Page 65 - JSOM Summer 2020

APPENDIX B:
COVERAGE, INITIAL DOSING, PREPARATION, AND
ADMINISTRATION OF ALL ANTIVENOMS INCLUDED IN THIS CPG

There are a number of different antivenoms included in this CPG WHO Category 1: Venomous snakes of highest medical
for snakebite treatment in AFRICOM, CENTCOM, INDOPA- importance.
COM, EUCOM, NORTHCOM, and SOUTHCOM. The cover- Defined as “highly venomous snakes which are common or wide-
age, initial dosing, preparation, and administration vary between spread and cause numerous snakebites, resulting in high levels of
products and details for each of them have been included in this morbidity, disability or mortality.”
appendix. Simplified algorithms for selecting and dosing each WHO Category 2: Venomous snakes of secondary medical
antivenom are included within the Regionally Specific Snakebite importance.
Treatment Guidelines for Each Combatant Command on pages Defined as “highly venomous snakes capable of causing morbid-
49–60.
ity, disability or death, for which exact epidemiological or clinical
World Health Organization: data may be lacking; and/or which are less frequently implicated
Categorization of Medically Significant Snake Species 160 (due to their activity cycles, behavior, habitat preferences or occur-
The World Health Organization (WHO) classifies the risk posed rence in areas remote to large human populations).”
by various venomous snakes by designating each species as either
Category 1 or Category 2 as described below. WHO guidelines NOTE ANTIVENOM INFUSION VS. DIRECT PUSH: For most
first line antivenoms in this CPG, administration using a 100–
state that the “species listed in Category 1 within a country, ter-
ritory or area should be considered as being of highest priority 250 mL IV bag and 10-minute IV/IO infusion is recommended in
order to get a full dose of antivenom onboard as quickly as pos-
for antivenom production on the basis that available knowledge
implicates them as being responsible for the greater burden in that sible and neutralize venom before further damage has occurred.
However, if this is not possible it is acceptable to dilute antivenom
particular setting.”
in 250 mL or 500 mL bags of isotonic solution and give over
10–30 minutes.

Reference Table: Product name abbreviations for all first line antivenoms recommended in this CPG

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