McKenna's Drug Handbook for Nursing & Midwifery, 7e

Antivenoms     1289

GI: abdominal pain, diarrhoea, nausea, vomiting. Skin: injection site reaction, urticaria, rash. Musculoskeletal: chest pain, myalgia. Other: allergic reactions, anaphylaxis , delayed serum sickness , chills, pyrexia. Interactions None reported. Contraindications Should not be used unless there is evidence of systemic envenoming with potential for serious toxic effects. care considerations • Brown snake venomcauses rapid coagulo­ pathythatmaybeassociatedwithrespiratory paralysis and thrombocytopenia. • Monitor FBC, platelets, INR and aPTT on presentation, immobilisation (if used) and 6 hours thereafter. • Monitor for signs and symptoms of bleeding (bruising, bleeding fromgums and venepuncturesites,epistaxis,gastrointestinal bleeding, haematuria, altered mental status suggesting intracranial haemorrhage). • In individuals with severe consumptive coagulopathy, fresh frozen plasma and/or cryoprecipitate should be considered early. • As product is sourced from horse plasma, potential for transmission of infectious disease cannot be ruled out. • Not administered by IM injection. • Venom detection kits should be used to detect and identify specific venom at the bite site or in urine where possible. • Anaphylactic reactions may be more likely in individuals who are atopic or have previously received equine serum. • Although considered controversial, individuals at risk of anaphylactic reactions maybegivenpremedicationwithadrenaline and antihistamine. • Have adrenaline 1:1000 available in case of anaphylactic reaction. • Severe cases should be managed in intensive care unit.

• Vinegar should be applied liberally to tentacles stuck to the skin in order to prevent greater spread of venom from nematocysts. Patient teaching • Advise person of risk of possible infectious disease transmission as venom sourced from sheep serum. • Instruct person to report any adverse effects—such as shortness of breath, itching, skin swelling, fever or chest pain— immediately. brown snake antivenom Brown Snake Antivenom Infusion Pregnancy risk category NR Use in sport: Permitted Available form Solution for infusion: 1000 U/vial Indications & dosages ➤ Treatment of Pseudonaja genus snake envenoming— Adults: 1000 U by slow IV infusion diluted 1 in 10 in Hartmann’s solution, repeated if necessary. Individuals with severe systemic envenoming may require several vials of antivenom. Most individuals require 3 vials and the use of 13 vials has been recorded. Children: 1000 Uby slow IV infusion diluted 1 in 5 in Hartmann’s solution, repeated if necessary. Action Antivenomeffectiveagainstvenomofbrown snake and othermembers of the Pseudonaj a genus such as Eastern brown snake, dugite and gwardar (Western brown snake). Route Onset Peak Duration IV Unknown Unknown Unknown

Adverse reactions CNS: headache.