Crotaline envenomation - Revision history

Athorne: /* Crotalinae equine immune F(ab')2 antivenom (Anavip)FDA Insert -ANAVIP https://www.fda.gov/media/92139/download */

2021-08-02T21:19:43Z

Crotalinae equine immune F(ab')2 antivenom (Anavip)FDA Insert -ANAVIP https://www.fda.gov/media/92139/download

← Older revision		Revision as of 21:19, 2 August 2021
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	==Crotalinae equine immune F(ab')2 antivenom ([[Anavip]])<ref>FDA Insert -ANAVIP https://www.fda.gov/media/92139/download</ref>==		==Crotalinae equine immune F(ab')2 antivenom ([[Anavip]])<ref>FDA Insert -ANAVIP https://www.fda.gov/media/92139/download</ref>==
			*Approved in 2015 for use in N. American pit viper envenomations.
	*Similar treatment indications		*Similar treatment indications
	*Given as 10 vials IV		*Given as 10 vials IV
	**Repeated Q1H as needed for initial control until local signs of envenomation are not progressing, systemic symptoms are resolved, and coagulation and other laboratory parameters have normalized or are trending toward normal.		**Repeated Q1H as needed for initial control until local signs of envenomation are not progressing, systemic symptoms are resolved, and coagulation and other laboratory parameters have normalized or are trending toward normal.
	*4 Vials IV maintenance dosing PRN for recurrence of symptoms.		*4 Vials IV maintenance dosing PRN for recurrence of symptoms.
	*Approved in 2015 for use in N. American pit viper envenomations.
	*Longer half life thought to reduce need for readministration and may reduce risk of recurrent subacute coagulopathy and bleeding vs Crofab <ref>Bush SP, Ruha AM, Seifert SA, et al. Comparison of F(ab')2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial. Clin Toxicol (Phila). 2015;53(1):37-45. doi:10.3109/15563650.2014.974263</ref>		*Longer half life thought to reduce need for readministration and may reduce risk of recurrent subacute coagulopathy and bleeding vs Crofab <ref>Bush SP, Ruha AM, Seifert SA, et al. Comparison of F(ab')2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial. Clin Toxicol (Phila). 2015;53(1):37-45. doi:10.3109/15563650.2014.974263</ref>

Athorne: /* Crotalinae equine immune F(ab')2 antivenom (Anavip)FDA Insert -ANAVIP https://www.fda.gov/media/92139/download */

2021-08-02T21:16:10Z

Crotalinae equine immune F(ab')2 antivenom (Anavip)FDA Insert -ANAVIP https://www.fda.gov/media/92139/download

← Older revision		Revision as of 21:16, 2 August 2021
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	*4 Vials IV maintenance dosing PRN for recurrence of symptoms.		*4 Vials IV maintenance dosing PRN for recurrence of symptoms.
	*Approved in 2015 for use in N. American pit viper envenomations.		*Approved in 2015 for use in N. American pit viper envenomations.
	*Longer half life thought to reduce need for readministration and may reduce risk of recurrent subacute coagulopathy and bleeding VS Crofab <ref>Bush SP, Ruha AM, Seifert SA, et al. Comparison of F(ab')2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial. Clin Toxicol (Phila). 2015;53(1):37-45. doi:10.3109/15563650.2014.974263</ref>		*Longer half life thought to reduce need for readministration and may reduce risk of recurrent subacute coagulopathy and bleeding vs Crofab <ref>Bush SP, Ruha AM, Seifert SA, et al. Comparison of F(ab')2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial. Clin Toxicol (Phila). 2015;53(1):37-45. doi:10.3109/15563650.2014.974263</ref>

	==Disposition==		==Disposition==

Athorne: /* Crotalinae equine immune F(ab')2 antivenom (Anavip) */

2021-08-02T21:15:37Z

Crotalinae equine immune F(ab')2 antivenom (Anavip)

← Older revision		Revision as of 21:15, 2 August 2021
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	{{Crofab dosing}}		{{Crofab dosing}}

	==Crotalinae equine immune F(ab')2 antivenom ([[Anavip]])==		==Crotalinae equine immune F(ab')2 antivenom ([[Anavip]])<ref>FDA Insert -ANAVIP https://www.fda.gov/media/92139/download</ref>==
	*Similar treatment indications		*Similar treatment indications
	*Given as 10 vials IV		*Given as 10 vials IV
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	*Approved in 2015 for use in N. American pit viper envenomations.		*Approved in 2015 for use in N. American pit viper envenomations.
	*Longer half life thought to reduce need for readministration and may reduce risk of recurrent subacute coagulopathy and bleeding VS Crofab <ref>Bush SP, Ruha AM, Seifert SA, et al. Comparison of F(ab')2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial. Clin Toxicol (Phila). 2015;53(1):37-45. doi:10.3109/15563650.2014.974263</ref>		*Longer half life thought to reduce need for readministration and may reduce risk of recurrent subacute coagulopathy and bleeding VS Crofab <ref>Bush SP, Ruha AM, Seifert SA, et al. Comparison of F(ab')2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial. Clin Toxicol (Phila). 2015;53(1):37-45. doi:10.3109/15563650.2014.974263</ref>


	==Disposition==		==Disposition==

Athorne at 21:14, 2 August 2021

2021-08-02T21:14:17Z

← Older revision		Revision as of 21:14, 2 August 2021
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	{{Crofab dosing}}		{{Crofab dosing}}

			==Crotalinae equine immune F(ab')2 antivenom ([[Anavip]])==
			*Similar treatment indications
			*Given as 10 vials IV
			**Repeated Q1H as needed for initial control until local signs of envenomation are not progressing, systemic symptoms are resolved, and coagulation and other laboratory parameters have normalized or are trending toward normal.
			*4 Vials IV maintenance dosing PRN for recurrence of symptoms.
			*Approved in 2015 for use in N. American pit viper envenomations.
			*Longer half life thought to reduce need for readministration and may reduce risk of recurrent subacute coagulopathy and bleeding VS Crofab <ref>Bush SP, Ruha AM, Seifert SA, et al. Comparison of F(ab')2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial. Clin Toxicol (Phila). 2015;53(1):37-45. doi:10.3109/15563650.2014.974263</ref>


	==Disposition==		==Disposition==

Athorne: /* Crofab administration */

2021-08-02T21:00:57Z

Crofab administration

← Older revision		Revision as of 21:00, 2 August 2021
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	{{Snake bite local treatment}}		{{Snake bite local treatment}}

	===~~[[Crotalidae polyvalent immune Fab (Crofab)\|Crofab]]~~ administration===		===Antivenom administration===
	*See below		*See below

	===Supportive care===		===Supportive care===
	*[[IVF]] and [[vasopressors]] if needed for hypotension		*[[IVF]] and [[vasopressors]] if needed for hypotension

Athorne: /* Indications */

2021-08-02T01:13:31Z

Indications

← Older revision		Revision as of 01:13, 2 August 2021
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	==Crotalidae Polyvalent Immune Fab (FabAV) Antivenin ([[Crofab]])==		==Crotalidae Polyvalent Immune Fab (FabAV) Antivenin ([[Crofab]])==
	===Indications===		===Indications===
	The following are criteria for administration after Crotalidae bite~~[3]~~		The following are criteria for administration after Crotalidae bite<ref>Crofab treatment agorithmn http://www.crofab.com/documents/CroFab-Treatment_Algorithm.pdf</ref>

	*Progression of swelling		*Progression of swelling

Athorne: /* Indications */

2021-08-02T01:11:39Z

Indications

← Older revision		Revision as of 01:11, 2 August 2021
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	==Crotalidae Polyvalent Immune Fab (FabAV) Antivenin ([[Crofab]])==		==Crotalidae Polyvalent Immune Fab (FabAV) Antivenin ([[Crofab]])==
	===Indications===		===Indications===
	The following are criteria for administration after Crotalidae bite [3]		The following are criteria for administration after Crotalidae bite[3]

	*Progression of swelling		*Progression of swelling

Athorne: /* Supportive care */

2021-08-02T01:10:27Z

Supportive care

← Older revision		Revision as of 01:10, 2 August 2021
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	*[[IVF]] and [[vasopressors]] if needed for hypotension		*[[IVF]] and [[vasopressors]] if needed for hypotension
	*Blood products rarely needed		*Blood products rarely needed
			*Consider early intubation for head and neck envenomations. High risk for edema and airway compromise.

	==Crotalidae Polyvalent Immune Fab (FabAV) Antivenin ([[Crofab]])==		==Crotalidae Polyvalent Immune Fab (FabAV) Antivenin ([[Crofab]])==

Athorne: /* Clinical Features */

2021-08-02T01:05:19Z

Clinical Features

← Older revision		Revision as of 01:05, 2 August 2021
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	*[[Dizziness]]		*[[Dizziness]]
	*Muscle fasciculations		*Muscle fasciculations
	*Ecchymoses may appear within minutes to hours		*Coagulopathy
			**Ecchymoses may appear within minutes to hours

	==Differential Diagnosis==		==Differential Diagnosis==

Athorne: /* Evaluation */

2021-08-02T01:04:23Z

Evaluation

← Older revision		Revision as of 01:04, 2 August 2021
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	==Evaluation==		==Evaluation==
			*Local injury (pain, progressive swelling, [[compartment syndrome]], lymphangitic spread with pain in the axillae for upper extremity bites or pain in the inguinal region for lower extremity)
			**Track progressive edema of the bitten extremity Q2H until progression stops
			**Mark on the patient a point in the mid-foot, mid-calf, and mid-thigh (lower extremity bite) vs mid-hand, mid-forearm, and mid-humerus (upper extremity bites) to ensure consistency between measurements.
			*Hematologic abnormality ([[thrombocytopenia]], prolonged PT, hypofibrinogenemia) - [[DIC]]-like syndrome
			*Systemic effects ([[hypotension]] resulting from third spacing)

	===Work-Up===		===Work-Up===
	*CBC		*CBC
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	*Fibrinogen		*Fibrinogen
	*Chemistry		*Chemistry

	~~===Evaluation===~~
	*Local injury (pain, progressive swelling, [[compartment syndrome]], lymphangitic spread with pain in the axillae for upper extremity bites or pain in the inguinal region for lower extremity)
	**Track progressive edema of the bitten extremity Q2H until progression stops
	**Mark on the patient a point in the mid-foot, mid-calf, and mid-thigh (lower extremity bite) vs mid-hand, mid-forearm, and mid-humerus (upper extremity bites) to ensure consistency between measurements.
	*Hematologic abnormality ([[thrombocytopenia]], prolonged PT, hypofibrinogenemia) - [[DIC]]-like syndrome
	*Systemic effects ([[hypotension]] resulting from third spacing)

	==Management==		==Management==