title: A large single-center experience with treatment of patients with crotalid envenomations: outcomes with and evolution of antivenin therapy.
abstract: BACKGROUND
  Antivenin (crotalid) polyvalent (ACP; Antivenin Crotalidae Polyvalent; Wyeth, Melville, NY) is associated with frequent allergic reactions. Allergic reactions are fewer with ovine Fab antivenin (FabAV). This study describes the management of crotalid envenomations in patients treated with FabAV or ACP, and without antivenin.
  
  
  METHODS
  We performed a retrospective chart review of crotalid envenomations over 10 years. Demographic data, hematologic profiles, details of antivenin administration, and in-hospital morbidity and mortality were collected.
  
  
  RESULTS
  There were no mortalities and a single amputation. Fewer fasciotomies were performed in the FabAV (9%) group versus the ACP group (24%). Mean hospital stay was 3.4 days. No allergic reactions were associated with FabAV. Fourteen of 211 reactions were associated with ACP (P < .001). Coagulopathy was frequent.
  
  
  CONCLUSIONS
  FabAV represents an improvement in management of crotalid envenomations because of reduced allergic reactions. Serious morbidity and mortality is rare. Coagulopathy is frequent but bleeding is not. Limb salvage is high. Surgical debridement and ACP are contraindicated when FabAV is available.
authors.affiliation: Division of Trauma and Emergency Surgery, Department of Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX 78229-3900, USA. Corneille@uthscsa.edu
authors.forename: Michael G
authors.initials: MG
authors.lastname: Corneille
authors.forename: Scott
authors.initials: S
authors.lastname: Larson
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Stewart
authors.forename: Daniel
authors.initials: D
authors.lastname: Dent
authors.forename: John G
authors.initials: JG
authors.lastname: Myers
authors.forename: Peter P
authors.initials: PP
authors.lastname: Lopez
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: McFarland
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000818:Animals; D000997:Antivenins / Q000009:adverse effects* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012909:Snake Bites / Q000628:therapy*; D016896:Treatment Outcome; D017819:Viperidae
chemical_list: D000997:Antivenins