Template:Crofab dosing - Revision history

ClaireLewis: /* Side Effects */

2019-09-28T17:26:50Z

Side Effects

← Older revision		Revision as of 17:26, 28 September 2019
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	===Side Effects===		===Side Effects===
	*Acute allergic reactions occur in <10% pts		*Acute [[allergic reactions]] occur in <10% pts
	**If occurs stop infusion and give epinephrine/antihistamines if needed		**If occurs stop infusion and give epinephrine/antihistamines if needed
	*Recurrent [[thrombocytopenia]] has been described up to 2 weeks after transfusion with FabAV and is likely a result of isolated renal clearance of FabAV and persistent presence of actual venom in serum.<ref>Ruha AM et al. Late hematologic toxicity following treatment of rattlesnake envenomation with crotalidae polyvalent immune Fab antivenom. Toxicon. 2011;57:53–59.</ref>		*Recurrent [[thrombocytopenia]] has been described up to 2 weeks after transfusion with FabAV and is likely a result of isolated renal clearance of FabAV and persistent presence of actual venom in serum.<ref>Ruha AM et al. Late hematologic toxicity following treatment of rattlesnake envenomation with crotalidae polyvalent immune Fab antivenom. Toxicon. 2011;57:53–59.</ref>
	**Warrants close monitoring of platelets by primary physician or return visit after discharge		**Warrants close monitoring of platelets by primary physician or return visit after discharge
	*[[Serum sickness]] is unlikely but precautions should be given to patents upon discharge		*[[Serum sickness]] is unlikely but precautions should be given to patents upon discharge

Rossdonaldson1: /* Maintenance therapy */

2017-08-14T06:04:25Z

Maintenance therapy

← Older revision		Revision as of 06:04, 14 August 2017
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	===Maintenance therapy===		===Maintenance therapy===
	*~~Infuse~~ 2~~-vial doses~~ at 6, 12, and ~~18hr after initial control achieved~~		*May repeat dose (2 vials) at 6, 12, and 18 hours later if symptoms not controlled<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref>
	*''Maintance therapy may be indicated after initial dosing based on local protocols even if control is achieved.<ref>Crofab treatment agorithmn http://www.crofab.com/documents/CroFab-Treatment_Algorithm.pdf</ref>		**''Maintance therapy may be indicated after initial dosing based on local protocols even if control is achieved.<ref>Crofab treatment agorithmn http://www.crofab.com/documents/CroFab-Treatment_Algorithm.pdf</ref>

	===Envenomation control measurement===		===Envenomation control measurement===

Rossdonaldson1: /* Initial Administration */

2017-08-14T06:03:25Z

Initial Administration

← Older revision		Revision as of 06:03, 14 August 2017
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	===Initial Administration===		===Initial Administration===
	*Initial dose: 6 vials<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref>		*Initial dose: 6 vials<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref>
	**May repeat dose (2 vials) at 6, 12, and 18 hours later if symptoms not controlled<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref>
	*Typically diluted into 250 cc or 1 L of normal saline and infused over an hour		*Typically diluted into 250 cc or 1 L of normal saline and infused over an hour
	*Same dose for both adults and pediatrics (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)		*Same dose for both adults and pediatrics (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)

Rossdonaldson1: /* Initial Administration */

2017-08-14T05:59:03Z

Initial Administration

← Older revision		Revision as of 05:59, 14 August 2017
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	===Initial Administration===		===Initial Administration===
	*Initial dose: 6 vials<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref>		*Initial dose: 6 vials<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref>
	**May repeat dose in 2 hours if symptoms not controlled		**May repeat dose (2 vials) at 6, 12, and 18 hours later if symptoms not controlled<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref>
	*Typically diluted into 250 cc or 1 L of normal saline and infused over an hour		*Typically diluted into 250 cc or 1 L of normal saline and infused over an hour
	*Same dose for both adults and pediatrics (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)		*Same dose for both adults and pediatrics (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)

Rossdonaldson1: /* Initial Administration */

2017-08-14T05:57:46Z

Initial Administration

← Older revision		Revision as of 05:57, 14 August 2017
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	===Initial Administration===		===Initial Administration===
	*Initial dose: 6 vials ~~in 250 mL normal saline~~<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref>		*Initial dose: 6 vials<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref>
	**May repeat dose in 2 hours if symptoms not controlled		**May repeat dose in 2 hours if symptoms not controlled
	*Typically diluted into 250 cc or 1 L of normal saline and infused over an hour.		*Typically diluted into 250 cc or 1 L of normal saline and infused over an hour
	*Same dose for both adults and pediatrics (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)		*Same dose for both adults and pediatrics (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)

Rossdonaldson1: /* Initial Administration */

2017-08-14T05:57:26Z

Initial Administration

← Older revision		Revision as of 05:57, 14 August 2017
Line 1:		Line 1:
	===Initial Administration===		===Initial Administration===
	*Initial dose: 6 vials<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref>		*Initial dose: 6 vials in 250 mL normal saline<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref>
	**May repeat dose in 2 hours if symptoms not controlled		**May repeat dose in 2 hours if symptoms not controlled
	*Typically diluted into 250 cc or 1 L of normal saline and infused over an hour.		*Typically diluted into 250 cc or 1 L of normal saline and infused over an hour.

Rossdonaldson1: /* Initial Administration */

2017-08-14T05:56:45Z

Initial Administration

← Older revision		Revision as of 05:56, 14 August 2017
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	===Initial Administration===		===Initial Administration===
	*Initial dose: 6 vials		*Initial dose: 6 vials<ref>Gerardo CJ. The efficacy of crotalidea polyvalent immune fab (ovine) antivenom versus placebo plus optional rescue therapy on recovery from copperhead snake envenomation: A randomized, double-blind, placebo-controlled, clinical trial. Annals of EM. August 2017. 70(2):233-244.</ref>
	**May repeat dose in 2 hours if symptoms not controlled		**May repeat dose in 2 hours if symptoms not controlled
	*Typically diluted into 250 cc or 1 L of normal saline and infused over an hour.		*Typically diluted into 250 cc or 1 L of normal saline and infused over an hour.

Rossdonaldson1: /* Initial Administration */

2017-08-14T05:52:48Z

Initial Administration

← Older revision		Revision as of 05:52, 14 August 2017
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	===Initial Administration===		===Initial Administration===
	*Initial dose: 4-6 vials		*Initial dose: 6 vials
	**May repeat dose in 2 hours if symptoms not controlled		**May repeat dose in 2 hours if symptoms not controlled
	*Typically diluted into 250 cc or 1 L of normal saline and infused over an hour.		*Typically diluted into 250 cc or 1 L of normal saline and infused over an hour.
	*Same dose for both adults and pediatrics (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)		*Same dose for both adults and pediatrics (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)

	===Maintenance therapy===		===Maintenance therapy===

Mholtz at 04:31, 6 July 2017

2017-07-06T04:31:15Z

← Older revision		Revision as of 04:31, 6 July 2017
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	*Administer antivenom as soon as possible if the indications are met and antivenom is available.<ref>Dart RC et al. Efficacy of post envenomation administration of antivenin. Toxicon. 1988;26:1218–1221.</ref>
	*Administration should slow swelling and decrease pain
	===Initial Administration===		===Initial Administration===
	~~CroFab is reconstituted~~ in ~~normal saline and typically~~ diluted into 250 cc or 1 L of normal saline and infused over an hour.		*Initial dose: 4-6 vials
	*~~The dosing of CroFab is the same~~ for adults and ~~children~~ (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)		**May repeat dose in 2 hours if symptoms not controlled
	*Establish initial control of envenomation by giving 4-6 vials		*Typically diluted into 250 cc or 1 L of normal saline and infused over an hour.
	*Control achieved? (Cessation of progression of all components of envenomation, including labs checked 2 hours after infusion started)		*Same dose for both adults and pediatrics (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)
	**'''If yes: '''then perform serial exams and consider maintenance therapy
	**'''If no:''' repeat infusion of 4-6 vials and then re-evaluate for control

	===Maintenance therapy===		===Maintenance therapy===
			*Infuse 2-vial doses at 6, 12, and 18hr after initial control achieved
	*''Maintance therapy may be indicated after initial dosing based on local protocols even if control is achieved.<ref>Crofab treatment agorithmn http://www.crofab.com/documents/CroFab-Treatment_Algorithm.pdf</ref>		*''Maintance therapy may be indicated after initial dosing based on local protocols even if control is achieved.<ref>Crofab treatment agorithmn http://www.crofab.com/documents/CroFab-Treatment_Algorithm.pdf</ref>
	**Infuse 2-vial doses at 6, 12, and 18hr after initial control achieved

	===Envenomation control measurement===		===Envenomation control measurement===
	*~~Must observe~~ for progression of envenomation during and after antivenom infusion		*Observe for progression of envenomation during and after antivenom infusion
	*Measure limb circumference at several ~~site~~ above and below bite		*Measure limb circumference at several sites above and below bite
	*Mark advancing border of edema q30min		*Mark advancing border of edema q30min
	*Repeat labs q4hr or after each course of antivenom (whichever is more frequent)		*Repeat labs q4hr or after each course of antivenom (whichever is more frequent)
	===~~Antivenom~~ Side Effects===
			===Side Effects===
	*Acute allergic reactions occur in <10% pts		*Acute allergic reactions occur in <10% pts
	**If occurs stop infusion and give epinephrine/antihistamines if needed		**If occurs stop infusion and give epinephrine/antihistamines if needed

Dtanen: update

2016-07-20T22:46:40Z

update

← Older revision		Revision as of 22:46, 20 July 2016
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	*Administration should slow swelling and decrease pain		*Administration should slow swelling and decrease pain
	===Initial Administration===		===Initial Administration===
	CroFab is reconstituted in normal saline and typically diluted into 250 cc of 1 L of normal saline and infused over an hour.		CroFab is reconstituted in normal saline and typically diluted into 250 cc or 1 L of normal saline and infused over an hour.
	*The dosing of CroFab is the same for adults and children (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)		*The dosing of CroFab is the same for adults and children (may have to adjust the dilution of CroFab for small children so that they are not volume overloaded)
	*Establish initial control of envenomation by giving 4-6 vials		*Establish initial control of envenomation by giving 4-6 vials