a. We do not recommend routine premedication with antihistamines or steroids
b. Dedicate one small bore (18-20 G in adults) IV line to antivenom administration and one large bore IV line (16-14 G in adults) for emergency resuscitation.
c. Prepare 1L Normal Saline (20 ml/kg in children) ready to give under pressure.
d. Prepare adrenaline 1:1000 (1mg in 1 mL) drawn up to a dose of 0.01 mg/kg (max. 0.3 mg, i.e. max 0.3 mL) and label “adrenaline for i.m. injection only (dose in mg)”.
e. Prepare an i.v. infusion of adrenaline 1mg in 100 mL (controlled by infusion pump or syringe driver) ready to attach by a side arm to the resuscitation line. Anti-reflux valves must be attached above the side arm on any other infusions using this i.v., to prevent adrenaline going back up into the other fluid bags. To prevent erroneous administration, do not attach the adrenaline infusion unless it is needed.
f. Record blood pressures on the other side to the fluid/adrenaline infusion, to avoid pronged cuff inflations and thus extravasation of infusion fluids.
a. Most reactions are related to the rate of antivenom infusion, and cause flushing, hypotension and bronchospasm. Some mild reactions resolve with temporary cessation of the antivenom infusion and recommencing it at a slower rate.
b. Envenomed patients may be severely coagulopathic, so it is important to be cautious when giving adrenaline to avoid blood pressure surges, which might lead to intracerebral haemorrhage.
c. Initial management of severe reactions (sudden hypotension, bronchospasm):
d. For reactions that do not respond to initial management:
Snakebite and Spiderbite Management Guidelines SA. Prof. Julian White
Government of South Australia Department of Health Guideline Ref G0034, August 2006
ASP Reaction Management Guidelines V1 9 Feb 2008