Page 76 - JSOM Summer 2020

SOUTHCOM – SOUTH AMERICA/CENTRAL AMERICA 3. Additional dosing: Additional doses of 5 vials INS-AAP may
LIQUID/REFRIGERATED be given at hours 2, 4, 6, 12, and 24 if needed.
Instituto Nacional de Salud, Colombia: Antiveneno Anticoral 4. Pretreatment: NOT ROUTINELY INDICATED unless patient
Polivalente (INS-AAP) 248 is unstable, asthmatic/atopic, known hypersensitivity or other
First Line (SOUTHCOM–SOUTH AMERICA): Broadest efficacy pretreatment criteria met. Low risk of severe allergic reactions
against neurotoxic snake bites by coral snakes or unknown species and other EARs.
in South America. Coral snakes are the only strictly neurotoxic 5. Preparation and administration: Dilute the entire dose of an-
species in SOUTHCOM. tivenom in a single 250–500 mL bag of isotonic solution and
administer by intravenous infusion over 10 minutes.
Second Line (SOUTHCOM–CENTRAL AMERICA): Should a. If a mild or moderate reaction occurs, slow the infusion and
treat most coral snake species in Central America but will have
some coverage gaps compared to the first line for Central America treat symptomatically with antihistamines, steroids, and/or
antiemetics as needed.
(BIOCL-COR).
b. If a severe reaction such as anaphylaxis occurs, stop the
Feasibility of use in austere environments: NOT RECOM- infusion and treat according to the anaphylaxis protocol
MENDED for operational settings. Liquid product that requires listed elsewhere in the CPG. Reassess the patient once the
cold chain refrigeration between 4–8° C/39.2–46.4° F. Recommend reaction has been controlled and resume the infusion at
storing several vials at a small number of strategically located Role a slower rate if any of the specific criteria for antivenom
2 & 3 facilities in South America. Likely to retain efficacy for sev- treatment listed elsewhere in the CPG have not completely
eral weeks in the field but should be disposed of after that duration resolved.
of time outside refrigeration.
Acknowledgments
Adverse reactions: High-quality product with low rates of reac- Joint Trauma System Clinical Practice Guidelines are developed
tions anticipated. by subject matter experts and peer reviewed by members serving
1. Indications: This polyvalent can be used to treat neurotoxic on the Defense Committee on Trauma: The Committee on Tacti-
envenomations by most major species of South American coral cal Combat Casualty Care; the Committee on Surgical Combat
snakes from the genus Micrurus as well as some Central Amer- Casualty Care; and the Committee on EnRoute Combat Casualty
ican species. Care. Special thanks to those who devote their time, expertise,
a. NEUROTOXIC: South American coral snakes (Micru- and experience to aid the JTS in publishing evidence-driven CPGs,
rus spp.) including Micrurus dumerilii, M. mipartitus, M. providing the optimum chance for survival and maximum poten-
surinamensis, M. isozonus, M. lemniscatus, M. spixi, M. tial for functional recovery.
Medemi
2. Initial dosing by syndrome: Joint Trauma System Clinical Practice Guideline
a. NEUROTOXIC syndrome initial dose = 10 vials
b. NOT INDICATED for hemotoxic envenomations References can be found online at
c. NOT INDICATED for cytotoxic envenomations https://jsom.us/2U7MhtP

For a glimpse into the
work done by the Asclepius
Snakebite Foundation,
please see the photo
gallery on pages 160–161.

74 | JSOM Volume 20, Edition 2 / Summer 2020