The unified treatment algorithm is a comprehensive procedure based on expert recommendations for proper treatment in the event of a pit viper snakebite.
“When treating a snakebite, there is a small window to provide care, and the importance of every decision is magnified.”
The interactive treatment algorithm can serve as a guide in preparation of and during snakebite envenomation.
Be prepared at every stage of envenomation management with guidance from the algorithm poster.
Read the clinical research behind the consensus treatment algorithm for the management of North American pit viper envenomation.
This information is adapted from general advice from a panel of US snakebite experts convened in May 2010. No algorithm can anticipate all clinical situations. Other valid approaches exist, and deviations from this information based on individual patient needs, local resources, local treatment guidelines, and patient preferences are expected.
This algorithm is not intended to represent a standard of care. For more information, please see the accompanying manuscript, available at www.biomedcentral.com.
It has been estimated that 7,000-8,000 people are bitten by venomous snakes per year. The number of morbidities can be decreased with preparation for aggressive and immediate medical intervention.1
1. Frequently Asked Questions. Department of Wildlife Ecology and Conservation website. Ufwildlife.ifas.ufl.edu/venomous_snake_faqs.shtml. Accessed May 23, 2018.
Do not administer CroFab® to patients with a known history of hypersensitivity to any of its components, or to papaya or papain unless the benefits outweigh the risks and appropriate management for anaphylactic reactions is readily available.
Coagulopathy: In clinical trials, recurrent coagulopathy (the return of a coagulation abnormality after it has been successfully treated with antivenin), characterized by decreased fibrinogen, decreased platelets, and elevated prothrombin time,
occurred in approximately half of the patients studied; one patient required re-hospitalization and additional antivenin administration. Recurrent coagulopathy may persist for 1 to 2 weeks or more. Patients who experience coagulopathy due to
snakebite should be monitored for recurrent coagulopathy for up to 1 week or longer. During this period, the physician should carefully assess the need for re-treatment with CroFab® and use of any type of anticoagulant or anti-platelet drug.
Hypersensitivity Reactions: Severe hypersensitivity reactions may occur with CroFab®. In case of acute hypersensitivity reactions, including anaphylaxis and anaphylactoid reactions, discontinue infusion and institute appropriate emergency treatment.
Patients allergic to papain, chymopapain, other papaya extracts, or the pineapple enzyme bromelain may also have an allergic reaction to CroFab®. Follow-up all patients for signs and symptoms of delayed allergic reactions or serum sickness (e.g.,
rash, fever, myalgia, arthralgia).
The most common adverse reactions (incidence ≥ 5% of subjects) reported in the clinical studies were urticaria, rash, nausea, pruritus and back pain. Adverse reactions involving the skin and appendages (primarily rash, urticaria, and pruritus)
were reported in 12 of the 42 patients. Two patients had a severe allergic reaction (severe hives and a severe rash and pruritus) following treatment and one patient discontinued CroFab® due to an allergic reaction. Recurrent coagulopathy due
to envenomation and requiring additional treatment may occur.
Please see full Prescribing Information.
CroFab® Crotalidae Polyvalent Immune Fab (Ovine) is a sheep-derived antivenin indicated for the management of adult and pediatric patients with North American crotalid envenomation. The term crotalid is used to describe the Crotalinae subfamily
(formerly known as Crotalidae) of venomous snakes which includes rattlesnakes, copperheads and cottonmouths/water moccasins.
To report suspected adverse reactions, contact BTG at 1-877-377-3784 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.