variation in practice exists.

Methods: A geographically diverse panel of experts was convened for the purpose of deriving an evidence-informed unified treatment algorithm. Research staff analyzed the extant medical literature and performed targeted analyses of existing databases to inform specific clinical decisions. A trained external facilitator used modified Delphi and structured consensus methodology to achieve consensus on the final treatment algorithm.

Results: A unified treatment algorithm was produced and endorsed by all nine expert panel members. This algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy.

Conclusions: Clinical manifestations and ideal treatment of crotaline snakebite differ greatly, and can result in severe complications. Using a modified Delphi method, we provide evidence-informed treatment guidelines in an attempt to reduce variation in care and possibly improve clinical outcomes.

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Figures

Figure 1
Figure 1
Unified Treatment Algorithm for the Management of Pit Viper Snakebite in the United States.
Figure 2
Figure 2
Factors Influencing Observation Time for Patients with Apparent Dry Bites and Initially Minor Envenomations Managed Without Antivenom.
See this image and copyright information in PMC

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