Page 60 - JSOM Summer 2020

Antivenom Algorithm:
NORTHCOM AOR NOTE:
Yellow background indicates that
a product meets both criteria below:
1) broad-spectrum regional coverage
Follow list of steps outlined in CPG: 2) freeze-dried / field-stable
Universal Approach to Snakebite
Assessment, Diagnosis, and Treatment

Patient
with S/Sx of
envenomation? NO
Monitor for 24 hours and
discharge according
YES to Step #17

UNITED STATES
/ CANADA

Syndrome?

HEMOTOXIC CYTOTOXIC
NEUROTOXIC

Coral snake bite?
(known or suspected) NO

YES Copperhead or
cottonmouth bite?
(known or suspected)

UNKNOWN
YES
NO
YES

CYTOTOXIC
signs/symptoms present? Rattlesnake bite?
(blistering, bruising, significant (known or suspected)
swelling, etc)

YES
NO
CROFAB / ANAVIP ARE BOTH
FIRST LINE FOR RATTLESNAKES

Rattlesnakes only: ANAVIP Rattlesnakes / Copperheads
1st line coral snakes: NACSA
REGIONAL COVERAGE FOR / Cottonmouths: CROFAB
REGIONAL COVERAGE FOR
CORAL SNAKE SPECIES IN USA RATTLESNAKE BITES IN USA / REGIONAL COVERAGE FOR ALL PIT
CANADA VIPER BITES IN USA / CANADA
Initial dose = 3 - 5 vials,
consult expert for additional doses Initial dose = 10 vials, Initial dose = 4 - 6 vials,
consult expert for additional doses consult expert for additional doses
NOTE:
NOTE:
Distribution of Coral Snake species in United States: See Unified treatment algorithm for the management of crotaline
AL, AR, AZ, FL, GA, LA, MS, NM, NC, OK, SC, TX snakebite in the United States (Lavonas et al. 2011) for specific
dosing and management guidelines on pit viper bites.

58 | JSOM Volume 20, Edition 2 / Summer 2020