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Meghan B Spyres, Aaron B Skolnik, Elizabeth C Moore, Richard D Gerkin, Angela Padilla-Jones, Anne-Michelle Ruha
OBJECTIVES: This study compares maintenance with clinical- and laboratory-triggered (as-needed [PRN]) antivenom dosing strategies with regard to patient-centered outcomes after rattlesnake envenomation. DESIGN: This is a retrospective cohort study of adult rattlesnake envenomations treated at a regional toxicology center. Data on demographics, envenomation details, antivenom administration, length of stay, and laboratory and clinical outcomes were compared between the PRN and maintenance groups...
June 2018: Critical Care Medicine
Charles J Gerardo, Eugenia Quackenbush, Brandon Lewis, S Rutherfoord Rose, Spencer Greene, Eric A Toschlog, Nathan P Charlton, Michael E Mullins, Richard Schwartz, David Denning, Kapil Sharma, Kurt Kleinschmidt, Sean P Bush, Samantha Ryan, Maria Gasior, Victoria E Anderson, Eric J Lavonas
STUDY OBJECTIVE: Copperhead snake (Agkistrodon contortrix) envenomation causes limb injury resulting in pain and disability. It is not known whether antivenom administration improves limb function. We determine whether administration of antivenom improves recovery from limb injury in patients envenomated by copperhead snakes. METHODS: From August 2013 through November 2015, we performed a multicenter, randomized, double-blind, placebo-controlled, clinical trial to evaluate the effect of ovine Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) antivenom therapy on recovery of limb function in patients with copperhead snake envenomation at 14 days postenvenomation...
August 2017: Annals of Emergency Medicine
Justin Rizer, Kaitlin Brill, Nathan Charlton, Joshua King
Crotalidae polyvalent immune Fab antivenom (CroFab), commonly used for the treatment of clinically significant North American crotalinae envenomation, is generally well-tolerated. A novel form of anaphylaxis due to an IgE antibody response to the mammalian oligosaccharide galactose-α-1,3-galactose (α-gal) has been established following red-meat consumption as well as IV administration of cetuximab, which contain the α-gal epitope. We present a case of α-gal allergy discovered after acute hypersensitivity reaction to FabAV...
August 2017: Clinical Toxicology
Katherine M McBride, William Bromberg, James Dunne
Venomous snakebites are fairly common in the United States and can present with a wide range of symptoms. A 48-year-old man presented after Eastern Diamondback rattlesnake envenomation. His hospital course was complicated by right leg compartment syndrome and delayed recurrent coagulopathy, requiring multiple doses of Crotalidae Polyvalent Immune Fab (CroFab) antivenom and transfusions. Thromboelastography was used as an adjunct to standard coagulation studies in monitoring his delayed recurrent coagulopathy...
April 1, 2017: American Surgeon
Abby M Bailey, Stephanie Justice, George A Davis, Kyle Weant
North American rattlesnake envenomations are known to produce coagulopathies and thrombocytopenia. However, the occurrence of delayed hematologic toxicity (less than seven days after envenomation) is poorly characterized in the medical literature. While the recurrence of hematologic derangements has been documented following envenomation, it is usually in the absence of clinically significant bleeding. Although commonly recommended to treat delayed coagulopathies, the effectiveness of crotalidae polyvalent immune Fab ovine (CroFab®) in managing this condition remains in question and warrants further investigation and exploration...
July 2017: American Journal of Emergency Medicine
Kristie L Williams, Megan Woslager, Stephanie L Garland, Roger P Barton, William Banner
BACKGROUND: Western Pygmy Rattlesnake (WPR) envenomation reportedly causes refractory and persistent coagulopathy when treated with CroFab(®) (Crotalidae Polyvalent Immune Fab). We report two cases where polyvalent equine anti-viper serum (AntivipmynTRI(®)) was used to treat recurrent coagulopathy in children. CASE DETAILS: The first patient was a 16-month-old male who was bitten by a confirmed WPR. The patient received a total of 18 vials of CroFab(®). His labs normalized, swelling gradually improved, and the child was discharged to home...
June 2017: Clinical Toxicology
Davinia Pla, Libia Sanz, Gareth Whiteley, Simon C Wagstaff, Robert A Harrison, Nicholas R Casewell, Juan J Calvete
BACKGROUND: Non-front-fanged colubroid snakes comprise about two-thirds of extant ophidian species. The medical significance of the majority of these snakes is unknown, but at least five species have caused life-threatening or fatal human envenomings. However, the venoms of only a small number of species have been explored. METHODS: A combined venomic and venom gland transcriptomic approach was employed to characterise of venom of Dispholidus typus (boomslang), the snake that caused the tragic death of Professor Karl Patterson Schmidt...
April 2017: Biochimica et Biophysica Acta
Michael T Steuerwald, Season R K Gabbard, Gillian A Beauchamp, Matthew K Riddle, Edward J Otten
The case presented here highlights an unconventional use of a helicopter emergency medical service (HEMS) to provide a specialized medication to a critically ill patient when definitive transport was delayed. A 39-year-old man presented to a rural hospital 1 hour after sustaining a copperhead envenomation. He developed severe symptoms and was intubated. Arrangements were made for transfer to a tertiary referral center by HEMS, but because of incoming weather conditions, the team would not be able to make the return flight safely...
November 2016: Air Medical Journal
Anthony J Saviola, Davinia Pla, Libia Sanz, Todd A Castoe, Juan J Calvete, Stephen P Mackessy
UNLABELLED: Here we describe and compare the venomic and antivenomic characteristics of both neonate and adult Prairie Rattlesnake (Crotalus viridis viridis) venoms. Although both neonate and adult venoms contain unique components, similarities among protein family content were seen. Both neonate and adult venoms consisted of myotoxin, bradykinin-potentiating peptide (BPP), phospholipase A2 (PLA2), Zn(2+)-dependent metalloproteinase (SVMP), serine proteinase, L-amino acid oxidase (LAAO), cysteine-rich secretory protein (CRISP) and disintegrin families...
May 21, 2015: Journal of Proteomics
Charles J Gerardo, Eric J Lavonas, Ross E McKinney
BACKGROUND: In 2000, the US Food and Drug Administration approved CroFab(®) Crotalidae Polyvalent Immune Fab, ovine (FabAV), which had received orphan drug designation, for use in patients with minimal to moderate North American crotaline envenomations including copperhead snakes. As existing evidence on the effectiveness of FabAV for this indication is limited, wide practice variation in its use exists. In order to provide more definitive clinical evidence as to the role of this treatment, a new randomized, placebo-controlled trial of FabAV specifically for copperhead bites was initiated...
October 2014: Clinical Trials: Journal of the Society for Clinical Trials
Frank G Walter, Uwe Stolz, Robert N E French, Peter B Chase, Jude McNally, Farshad Shirazi
OBJECTIVE: The goal of this study was to analyze trends in the annual rates of reported medical outcomes of cottonmouth (Agkistrodon piscivorus) snakebites in the United States, published in the annual reports of the American Association of Poison Control Centers in the course of 29 years. METHODS: This was a retrospective analysis of medical outcomes for cottonmouth snakebite victims who developed fatal, major, moderate, minor, or no effects. The annual rates for these medical outcomes were calculated by dividing the annual number of patients in each outcome category by the total annual number of people reported as being bitten by cottonmouths...
March 2014: Southern Medical Journal
Jesus A Correa, Sara C Fallon, Andrea T Cruz, Glenda H Grawe, Phong V Vu, Daniel M Rubalcava, Brent Kaziny, Bindi J Naik-Mathuria, Mary L Brandt
BACKGROUND: The optimal management of children with snake bite injuries is not well defined. The purpose of this study was to review the use of antivenom, diagnostic tests, and antibiotics in children bitten by venomous snakes in a specific geographic region (Southeast Texas). METHODS: This is a retrospective single-center review of all patients with snake bite injury from 1/2006 to 6/2012. An envenomated bite was defined as causing edema, discoloration of the skin, necrosis, or systemic effects...
June 2014: Journal of Pediatric Surgery
Susanne J Spano, Rais Vohra, Fernando Macias
OBJECTIVE: The purpose of this institutional review board-approved, cross-sectional study was to identify residual symptoms and signs of envenomation reported by snakebite survivors via a telephone survey. METHODS: Victims of rattlesnake bite who were treated at a single hospital center during a 10-year period were contacted through a telephone survey. Study subjects were included through a diagnosis-based retrospective chart review of snakebite victims, and excluded if they did not receive rattlesnake antivenom...
June 2014: Wilderness & Environmental Medicine
Kartik Sunagar, Eivind A B Undheim, Holger Scheib, Eric C K Gren, Chip Cochran, Carl E Person, Ivan Koludarov, Wayne Kelln, William K Hayes, Glenn F King, Agosthino Antunes, Bryan Grieg Fry
UNLABELLED: Due to the extreme variation of venom, which consequently results in drastically variable degrees of neutralization by CroFab antivenom, the management and treatment of envenoming by Crotalus oreganus helleri (the Southern Pacific Rattlesnake), one of the most medically significant snake species in all of North America, has been a clinician's nightmare. This snake has also been the subject of sensational news stories regarding supposed rapid (within the last few decades) evolution of its venom...
March 17, 2014: Journal of Proteomics
David Gerring, Thomas R King, Richard Branton
BACKGROUND: Reconstitution of CroFab(®) (Crotalidae Polyvalent Immune Fab [ovine]) lyophilized drug product was previously performed using 10 mL sterile water for injection followed by up to 36 min of gentle swirling of the vial. CroFab has been clinically demonstrated to be most effective when administered within 6 h of snake envenomation, and improved clinical outcomes are correlated with quicker timing of administration. An alternate reconstitution method was devised, using 18 mL 0...
July 2013: Toxicon: Official Journal of the International Society on Toxinology
Timothy J Wiegand, Paul M Wax, Tayler Schwartz, Yaron Finkelstein, Rachel Gorodetsky, Jeffrey Brent
In 2010, the American College of Medical Toxicology established its Case Registry, the Toxicology Investigators Consortium (ToxIC). ToxIC is a prospective registry, which exclusively compiles suspected and confirmed toxic exposure cases cared for at the bedside by medical toxicologists at its participating sites. The Registry aims to fulfill two important gaps in the field: a real-time toxicosurveillance system to identify current poisoning trends and a powerful research tool in toxicology. ToxIC allows extraction of information from medical records making it the most robust multicenter database on chemical toxicities in existence...
December 2012: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Andrew M King, William S Crim, Nathan B Menke, Anthony F Pizon
UNLABELLED: Documented envenomations by the pygmy rattlesnake (Sistrurus miliarius barbouri) are rare. While there have been no documented fatalities, several older case reports describe significant morbidity. We describe the first known case of pygmy rattlesnake envenomation that was treated with Crotalidae Polyvalent Immune Fab Antivenom (CroFab®). CASE: A 28-year-old man with no significant past medical history presented after being envenomated on the right hand by his friend's pet pygmy rattlesnake...
December 1, 2012: Toxicon: Official Journal of the International Society on Toxinology
Gillian M Keating, Katherine A Lyseng-Williamson
Intravenous crotalidae polyvalent immune Fab (CroFab(®)) is effective in patients with minimal, moderate or severe crotaline envenomation, halting the progression of local venom effects and ameliorating haematological and other systemic abnormalities of envenomation. Despite treatment, patients may experience delayed-onset or recurrent venom effects (e.g. coagulopathy). Intravenous crotalidae polyvalent immune Fab is generally well tolerated, with acute hypersensitivity reactions being the most commonly occurring adverse event...
August 1, 2012: Clinical Drug Investigation
Henry C Farrar, Taylor Grayham, Branson Bolden, Dileep Vyas, James Graham, Laura P James
There are limited data on the use of Crotalidae Polyvalent Immune FAB-Ovine (CroFab) in the management of crotalid envenomations in children. Thus, the primary objective of this retrospective chart review was to evaluate the safety and tolerability of CroFab in a pediatric population. Over an 8-year time period at this institution, there were 204 admissions for snakebite of which 82 received CroFab. Children who received CroFab were more often associated with bites to the hands and fingers and tended to have more significant envenomations as indicated by longer hospital stays, greater tissue injury, and a tendency to require surgery more often...
October 2012: Clinical Pediatrics
Robert A Armentano, Michael Schaer
OBJECTIVE: To provide a review and update on the medical management of pit viper envenomation in dogs. ETIOLOGY: Pit viper snake (Crotalidae) envenomation in dogs is a common emergency in the United States. At least 50 enzymes contribute to snake venom potency that causes soft tissue damage, vasculotoxicity, coagulopathy, cytotoxicity, and necrosis. DIAGNOSIS: Snakebite envenomation may be identified by fang puncture wounds but primarily as a focal site with a rapid onset of severe swelling, hemorrhage, pain, and potentially necrosis...
October 2011: Journal of Veterinary Emergency and Critical Care
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