Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop

BMC Emergency Medicine

Research Article

Sean P Bush¹  William H Richardson²  Vikhyat Bebarta³  Steve C Curry⁴  Anne-Michelle Ruha⁴  William P Kerns⁵  Jeffrey N Bernstein⁶  David A Tanen⁷  Steven A Seifert⁸  William Banner⁹  Eric J Lavonas^1,10  Richard C Dart^1,10 

[1] Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA;Department of Emergency Medicine, Palmetto Health Richland, Columbia, South Carolina, USA;Palmetto Poison Center, University of South Carolina, Columbia, South Carolina, USA;Department of Emergency Medicine, Wilford Hall Medical Center, San Antonio, Texas, USA;Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, Arizona, USA;Division of Medical Toxicology, Department of Emergency Medicine and Carolinas Poison Center, Carolinas Medical Center, Charlotte, North Carolina, USA;Florida Poison Information Center, Miami, Florida, USA;Emergency Care Center, Jackson Memorial Hospital, Miami, Florida, USA;Naval Medical Center, San Diego, California, USA;Division of Medical Toxicology, Department of Emergency Medicine, University of California at San Diego, San Diego, California, USA;New Mexico Poison and Drug Information Center, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA;Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA;Oklahoma Poison Center, College of Pharmacy, University of Oklahoma, Oklahoma City, Oklahoma, USA;Pediatric Intensive Care Unit, Integris Baptist Medical Center, Oklahoma City, Oklahoma, USA;Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, USA;Division of Medical Toxicology, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA;

关键词: Panel Member;    Initial Control;    Poison Center;    Recurrence Phenomenon;    Snake Envenomation;   

DOI  :  10.1186/1471-227X-11-2

 received in 2010-08-11, accepted in 2011-02-03,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundEnvenomation by crotaline snakes (rattlesnake, cottonmouth, copperhead) is a complex, potentially lethal condition affecting thousands of people in the United States each year. Treatment of crotaline envenomation is not standardized, and significant variation in practice exists.MethodsA geographically diverse panel of experts was convened for the purpose of deriving an evidence-informed unified treatment algorithm. Research staff analyzed the extant medical literature and performed targeted analyses of existing databases to inform specific clinical decisions. A trained external facilitator used modified Delphi and structured consensus methodology to achieve consensus on the final treatment algorithm.ResultsA unified treatment algorithm was produced and endorsed by all nine expert panel members. This algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy.ConclusionsClinical manifestations and ideal treatment of crotaline snakebite differ greatly, and can result in severe complications. Using a modified Delphi method, we provide evidence-informed treatment guidelines in an attempt to reduce variation in care and possibly improve clinical outcomes.

【 授权许可】

CC BY   
© Lavonas et al; licensee BioMed Central Ltd. 2011