This antivenom also does not consider treatment with other antivenom products under

development. Because the panel members are all hospital-based physicians, the panel did not evaluate field first aid or other prehospital therapy. In order to create an algorithm that was simple enough to be used effectively, the panel decided not Inhibitors,research,lifescience,medical to include specific recommendations for the management of certain rare manifestations of crotaline snakebite. These included snakebites to the head and neck, snakebites causing rhabdomyolysis, and apparent anaphylactic or anaphylactoid reactions to venom. In addition the panel recognized that no treatment algorithm could Selleck Stattic provide ideal advice for all situations or serve as a substitute for clinical judgment. Legitimate variations in practice will always exist, and care may appropriately vary based on several factors, including Inhibitors,research,lifescience,medical patient presentation, available treatment resources, patient comorbidities, and patient preference. The panel explicitly determined that the consensus treatment algorithm is not a standard of care. Patient assessment and initial management (box 1) The initial approach to management of a patient with suspected pit viper snake envenomation begins with history, physical examination, and measurement of vital signs. Palpation of the envenomated area and marking the leading edge of swelling and tenderness every Inhibitors,research,lifescience,medical 15 – 30 minutes is

a useful way to determine whether local tissue effects have stabilized or are progressing [7]. Inhibitors,research,lifescience,medical Although not evidence based, the panel recommends immobilization and elevation of the envenomated extremity to reduce

swelling. In order to avoid obstructing lymphatic outflow, speed resolution of swelling, and possibly reduce the risk of blister formation in flexor creases, major joints such as the elbow should be maintained in relative extension (≤ 45 degrees of flexion). Opioids are preferred over non-steroidal anti-inflammatory Inhibitors,research,lifescience,medical drugs (NSAIDs) because of the theoretical risk of bleeding associated with NSAID use in patients who may develop coagulopathy or thrombocytopenia due to envenomation. Vasopressin Receptor Although Clostridium tetani infection has not been reported following crotaline snakebite, it has occurred following envenomation by other vipers [14,15]. Standard recommendations for tetanus booster immunization (DTaP, Tdap, or Td as appropriate for the patient’s age) should be followed [16]. Notification of a certified poison center is recommended for all cases of snake envenomation, for two reasons. First, poison center personnel can identify situations where use of this algorithm may be inappropriate, and can provide treatment recommendations based on local snake species and medical treatment resources. Second, certified poison centers provide de-identified data to the National Poison Data System, which is used by public health professionals and policy-makers.