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

BMC Emergency Medicine

Volumn 11, Issue , 2011, Pages

  Lavonas, Eric J ^a,b,f   Ruha, Anne Michelle ^c   Banner, William ^d,e   Bebarta, Vikhyat ^g   Bernstein, Jeffrey N ^g,h   Bush, Sean P ⁱ   Kerns II, William P ^j   Richardson, William H ^k,l   Seifert, Steven A ^m,n   Tanen, David A ^o,p   Curry, Steve C ^c   Dart, Richard C ^a,b  

^a ROCKY MOUNTAIN POISON AND DRUG CENTER   (United States)

^b UNIVERSITY OF COLORADO SCHOOL OF MEDICINE   (United States)

^c BANNER GOOD SAMARITAN MEDICAL CENTER   (United States)

^d UNIVERSITY OF OKLAHOMA   (United States)

^e INTEGRIS BAPTIST MEDICAL CENTER   (United States)

^f WILFORD HALL MEDICAL CENTER   (United States)

^g Florida Poison Information Center   (United States)

^h JACKSON MEMORIAL HOSPITAL   (United States)

ⁱ LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE   (United States)

^j CAROLINAS MEDICAL CENTER   (United States)

^k Palmetto Health Richland ^*  (United States)

^l UNIVERSITY OF SOUTH CAROLINA   (United States)

^m UNIVERSITY OF NEW MEXICO   (United States)

ⁿ UNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE   (United States)

^o NAVAL MEDICAL CENTER SAN DIEGO   (United States)

^p UNIVERSITY OF CALIFORNIA   (United States)

more..

Author keywords

[No Author keywords available]

Indexed keywords

ADRENALIN; ANTIHISTAMINIC AGENT; OPIATE; SNAKE VENOM ANTISERUM; STEROID; SNAKE VENOM; VENOM ANTISERUM;

ALGORITHM; ANGIONEUROTIC EDEMA; ARTICLE; BLOOD CLOTTING DISORDER; CARDIOTOXICITY; CLINICAL DECISION MAKING; COMPARTMENT SYNDROME; CONSENSUS; CRYOTHERAPY; DATA BASE; DELPHI STUDY; EMBASE; ENVENOMATION; EVIDENCE BASED PRACTICE; FASCICULATION; FASCIOTOMY; GEOGRAPHY; HUMAN; HYPERSENSITIVITY REACTION; HYPOTENSION; IMMUNIZATION; LABORATORY TEST; MEDICAL LITERATURE; MEDLINE; MYOKYMIA; NAUSEA; NEUROTOXICITY; NONHUMAN; OUTCOME ASSESSMENT; PATIENT ASSESSMENT; PHYSICAL EXAMINATION; PRURITUS; RHABDOMYOLYSIS; SIDE EFFECT; SKIN TEST; SNAKE; SNAKEBITE; THROMBOCYTE COUNT; THROMBOCYTOPENIA; TREATMENT RESPONSE; UNITED STATES; URTICARIA; VASODILATATION; VOMITING; WHEEZING; ANIMAL; CONFERENCE PAPER; CONSENSUS DEVELOPMENT; DECISION SUPPORT SYSTEM; EVIDENCE BASED EMERGENCY MEDICINE; PATHOPHYSIOLOGY; PRACTICE GUIDELINE;

ALGORITHMS; ANIMALS; ANTIVENINS; CROTALID VENOMS; DECISION SUPPORT TECHNIQUES; DELPHI TECHNIQUE; EVIDENCE-BASED EMERGENCY MEDICINE; HUMANS; SNAKE BITES; UNITED STATES; VIPERIDAE;

EID: 79551569230     PISSN: None     EISSN: 1471227X     Source Type: Journal    
DOI: 10.1186/1471-227X-11-2     Document Type: Article

References (93)

1. O'Neil ME, Mack KA, Gilchrist J, Wozniak EJ. Snakebite injuries treated in United States emergency departments, 2001-2004. Wilderness Environ Med 2007, 18(4):281-287.
2. Langley R. Animal-related fatalities in the United States - an update. Wilderness Environ Med 2005, 16:67-74.
3. Spiller HA, Bosse GM, Ryan ML. Use of antivenom for snakebites reported to United States poison centers. Am J Emerg Med 2010,
4. Walter FG, Stolz U, Shirazi F, McNally J, Walter FG, Stolz U, Shirazi F, McNally J. Epidemiology of severe and fatal rattlesnake bites published in the American Association of Poison Control Centers' Annual Reports. Clin Toxicol 2009, 47(7):663-669.
5. Goto CS, Feng SY. Crotalidae polyvalent immune Fab for the treatment of pediatric crotaline envenomation. Pediatr Emerg Care 2009, 25(4):273-279. 10.1097/PEC.0b013e31819f1f1e, 19369845.
6. Campbell BT, Corsi JM, Boneti C, Jackson RJ, Smith SD, Kokoska ER. Pediatric snakebites: lessons learned from 114 cases. J Pediatr Surg 2008, 43(7):1338-41. 10.1016/j.jpedsurg.2007.11.011, 18639692.
7. Gold BS, Dart RC, Barish RA. Bites of venomous snakes. N Engl J Med 2002, 347(5):347-356. 10.1056/NEJMra013477, 12151473.
8. Dart RC. Can steel heal a compartment syndrome caused by rattlesnake venom?. Ann Emerg Med 2004, 44(2):105-107. 10.1016/j.annemergmed.2004.03.013, 15278080.
9. Corneille MG, Larson S, Stewart RM, Dent D, Myers JG, Lopez PP, McFarland MJ, Cohn SM. A large single-center experience with treatment of patients with crotalid envenomations: outcomes with and evolution of antivenin therapy. Am J Surg 2006, 192(6):848-852. 10.1016/j.amjsurg.2006.08.056, 17161106.
10. Tanen D, Ruha A, Graeme K, Curry S. Epidemiology and hospital course of rattlesnake envenomations cared for at a tertiary referral center in central Arizona. Acad Emerg Med 2001, 8(2):177-182. 10.1111/j.1553-2712.2001.tb01284.x, 11157295.
11. Dart RC, Seifert SA, Boyer LV, Clark RF, Hall E, McKinney P, McNally J, Kitchens CS, Curry SC, Bogdan GM, et al. A randomized multicenter trial of Crotalinae polyvalent immune Fab (ovine) antivenom for the treatment for crotaline snakebite in the United States. Arch Intern Med 2001, 161(16):2030-2036. 10.1001/archinte.161.16.2030, 11525706.
12. Dart RC, Seifert SA, Carroll L, Clark RF, Hall E, Boyer-Hassen LV, Curry SC, Kitchens CS, Garcia RA. Affinity-purified, mixed monospecific crotalid antivenom ovine Fab for the treatment of crotalid venom poisoning. Ann Emerg Med 1997, 30(1):33-39. 10.1016/S0196-0644(97)70107-0, 9209222.
13. Stanford CF, Bebarta VS, Holstege CP, Bush SP, Richardson WH, Olsen D, Dart RC. Is Crotaline Fab Antivenom efficacious for severe envenomations? [abstract]. Clin Toxicol 2007, 45(6):619.
14. Suankratay C, Wilde H, Nunthapisud P, Khantipong M, Suankratay C, Wilde H, Nunthapisud P, Khantipong M. Tetanus after white-lipped green pit viper (Trimeresurus albolabris) bite. Wilderness Environ Med 2002, 13(4):256-261.
15. Habib A. Tetanus complicating snakebite in northern Nigeria; clinical presentation and public health implications. Acta Trop 2003, 85(1):87-91. 10.1016/S0001-706X(02)00234-6, 12505187.
16. Anonymous ACIP Recommendations for Vaccination. 2010, Atlanta, Georgia: Centers for Disease Prevention and Control, accessed July 1, 2010, Anonymous., http://www.cdc.gov/vaccines/pubs/acip-list.htm
17. Russell F. Snake Venom Poisoning 1983, Great Neck, NY, Scholium International, 3.
18. Curry S, Horning D, Brady P, Requa R, Kunkel D, Vance M. The legitimacy of rattlesnake bites in central Arizona. Ann Emerg Med 1989, 18(6):658-663. 10.1016/S0196-0644(89)80523-2, 2729691.
19. Ownby CL. Structure, function and biophysical aspects of the myotoxins from snake venoms. J Toxicol - Toxin Rev 1998, 17(2):213-238.
20. Gutierrez JM, Rucavado A. Snake venom metalloproteinases: Their role in the pathogenesis of local tissue damage. Biochimie 2000, 82(9-10):841-850. 10.1016/S0300-9084(00)01163-9, 11086214.
21. Moura-da-Silva A, Laing G, Paine M, Dennison J, Politi V, Crampton J, Theakston D. Processing of pro-tumour necrosis factor-α by venom metalloproteinases: a hypothesis towards explaining local tissue damage following snakebite. Toxicon 1997, 35(6):814-815.
22. Crocker P, Zad O, Milling T, Maxson T, King B, Whorton E. Human cytokine response to Texas crotaline envenomation before and after antivenom administration. Am J Emerg Med 2010,
23. Kitchens CS. Hemostatic aspects of envenomation by North American snakes. Hematol Oncol Clin North Am 1992, 6(5):1189-1195.
24. Hutton R, Warrell D. Action of snake venom components on the haemostatic system. Blood Rev 1993, 7(3):176-189. 10.1016/0268-960X(93)90004-N, 8241832.
25. Boyer LV, Seifert SA, Clark RF, McNally JT, Williams SR, Nordt SP, Walter FG, Dart RC. Recurrent and persistent coagulopathy following pit viper envenomation. Arch Intern Med 1999, 159(7):706-710. 10.1001/archinte.159.7.706, 10218750.
26. Ruha AM, Curry SC, Beuhler M, Katz K, Brooks DE, Graeme KA, Wallace K, Gerkin R, Lovecchio F, Wax P, Selden B. Initial postmarketing experience with Crotalidae polyvalent immune Fab for treatment of rattlesnake envenomation. Ann Emerg Med 2002, 39(6):609-615. 10.1067/mem.2002.123698, 12023703.
27. Kitchens C, Eskin T. Fatality in a case of envenomation by Crotalus adamanteus initially successfully treated with polyvalent ovine antivenom followed by recurrence of defibrinogenation syndrome. J Med Toxicol 2008, 4(3):180-183. 10.1007/BF03161198, 18821492.
28. Fazelat J, Teperman SH, Touger M, Fazelat J, Teperman SH, Touger M. Recurrent hemorrhage after western diamondback rattlesnake envenomation treated with Crotalidae polyvalent immune Fab (ovine). Clin Toxicol 2008, 46(9):823-826.
29. O'Brien NF, DeMott MC, Suchard JR, Clark RF, Peterson BM. Recurrent coagulopathy with delayed significant bleeding after crotaline envenomation. Pediatr Emerg Care 2009, 25(7):457-459.
30. Camilleri C, Offerman S, Gosselin R, Albertson T, Camilleri C, Offerman S, Gosselin R, Albertson T. Conservative management of delayed, multicomponent coagulopathy following rattlesnake envenomation. Clin Toxicol 2005, 43(3):201-206.
31. Ruha AM, Curry SC, Albrecht C, Riley B, Pizon A. Late hematologic toxicity following treatment of rattlesnake envenomation with crotalidae polyvalent immune fab antivenom. Toxicon 2010, 57(1):53-9. 10.1016/j.toxicon.2010.09.014, 20920516.
32. Bush SP, Siedenburg E. Neurotoxicity associated with suspected southern Pacific rattlesnake (Crotalus viridis helleri) envenomation. Wilderness Environ Med 1999, 10(4):247-249.
33. Richardson WH, Goto CS, Gutglass DJ, Williams SR, Clark RF. Rattlesnake envenomation with neurotoxicity refractory to treatment with crotaline Fab antivenom. Clin Toxicol 2007, 45(5):472-475.
34. Clark RF, Williams SR, Nordt SP, Boyer-Hassen LV. Successful treatment of crotalid-induced neurotoxicity with new polyspecific crotalid Fab antivenom. Ann Emerg Med 1997, 30(1):54-57. 10.1016/S0196-0644(97)70111-2, 9209226.
35. Glenn JL, Straight RC, Wolfe MC, D L. Geographical variation in Crotalus scutulatus scutulatus (Mojave rattlesnake) venom properties. Toxicon 1983, 21(1):119-130. 10.1016/0041-0101(83)90055-7, 6342208.
36. Lavonas EJ, Schaefer TH, Kokko J, Mlynarchek SL, Bogdan GM. Crotaline Fab antivenom appears to be effective in cases of severe North American pit viper envenomation: an integrative review. BMC Emerg Med 2009, 9(13). epub, 2713980, 19545426.
37. Lavonas EJ, Kokko J, Schaeffer TH, Mlynarchek SL, Bogdan GM, Dart RC. Short-term outcomes following Fab antivenom therapy for severe crotaline snakebite. Ann Emerg Med 2010, 57(2):128-137. 10.1016/j.annemergmed.2010.06.550, 20952098.
38. Lavonas EJ, Kerns WP, Gerardo CJ, Richardson W, Whitlow KS, Berkoff DJ. Long-term limb function outcomes after copperhead snakebite [abstract]. Ann Emerg Med 2008, 52(4):S141-142.
39. Bush SP, Green SM, Moynihan JA, Hayes WK, Cardwell MD. Crotalidae polyvalent immune Fab (ovine) antivenom is efficacious for envenomations by Southern Pacific rattlesnakes (Crotalus helleri). Ann Emerg Med 2002, 40(6):619-624. 10.1067/mem.2002.129939, 12447339.
40. Lavonas EJ, Gerardo CJ, O'Malley G, Arnold TC, Bush SP, Banner W, Steffens M, Kerns WP. Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite. Ann Emerg Med 2004, 43(2):200-206. 10.1016/j.annemergmed.2003.08.009, 14747809.
41. Yin S, Kokko J, Lavonas E, Mlynarchek S, Bogdan G, Schaeffer T. Factors associated with difficulty achieving initial control with Crotalidae Polyvalent Immune Fab antivenom in snakebite patients. Acad Emerg Med 2010, 18(1):46-52.
42. Offerman S, Barry J, Richardson W, Tong T, Tanen D, Bush S, Clark R. Subcutaneous crotaline Fab antivenom for the treatment of rattlesnake envenomation in a porcine model. Clin Toxicol 2009, 47(1):61-68.
43. Anonymous Prescribing Information: CroFab®. accessed July 1, 2010, Anonymous., http://www.btgplc.com/PubContent/Docs/CroFab%20PI.pdf
44. Cannon R, Ruha AM, Kashani J. Acute hypersensitivity reactions associated with administration of Crotalidae polyvalent immune Fab antivenom. Ann Emerg Med 2008, 51(4):407-411. 10.1016/j.annemergmed.2007.09.036, 18191286.
45. Holstege CP, Wu J, Baer AB. Immediate hypersensitivity reaction associated with the rapid infusion of Crotalidae polyvalent immune Fab (ovine). Ann Emerg Med 2002, 39(6):677-679. 10.1067/mem.2002.124442, 12023715.
46. Janes D, Bush S, Kolluru G. Large snake size suggests increased snakebite severity in patients bitten by rattlesnakes in southern California. Wilderness Environ Med 2010, 21(2):120-126. 10.1016/j.wem.2010.01.010, 20591373.
47. Offerman SR, Bush SP, Moynihan JA, Clark RF, Offerman SR, Bush SP, Moynihan JA, Clark RF. Crotaline Fab antivenom for the treatment of children with rattlesnake envenomation. Pediatrics 2002, 110(5):968-971. 10.1542/peds.110.5.968, 12415038.
48. Schmidt JM, Schmidt JM. Antivenom therapy for snakebites in children: is there evidence?. Curr Opin Pediatr 2005, 17(2):234-238. 10.1097/01.mop.0000152621.67049.f2, 15800419.
49. Chuang R, Kokko J, Mlynarchek S, Schaeffer T, Bogdan G, Lavonas E. Rattlesnake versus Agkistrodon envenomations: venom effects differences [abstract]. Abstracts from Venom Week 2009, June 1-4, 2009 Albuquerque NM. J Med Toxicol 2010, 6(2):240-1. Seifert SA.
50. Offerman SR, Barry JD, Schneir A, Clark RF. Biphasic rattlesnake venom-induced thrombocytopenia. J Emerg Med 2003, 24(3):289-293. 10.1016/S0736-4679(02)00763-1, 12676300.
51. Lintner C, Keyler D, Bilden E. Prairie rattlesnake (Crotalus viridis viridis) envenomation: recurrent coagulopathy in a child treated with immune Fab [abstract]. Snakebites in the new millennium. Proceedings of a state-of-the-art symposium. J Med Toxicol 2006, 2(1):33-4. Seifert SA.
52. Seifert SA, Boyer LV, Dart RC, Porter RS, Sjostrom L. Relationship of venom effects to venom antigen and antivenom serum concentrations in a patient with Crotalus atrox envenomation treated with a Fab antivenom. Ann Emerg Med 1997, 30(1):49-53. 10.1016/S0196-0644(97)70110-0, 9209225.
53. Hurlbut K, Dart R, Spaite D, McNally J. Reliability of clinical presentation for predicting significant pit viper envenomation. Ann Emerg Med 1988, 17(4):438-439.
54. Miller MA, Dyer JE, Olson KR. Two cases of rattlesnake envenomation with delayed coagulopathy. Ann Emerg Med 2002, 39(3):348. 10.1067/mem.2002.121998, 11867998.
55. Wasserberger J, Ordog G, Merkin TE. Southern Pacific rattlesnake bite: a unique clinical challenge. J Emerg Med 2006, 31(3):263-266. 10.1016/j.jemermed.2005.09.018, 16982358.
56. Kerns W, Tomaszewski C. Airway obstruction following canebrake rattlesnake envenomation. J Emerg Med 2001, 20(4):377-380. 10.1016/S0736-4679(01)00315-8, 11348818.
57. Boyer LV, Seifert SA, Cain JS. Recurrence phenomena after immunoglobulin therapy for snake envenomations: Part 2. Guidelines for clinical management with crotaline Fab antivenom. Ann Emerg Med 2001, 37(2):196-201. 10.1067/mem.2001.113134, 11174239.
58. Ruha AM, Curry SC. Recombinant factor VIIa for treatment of gastrointestinal hemorrhage following rattlesnake envenomation. Wilderness Environ Med 2009, 20(2):156-160. 10.1580/08-WEME-CR-229R1.1, 19594209.
59. Gutierrez JM, Rucavado A, Escalante T, Diaz C. Hemorrhage induced by snake venom metalloproteinases: Biochemical and biophysical mechanisms involved in microvessel damage. Toxicon 2005, 45(8):997-1011. 10.1016/j.toxicon.2005.02.029, 15922771.
60. Yip L. Rational use of Crotalidae polyvalent immune Fab (ovine) in the management of crotaline bite. Ann Emerg Med 2002, 39(6):648-650. 10.1067/mem.2002.124450, 12023708.
61. Kitchens C, Hunter S, Van Mierop L. Severe myonecrosis in a fatal case of envenomation by the canebrake rattlesnake (Crotalus horridus atricaudatus). Toxicon 1987, 25(4):455-458. 10.1016/0041-0101(87)90080-8, 3617084.
62. Curry S, Kraner J, Kunkel D, Ryan P, Vance M, Requa R, Ruggieri S. Noninvasive vascular studies in management of rattlesnake envenomations to extremities. Ann Emerg Med 1985, 14(11):1081-1084. 10.1016/S0196-0644(85)80926-4, 4051274.
63. Tanen D, Danish D, Grice G, Riffenburgh R, Clark R. Fasciotomy worsens the amount of myonecrosis in a porcine model of crotaline envenomation. Emerg Med 2004, 44(2):99-104.
64. Shaw BA, Hosalkar HS. Rattlesnake bites in children: Antivenin treatment and surgical indications. J Bone Joint Surg 2002, 84(9):1624-1629.
65. Curry S, O'Connor A, Ruha A. Rapid-onset shock and/or anaphylactoid reactions from rattlesnake bites in central Arizona. Clin Toxicol 2010,
66. Litovitz T, Klein-Schwartz W, Rodgers G, Cobaugh D, Youniss J, Omslaer J, May M, Woolf A, Benson B. 2001 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2002, 20(5):391-452. 10.1053/ajem.2002.34955, 12216043.
67. Lai M, Klein-Schwartz W, Rodgers G, Abrams J, Haber D, Bronstein A, Wruk K. 2005 Annual report of the American Association of Poison Control Centers' National Poisoning and Exposure Database. Clin Toxicol 2006, 44:803-932.
68. Ownby C, Colberg T, Odell G. In vivo ability of antimyotoxin a serum plus polyvalent (Crotalidae) antivenom to neutralize prairie rattlesnake (Crotalus viridis viridis) venom. Toxicon 1986, 24(2):197-200. 10.1016/0041-0101(86)90122-4, 3705096.
69. Clark RF, Selden BS, Furbee B. The incidence of wound infection following crotalid envenomation. J Emerg Med 1993, 11(5):583-586. 10.1016/0736-4679(93)90313-V, 8308237.
70. Angel MF, Zhang F, Jones M, Henderson J, Chapman SW, Angel MF, Zhang F, Jones M, Henderson J, Chapman SW. Necrotizing fasciitis of the upper extremity resulting from a water moccasin bite. South Med J 2002, 95(9):1090-1094.
71. Scharman EJ, Noffsinger VD. Copperhead snakebites: clinical severity of local effects. Ann Emerg Med 2001, 38(1):55-61. 10.1067/mem.2001.116148, 11423813.
72. Alberts MB, Shalit M, LoGalbo F. Suction for venomous snakebite: a study of "mock venom" extraction in a human model. Ann Emerg Med 2004, 43(2):181-186. 10.1016/S0196-0644(03)00813-8, 14747805.
73. Bush SP, Hegewald KG, Green SM, Cardwell MD, Hayes WK. Effects of a negative pressure venom extraction device (Extractor) on local tissue injury after artificial rattlesnake envenomation in a porcine model. Wilderness Environ Med 2000, 11(3):180-8.
74. Cohen W, Wetzel W, Kadish A. Local heat and cold application after eastern cottonmouth moccasin (Agkistrodon piscivorus) envenomation in the rat: effect on tissue injury. Toxicon 1992, 30(11):1383-1386. 10.1016/0041-0101(92)90513-5, 1485335.
75. Frank H. What are we doing? An evaluation of cryotherapy for envenomation. Western J Med 1971, 114(5):25-27.
76. Guderian R, Mackenzie C, Williams J. High voltage shock treatment for snake bite. Lancet 1986, 2:229. 10.1016/S0140-6736(86)92535-3, 2873481.
77. Dart RC, Gustafson RA. Failure of electric shock treatment for rattlesnake envenomation. Ann Emerg Med 1991, 20(6):659-661. 10.1016/S0196-0644(05)82389-3, 2039106.
78. Johnson E, Kardong KV, Mackessy SP. Electric shocks are ineffective in the treatment of lethal effects of rattlesnake envenomation in mice. Toxicon 1987, 25(12):1347-1349. 10.1016/0041-0101(87)90013-4, 3438923.
79. Howe NR, Meisenheimer JL. Electric shock does not save snakebitten rats. Ann Emerg Med 1988, 17(3):254-256. 10.1016/S0196-0644(88)80118-5, 3257850.
80. Welch B, Gales BJ. Use of stun guns for venomous bites and stings: a review. Wilderness Environ Med 2001, 12(2):111-117.
81. Gold BS. Electric shock: a potentially hazardous approach to treating venomous snakebite. Maryland Med J 1993, 42(3):244-245.
82. Reid H, Thean P, Martin W. Specific antivenin and prednisone in viper-bite poisoning: controlled trial. BMJ 1963, 2(5369):1387-1380. 10.1136/bmj.2.5369.1378, 1873602, 14065063.
83. Reid H, Theakston R. The management of snake bite. Bull World Health Organ 1983, 61(6):885-895. 2536242, 6609008.
84. Amaral CFS, Campolina D, Dias MB, Bueno CM, Rezende NA. Tourniquet ineffectiveness to reduce the severity of envenoming after Crotalus durissus snake bite in Belo Horizonte, Minas Gerais, Brazil. Toxicon 1998, 36(5):805-808. 10.1016/S0041-0101(97)00132-3, 9655642.
85. Bush S, Green S, Laack T, Hayes W, Cardwell M, Tanen D. Pressure immobilization delays mortality and increases intracompartmental pressure after artificial intramuscular rattlesnake envenomation in a porcine model. Ann Emerg Med 2004, 44(6):599-604. 10.1016/j.annemergmed.2004.06.007, 15573035.
86. Meggs W, Courtney C, O'Rourke D, Brewer K. Pilot studies of pressure-immobilization bandages for rattlesnake envenomations. Clin Toxicol 2010, 48(1):61-63.
87. Burgess J, Dart R, Egen N, Mayersohn M. Effects of constriction bands on rattlesnake venom absorption: A pharmacokinetic study. Ann Emerg Med 1992, 21(9):1086-1093. 10.1016/S0196-0644(05)80649-3, 1514719.
88. Anonymous The efficacy of Crotaline Fab antivenom for copperhead snake envenomations - clinical trial. [Clinical trial identifier NCT00303303] accessed July 1, 2010, Anonymous., http://www.clinicaltrials.gov/ct2/show/NCT00868309
89. Anonymous A comparison of Crotalinae (pit viper) equine immune F(ab)2 antivenom (Anavip) and Crotalidae polyvalent immune Fab, ovine antivenom (CroFab) in the treatment of pit viper envenomation. [Clinical trial identifier NCT00868309] accessed July 1, 2010, Anonymous., http://www.clinicaltrials.gov/ct2/results?term=00868309
90. Anonymous Phase 3 multicenter comparative study to confirm safety and effectiveness of the F(ab)2 antivenom Anavip. [Clinical trial identifier NCT00636116] accessed July 1, 2010, Anonymous., http://www.clinicaltrials.gov/ct2/results?term=NCT00636116
91. Guyatt G, Oxman A, Kunz R, Falck-Yttr Y, Vist G, Liberati A, Schunemann H. Rating quality of evidence and strength of recommendations: Going from evidence to recommendations. BMJ 2008, 336:1049-1051. 10.1136/bmj.39493.646875.AE, 18467413.
92. Weant K, Johnson P, Bowers R, Armistead J. Evidence-based, multidisciplinary approach to the development of a Crotalidae polyvalent antivenin (CroFab) protocol at a university hospital. Ann Pharmacother 2010, 44:447-455. 10.1345/aph.1M527, 20124465.
93. Cribari C. Management of poisonous snakebite. 2004, Chicago: American College of Surgeons Committee on Trauma, accessed July 1, 2010., http://www.facs.org/trauma/publications/snakebite.pdf