Location of care above). intracranial, gastrointestinal bleeding). However, since WHO has no suggested specific protocol for our region, a modified WHO protocol focused on specific snakes of Iran (developed by Iranian Ministry of Health) is used in our country [5]. Serial blood tests and clinical examinations take a minimum of 12 hours after the time of the bite; these can occur in Emergency Departments or with inpatient units depending on local experience and level of comfort. The role of FFP or cryoprecipitate is controversial and should be discussed with a clinical toxicologist; generally it is indicated if the child is bleeding. The Emergency Care Clinical Network and the Victorian Poison Information Centre will make the new clinical pathways accessible to relevant clinicians and health services throughout the state. %%EOF j. Antivenom Therapy Haddad generally advises 10, 10–20, and more than 20 vials for mild, moderate, and severe envenomations, which is far beyond the vials recommended by GF (4–6 in each step before reconsideration) while having 3 to maximum 20 vials by WHO [5–7]. Supportive Treatment Fresh frozen plasma Cryoprecipitate (fibrinogen, Factor VIII), Fresh whole blood, Platelet concentrate. The Monash Health clinical toxicologist on-call should be consulted in all cases of suspected snakebite. In a previous study from our center, two deaths were reported following venomous animals envenomation [8]. Deaths are very rare. management flowchart below. h�b``�g``�������01G��ű���!,�����$^��a��e�c���d�����}�z3��;/�C���5�d�p`x�$�"�� Р���������v>� E�٘g��o�q�k(jd r߰{�%�?�d�kx��h�����Cm���8�.���>6ǁa�*gղҭ�%K�?U��*i�6�;���Y.�6́���S�W y��%#`f��:�.k�똀��k�?T�7@� ��I` In a try to unify the protocol of snake bite treatment in our center, we reviewed the files of the snake-bitten patients and compared the outcome and frequency of complications between them to determine which protocol was probably the best for the management of these patients. Immobilise the joints either side of the bite site (use a splint), Chase, M. C. Fernandez, and J. McNally, “Venomous snakes,” in, H. Hassanian-Moghaddam, N. Zamani, M. Rahimi, S. Shadnia, A. Pajoumand, and S. Sarjami, “Acute adult and adolescent poisoning in Tehran, Iran; the epidemiologic trend between 2006 and 2011,”, C.-Y. Evidence of venom movement (e.g. 182 0 obj <>stream 2 0 obj Occurs in about 30% of children given antivenom. m. Special Topics, ii. For 24 hour advice, contact Victorian Poisons Information Centre 131126. 1. The diagnosis of envenomation is based on the aforementioned history, examination and laboratory test findings. endobj However, based on the number of the vials advised by each protocol, Haddad suggests the most invasive treatment. ���:���4��:d�=$k�X䋱��Ӛ�������U]�`7]�u]�G��/.W����I�=��~G1� 1;���k��T��_r��2zR���]�����6�r5Ü;�r�K���f��ԝ���‹�Xګ}&���%����hh��_�u"��lߋڙG�g��et�\0j�t�`����e��'����z1���QD������B�(�R����)�W��;,�Tǩ[^�����Tř/�ʇ� �3�Xܟ6r�s �"��z.�v�3��^��a�f��+\�r���Ht� ~ܛ�Q�'3X�J����K>�����9�|��+[$ߒ��. The study was approved by the Local Ethics Committee of Shahid Beheshti University of Medical Sciences. In conclusion, although Haddad’s protocol seems to be the best for treatment of snake-bitten patients in our region, this cannot be strictly concluded because of the limited sample size. Their main postdischarge complications were evaluated using a self-made questionnaire evaluating the development of serum sickness, cellulitis, and permanent complications such as deformity of the bitten limb. Management issues relating to envenoming by specific snakes, a) Cobra For further information see management of snake bite in emergency departments. • Pain, swelling, or ecchymosis within 5-7.5 cm of bite site • Pain, swelling, or ecchymosis involving less than half the extremity (7.5-50 cm from bite site) • Pain, swelling, or ecchymosis involving half to all of extremity (50-100 cm from bite site) This means call 911 or emergency services as soon as you can, because even if the bite isn’t that painful initially, you still need to treat it as if it’s potentially life-threatening. We are committed to sharing findings related to COVID-19 as quickly as possible. Snake bite is uncommon in Victoria and envenomation (systemic poisoning from the bite) is rare. endobj Our cloud-based tool has features to steer each phase of your project to a successful end. A total of 147 viper-bitten patients had been referred to us during the study period. �[G���C��Ŷ�h�æ�����f��kf��� ��VJqH��)���>��=�H!�1,��1` D7�L����w�����dO!~>��C�j !�=��a5 In Iran, of three types of antivenom, only polyvalent one is produced by the Razi Vaccine and Serum Research Institute. Gain 2 points of intravenous access, with at least one large bore cannula. cardiac arrest, shock, bleeding) and there is no antivenom available, the retrieval team should bring the antivenom to the regional centre to be administered there prior to transfer. Giving antivenom should occur in consultation with a clinical toxicologist. Copyright © 2016 Afshin Mohammad Alizadeh et al. Tends to occur 4 – 14 days following antivenom administration. Once the possibility of snakebite has been raised, it is important to determine whether a child has been envenomed to establish the need for antivenom. Complications including serum sickness, deformity, compartment syndrome needing fasciotomy, amputation, necrosis, and neuropathy were detected in 10 (19.2%), 7 (13.5%), 4 (7.7%), 2 (3.8%), 2 (3.85), and 1 (1.9%) patients, respectively. H��WYo��~�_�OA3���I.�ь� 6b� ~�C��ul��l��SG_$G�c�=dwUu�W_U�����[%�^��?-������xy��:�����vu�Z�+OӋ�G�сN;�^�N����b���N�mN���O����~�����ٷN�O����y�탼I��j>���*��pf*�V�6� A VDK may be indicated if the snakebite is from a non-Victorian snake. A new clinical guideline for the management of snake bites in emergency departments was launched today at Austin Health. You can use it as a flowchart maker, network diagram software, to create UML online, as an ER diagram tool, to design database schema, to build BPMN online, as a circuit diagram maker, and more. In the remaining 52 patients, 46 (88%) were males. The most important complications were considered to be deformity, compartment syndrome, and amputation and were more frequent after the use of WHO and GF protocols (23.1% versus 76.9%; none in Haddad; = NS). Victorian Poisons Information Centre medical director Dr Shaun Greene said this was the first time in Victoria that a consensus evidence-based clinical pathway had been developed, based on input from local and national experts. %PDF-1.7 According to our results, although the sample size is limited, Haddad protocol seems to be the best method of snake bite treatment. The best thing you can do, and the best thing you can tell your children this summer, is to leave snakes alone. 108 0 obj <>/Filter/FlateDecode/ID[<63F633A1A9C56C4A93641861BA66B3CD>]/Index[11 172]/Info 10 0 R/Length 303/Prev 700836/Root 12 0 R/Size 183/Type/XRef/W[1 3 1]>>stream i. Venomous Snakes in a Nutshell The criteria for assessing compliance to the treatment protocol were based on severity of envenomation defined in each protocol, number of used vials, and repetition of it during hospitalization course. A letter should also be written to the child’s GP regarding this.