Clinical Algorithms for Medical Professionals
This page contains several clinical algorithms designed to guide the medical provider through the process of assessing, diagnosing, and treating a patient including preparation and administration of antivenom. These are not intended for laypeople and should only be performed by a trained provider. Download links are provided in bolded blue text for printable PDF files of each algorithm.
The following algorithm lays out a consistent process for the assessment, diagnosis, treatment, and extended management of a patient suffering from an unknown snakebite in an austere environment. Antivenom dosages here are based upon use of the Inosan® product and may vary depending on the specific antivenom used; however, the basic progression of dosages increasing from left to right in conjunction with an increase in severity should remain consistent (i.e. X vials for local envenomation, X•2 for moderate systemic envenomation, X•4 for a severe systemic envenomation or neurotoxic envenomation, etc). The key here is to identify the syndrome of the envenomation, then identify the severity of the syndrome, then dose the antivenom based on the specific syndrome and the severity of said syndrome at time of assessment. Contact us via the email button at the bottom if you have any questions. Click here to download the assessment, diagnosis, and treatment algorithm!
The following algorithm details a basic procedure for preparation and administration of new 3rd generation lyophilized antivenoms such as the Inosan® products. Click here to download the antivenom administration algorithm! Note in particular the following critical information:
- There are no absolute contraindications to antivenom therapy! The only definitive treatment for a snake envenomation is the appropriate antivenom at the appropriate dose, which can be determined based on the algorithm for snakebite management shown above.
- Skin testing should not be performed as it wastes valuable antivenom, wastes time, and has absolutely zero predictive value or impact on the decision to treat with antivenom.
- Antivenom should be given by intravenous or intraosseous injection only and should not be given intramuscularly.
- Antivenom may be given as a bolus or a drip, depending on a number of factors including the brand of antivenom used and the condition of the patient.
- The only effective pre-treatment to reduce incidence of adverse reactions is to administer 0.25 mg of 1:1000 epinephrine subcutaneously 5 minutes prior to administering the antivenom injection.
- Antihistamines and steroids have value in treating anaphylaxis and other allergic reactions if they occur, but they negate the benefits of pre-treatment with epinephrine if given prior to antivenom use and should not be given unless a reaction actually occurs.
- For severe allergic reactions, consider using an intravenous epinephrine infusion.