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SUDDEN COLLAPSE SYNDROME TREATMENT PROTOCOL
Patient presents within 30min of the bite with rapid onset shock ± angioedema, altered mental
status, systemic bleeding, and diarrhea.
1. Stabilize with IM/IV epinephrine and fluids as per anaphylaxis protocols:
a. First line treatment of anaphylaxis is rapid administration of Epinephrine (1:1000) 0.5mg IM
2. Intubate for airway edema not rapidly responsive to Epinephrine.
3. Follow Epinephrine immediately with a high dose of the appropriate regional antivenom given
by rapid IV/IO push during the resuscitation.
4. Maintain blood pressure with IV/IO fluids and Epinephrine until antivenom has taken effect to
reverse the hypotension.
**Notes/Pearls**
• Don’t try to ID the snake. Snake identification is unreliable; do not attempt it purposely.
DO NOT attempt to catch or kill the snake.
• Determine snakebite treatment by the clinical presentation and evolution of signs and
symptoms in the patient rather than the identity of the snake.
• DO NOT apply constricting bandages or tourniquets, as these may worsen local tissue injury
and increase the risk of permanent disability.
• Establish a timeline and trend changes over time. Serial assessments and documentation are
essential. Snakebites are clinically dynamic emergencies and can change dramatically until
control has been achieved.
• Treat anaphylactic reactions or hypovolemic shock as soon as they are recognized.
Reference: CPG ID #81 (Global Snake Envenomation)

34 • MEDICAL