Page 41 - 2026 SMOG

GLOBAL SNAKE ENVENOMATION
Initial Antivenom Treatment
Antivenom dosing, preparation, and administration recommendations vary by product.
Simplified universal diagnosis and treatment criteria for snakebite worldwide
Neurotoxic Hemotoxic Cytotoxic
Mild Local S/Sx (paresthesia; Coagulopathy ± Severe pain; edema
neuropathic pain; persistence of local below the elbow or
piloerection; muscle bleeding from bite knee; limited blistering
spasm, fasciculations) within several inches
of the bite wound
Moderate Systemic S/Sx (bilateral Moderate systemic Edema above the
ptosis GI symptoms; bleeding (old scabs, elbow or knee but not
visual, auditory, or other gingival bleeding, beyond the shoulder
sensory disturbances; epistaxis, etc.); bruising or hip; moderate local
widespread hyperesthesia) distant from the bite blistering along the
wound bitten limb segment
Severe Difficulty speaking; altered Active GI bleed (usually Progressive edema
mental status; respiratory hematemesis) or other beyond shoulder or
muscle weakness causing internal bleeding; severe hip; severe necrosis or
difficulty breathing; shock anemia; altered mental widespread blistering;
or otherwise unstable status; shock or otherwise symptomatic bite to
patient unstable patient head, neck, or torso;
altered mental status;
shock or otherwise
unstable patient
Criteria for Additional doses if: Additional doses if: Additional doses if:
additional persistence or worsening persistence, resumption, significant increase in
AV doses at of systemic neurotoxic or new onset of any edema (such as beyond
hours 2, 4, S/Sx. Continue to re- active external or internal the major joint) OR
6, 12, 24 administer 2vial boluses as bleeding OR S/Sx of significant increase in
(as needed) needed at hours 2, 4, 6, 12, active venom confirmed pain (severity of pain
and 24 until indications by secondary recurrence of and/or how far pain
of improvement begin to abnormal WBCT radiates up the bitten
appear ( ➝ SBC, ➝ LOC, limb)
➝ strength, etc.)

2026 Standard Medical Operating Guidelines (SMOG) • 33