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BMC Emergency Medicine

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

  • Eric J Lavonas1, 2Email author,
  • Anne-Michelle Ruha3,
  • William Banner4, 5,
  • Vikhyat Bebarta6,
  • Jeffrey N Bernstein7, 8,
  • Sean P Bush9,
  • William P KernsII10,
  • William H Richardson11, 12,
  • Steven A Seifert13, 14,
  • David A Tanen15, 16,
  • Steve C Curry3 and
  • Richard C Dart1, 2
Contributed equally
BMC Emergency Medicine201111:2

Received: 11 August 2010

Accepted: 3 February 2011

Published: 3 February 2011

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Archived Comments

  1. further issues with wound care

    13 September 2011

    John Benitez, Vanderbilt University Medical Center

    The authors are to be commended for putting together a good diverse group of experts on managing snakebites (Crotalid) in the US. It puts together an organized approach to evaluating the victim of a snake bite.

    I would encourage, and I hope there was no disagreement in the panelists, that antibiotics not be routinely used, unless there are clear indications for doing so. Also missing from the article was any statement of need for appropriate range of motion (ROM) exercises that a patient should be encouraged to do or taught to do to avoid further complications post discharge such as contractures and loss of function of digits. We routinely encourage AROM (and where necessary PROM) exercises for the patient during hospitalization and post-hospitalization. If followed up in clinic afterwards we also monitor their symptoms, labs if appropriate, and functional capacity in the extremity involved, and use it as an opportunity to review AROM. In certain cases we find that we need to instruct some physcal therapists as to the potential long term problem following a snakebite, and what to look for and what to encourage the patient to do, if they get consulted on such cases.

    Competing interests


Authors’ Affiliations

Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority
Division of Medical Toxicology, Department of Emergency Medicine, University of Colorado School of Medicine
Department of Medical Toxicology, Banner Good Samaritan Medical Center
Oklahoma Poison Center, College of Pharmacy, University of Oklahoma
Pediatric Intensive Care Unit, Integris Baptist Medical Center
Department of Emergency Medicine, Wilford Hall Medical Center
Florida Poison Information Center
Emergency Care Center, Jackson Memorial Hospital
Department of Emergency Medicine, Loma Linda University School of Medicine
Division of Medical Toxicology, Department of Emergency Medicine and Carolinas Poison Center, Carolinas Medical Center
Department of Emergency Medicine, Palmetto Health Richland
Palmetto Poison Center, University of South Carolina
New Mexico Poison and Drug Information Center, College of Pharmacy, University of New Mexico
Department of Emergency Medicine, University of New Mexico School of Medicine
Naval Medical Center
Division of Medical Toxicology, Department of Emergency Medicine, University of California at San Diego