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Environmental

SNAKEBITE SUDDEN

COLLAPSE SYNDROME
Signs and Symptoms: Differential Diagnosis:
• Rapid onset of Shock (<30 min) from bite • Neurotoxic Syndrome
with any of the following: • Allergic reactions
• Angioedema
• Altered Mental Status
• Systemic Bleeding
• Diarrhea
Continued from:
Tactical Evacuation Guideline Patient presents with signs and symptoms of
or
Snakebite Envenomation sudden collapse syndrome post snakebite
Management
n
Stabilize with Epinephrine:
IM: 0.3–0.5mg (0.3–0.5mL 1:1000) or EpiPen®
IV Bolus: 100mcg over 5–10min; mix 0.1mg (0.1mL of 1:1000 in
10mL NS, and infuse over 5–10min)
Initiate infusion if hypotension not responsive to IM/IV:
IV Infusion: Start at 1mcg/min; mix 1mg (1mL of 1:1000 in 500mL
NS, and infuse at 0.5mL/min; titrate as needed
Administer high dose (6
vials) of appropriate regional
antivenom by rapid IV/IO Airway edema responsive to NO
push: Epinephrine Airway Guideline
(Refer to JOINT TRAUMA YES
SYSTEM CLINICAL
PRACTICE GUIDELINE (JTS YES Regional Antivenom Available? Establish Advanced Airway per
CPG) Global Snake procedure in the following
Envenomation Management sequence:
(CPG ID: 81) for 1st and 2nd NO (Move to next procedure per individual
line ANTIVENOM based on competencies, contraindications, ENVIRONMENTAL
Region and Syndrome. Follow and/or attempt failures)
JTS CPG for ANTIVENOM Maintain SBP >90<100 with IV/IO Fluid • ENDOTRACHEAL INTUBATION
administrations.) Resuscitation and Epinephrine and transport to • BIAD
location with appropriate regional antivenom
• CRICOTHYROIDOTOMY
See Snakebite Envenomation When appropriate, return to:
Clinical Syndromes Guideline Snakebite Envenomation Management:
General Principles
and/or
Tactical Evacuation Guideline
Pearls:
• Anaphylactic reactions (or hypovolemic shock) should be treated aggressively while simultaneously treating for severe
envenomation with appropriate regional antivenom.
• Priority of care for a patient in snakebite sudden collapse syndrome is the consideration of the shorter of two options:
evacuating the patient to a location with antivenom or bringing the antivenom to the patient.
• Most patients presenting with hypotension or angioedema are responsive to epinephrine, but may require IV epinephrine
infusions to achieve this effect if they are unresponsive to IM epinephrine
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