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Management of Tissue Loss After Agkistrodon Snakebite: Appropriate Use of Crotalidae-Fab Antivenin.
J Trauma Nurs. 2016 May-Jun; 23(3):169-72.JT

Abstract

Although initially created for the treatment of rattlesnake (genus: Crotalus) bites, Crotalidae-Fab antivenin is used to treat many different pit viper envenomations. However, the efficacy of Crotalidae-Fab in preventing tissue loss from copperhead (Agkistrodon contortrix) or cottonmouth (Agkistrodon piscivorus) snakebites remains unclear. Recent reports show that Agkistrodon-related bites rarely require treatment beyond simple observation and pain control. The purpose of this study was to examine the amount of tissue loss in patients who received Crotalidae-Fab compared with those who did not after an Agkistrodon bite. After institutional review board approval, a retrospective study was completed at a Level 1 trauma center. Between 2009 and 2013, a total of 57 snakebites were identified. Of the 57 bites, the snake species was documented in 36 cases including 31 copperheads, 1 cottonmouth, and 4 rattlesnakes. The other 21 bites were from unknown or nonvenomous species. Of the 32 Agkistrodon-related bites, 15 patients received Crotalidae-Fab (average of 3 vials administered) and 17 did not receive Crotalidae-Fab. None of the 32 patients, regardless of treatment option, had tissue loss or required surgical interventions. Only 1 patient received Crotalidae-Fab and debridement of a vesicle associated with the bite. No clinically significant differences were observed between the groups. These findings support previous literature that failed to show added benefit of Crotalidae-Fab treatment for Agkistrodon bites beyond patient comfort and pain control. Evaluation of current protocols for Agkistrodon envenomations is warranted. Snakebite wound education in trauma physicians and nurses may decrease unnecessary use of antivenom medication.

Authors+Show Affiliations

Trauma and Burn Surgery, Mercy Clinic-Springfield, Springfield, Missouri (Dr Larson); Department of Trauma Services (Mr Schaefer) and Division of Trauma & Burn Research (Ms Austin and Dr Finley), Mercy Hospital-Springfield, Springfield, Missouri; and Jordan Valley Innovation Center, Center for Biomedical and Life Sciences, Springfield, Missouri (Mr Norton).No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27163225

Citation

Larson, Kenneth W., et al. "Management of Tissue Loss After Agkistrodon Snakebite: Appropriate Use of Crotalidae-Fab Antivenin." Journal of Trauma Nursing : the Official Journal of the Society of Trauma Nurses, vol. 23, no. 3, 2016, pp. 169-72.
Larson KW, Schaefer KR, Austin C, et al. Management of Tissue Loss After Agkistrodon Snakebite: Appropriate Use of Crotalidae-Fab Antivenin. J Trauma Nurs. 2016;23(3):169-72.
Larson, K. W., Schaefer, K. R., Austin, C., Norton, R., & Finley, P. J. (2016). Management of Tissue Loss After Agkistrodon Snakebite: Appropriate Use of Crotalidae-Fab Antivenin. Journal of Trauma Nursing : the Official Journal of the Society of Trauma Nurses, 23(3), 169-72. https://doi.org/10.1097/JTN.0000000000000207
Larson KW, et al. Management of Tissue Loss After Agkistrodon Snakebite: Appropriate Use of Crotalidae-Fab Antivenin. J Trauma Nurs. 2016 May-Jun;23(3):169-72. PubMed PMID: 27163225.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of Tissue Loss After Agkistrodon Snakebite: Appropriate Use of Crotalidae-Fab Antivenin. AU - Larson,Kenneth W, AU - Schaefer,Keith R, AU - Austin,Cindy, AU - Norton,Rhy, AU - Finley,Phillip J, PY - 2016/5/11/entrez PY - 2016/5/11/pubmed PY - 2017/9/14/medline SP - 169 EP - 72 JF - Journal of trauma nursing : the official journal of the Society of Trauma Nurses JO - J Trauma Nurs VL - 23 IS - 3 N2 - Although initially created for the treatment of rattlesnake (genus: Crotalus) bites, Crotalidae-Fab antivenin is used to treat many different pit viper envenomations. However, the efficacy of Crotalidae-Fab in preventing tissue loss from copperhead (Agkistrodon contortrix) or cottonmouth (Agkistrodon piscivorus) snakebites remains unclear. Recent reports show that Agkistrodon-related bites rarely require treatment beyond simple observation and pain control. The purpose of this study was to examine the amount of tissue loss in patients who received Crotalidae-Fab compared with those who did not after an Agkistrodon bite. After institutional review board approval, a retrospective study was completed at a Level 1 trauma center. Between 2009 and 2013, a total of 57 snakebites were identified. Of the 57 bites, the snake species was documented in 36 cases including 31 copperheads, 1 cottonmouth, and 4 rattlesnakes. The other 21 bites were from unknown or nonvenomous species. Of the 32 Agkistrodon-related bites, 15 patients received Crotalidae-Fab (average of 3 vials administered) and 17 did not receive Crotalidae-Fab. None of the 32 patients, regardless of treatment option, had tissue loss or required surgical interventions. Only 1 patient received Crotalidae-Fab and debridement of a vesicle associated with the bite. No clinically significant differences were observed between the groups. These findings support previous literature that failed to show added benefit of Crotalidae-Fab treatment for Agkistrodon bites beyond patient comfort and pain control. Evaluation of current protocols for Agkistrodon envenomations is warranted. Snakebite wound education in trauma physicians and nurses may decrease unnecessary use of antivenom medication. SN - 1078-7496 UR - https://www.unboundmedicine.com/medline/citation/27163225/Management_of_Tissue_Loss_After_Agkistrodon_Snakebite:_Appropriate_Use_of_Crotalidae_Fab_Antivenin_ L2 - http://dx.doi.org/10.1097/JTN.0000000000000207 DB - PRIME DP - Unbound Medicine ER -