title: Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop.
abstract: BACKGROUND
  Envenomation by crotaline snakes (rattlesnake, cottonmouth, copperhead) is a complex, potentially lethal condition affecting thousands of people in the United States each year. Treatment of crotaline envenomation is not standardized, and significant variation in practice exists.
  
  
  METHODS
  A geographically diverse panel of experts was convened for the purpose of deriving an evidence-informed unified treatment algorithm. Research staff analyzed the extant medical literature and performed targeted analyses of existing databases to inform specific clinical decisions. A trained external facilitator used modified Delphi and structured consensus methodology to achieve consensus on the final treatment algorithm.
  
  
  RESULTS
  A unified treatment algorithm was produced and endorsed by all nine expert panel members. This algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy.
  
  
  CONCLUSIONS
  Clinical manifestations and ideal treatment of crotaline snakebite differ greatly, and can result in severe complications. Using a modified Delphi method, we provide evidence-informed treatment guidelines in an attempt to reduce variation in care and possibly improve clinical outcomes.
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, USA. eric.lavonas@rmpdc.org
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lavonas
authors.forename: Anne-Michelle
authors.initials: AM
authors.lastname: Ruha
authors.forename: William
authors.initials: W
authors.lastname: Banner
authors.forename: Vikhyat
authors.initials: V
authors.lastname: Bebarta
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Bernstein
authors.forename: Sean P
authors.initials: SP
authors.lastname: Bush
authors.forename: William P
authors.initials: WP
authors.lastname: Kerns
authors.forename: William H
authors.initials: WH
authors.lastname: Richardson
authors.forename: Steven A
authors.initials: SA
authors.lastname: Seifert
authors.forename: David A
authors.initials: DA
authors.lastname: Tanen
authors.forename: Steve C
authors.initials: SC
authors.lastname: Curry
authors.forename: Richard C
authors.initials: RC
authors.lastname: Dart
mesh_terms: D000465:Algorithms; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage / Q000009:adverse effects; D003435:Crotalid Venoms / Q000633:toxicity; D003661:Decision Support Techniques; D003697:Delphi Technique; D055416:Evidence-Based Emergency Medicine; D006801:Humans; D012909:Snake Bites / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014481:United States; D017819:Viperidae
chemical_list: D000997:Antivenins; D003435:Crotalid Venoms