Background: The goal of antivenom administration for snake-bitten patients is to achieve therapeutic response (initial control), which means reversal of the venom-induced effects through neutralizing the venom. The aim of this study was to identify Snakebite prognostic factors of weak therapeutic response prior to antivenom administration.Methods: This was a retrospective study of patients with viperidae Snakebite envenomation who were admitted to Mashhad Toxicology Centre during 2007-2011. Demographic features, clinical manifestations and Snakebite severity score (SSS) were collected prior to antivenom administration. Total number of antivenom vials administered to achieve therapeutic response and duration of hospitalization were also recorded. Potential factors in Snakebite prognosis were analyzed by comparing in two groups of achieving therapeutic response with less than 5 vials and over 5 to calculate odds ratio.Results: Total of 108 patients (male/female: 85/23) with mean (SD) age of 34.5 (17.0) were studied. The most common manifestations included fang marks (100%), pain (100%), ecchymosis (89%), swelling (83%), blister formation (48%) and thrombocytopenia (25%). In univariate analysis, thrombocytopenia (P=0.01), spontaneous bleeding (P=0.02), coagulopathic disturbances (P=0.007), swelling (P=0.003), progressive swelling (P=0.005), ecchymosis (P=0.05) and respiratory distress (P=0.05) were significantly correlated to weak therapeutic response. Swelling and spontaneous bleeding were the strongest Snakebite prognostic factors, as respectively they put the patients at 12.4 and 10.4 fold risks for difficult achievement of therapeutic response.Conclusions: In Snakebite, some clinical manifestations in the first hours of admission and prior to antivenom administration are associated with weak therapeutic response. Identifying these prognostic factors, can assist health care providers to better estimate the patient’s needs and predict the final consequences.

Background: Overwhelming life experiences can trigger stress disorders including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). The objective of this study was to investigate the frequency of and predictive factors for ASD and PTSD in Snakebite victims.Methods: In this study, Snakebite victims who were admitted to Mashhad Medical Toxicology Centre, Imam Reza Hospital, Iran, from 1st November 2010 to 30th April 2012 were enrolled. Psychiatric symptoms of patients were evaluated after stabilization of patients’ clinical condition. Structured Clinical Interview for DSM-IV Axis I Disorder questionnaire was used for interviewing the patients. Patients underwent 4 scheduled psychiatric interviews on admission, 3 weeks post-bite, 6 weeks post-bite and 6 months post-bite.Results: Fifty-three patients (74% men) were included in the study with mean (SD) age of 33.6 (15.0) years. Patients were given psychological consultations during the study while they received no psychiatric medication. The set of efforts to avoid activities, places, or people that arouse recollections of the trauma was the most common symptom found in all visits. Re-experience was the most common class of symptoms in all visits. On admission and the 3rd week post-bite, 36% and 15% of patients had ASD. Moreover, 8% of patients developed PTSD and only 4% of patients developed chronic PTSD. ASD on admission (P<0.001), ASD in 3rd week (P=0.02) and PTSD (P=0.01) were developed in patients with significantly younger ages. In addition, the presence of ASD on admission (P<0.001), ASD in 3rd week (P=0.003) and PTSD (P=0.003) was significantly higher in female gender.Conclusion: Snakebite is not only an emergency medical problem, but also is a traumatic event that can cause stress disorders. It is prudent to refer all Snakebite victims, especially women in younger ages, to psychiatric specialist for better evaluation and psychological treatments.

Background: Snakebite in Iran has been a health concern. However, management of Snakebite is not standardized and varies from center to center. This study is aimed at devising an evidence-based comprehensive protocol for Snakebite management in Iran, to reduce unnecessary variations in practice.Materials and Methods: A narrative search in electronic databases was performed. Fifty peer-reviewed articles, guidelines, and textbooks were reviewed and practical details were extracted. Our currently used protocol in the Mashhad Toxicology Center was supplemented with this information. Consequently an improved wide-range protocol was developed. The protocol was then discussed and amended within a focus group comprised of medical toxicologists and internal medicine specialists. The amended version was finally discussed with expert physicians specialized in different areas of medicine, to be optimized by supplementing other specific considerations.Results: During a one-year process, the protocol was finalized. The final version of the protocol, which was designed in six steps, comprised of three components: A schematic algorithm, a severity grading scale, and instructions for supportive and adjunctive treatments. The algorithm pertains to both Viperidae and Elapidae Snakebite envenomations and consists of a planned course of action and dosing of antivenom, based on the severity of the envenomation.Conclusion: Snakebite envenomation is a clinical toxicologic emergency, which needs to be treated in a timely and organized manner. Hence, a multi-aspect protocol was designed to improve the clinical outcomes, reduce unnecessary administration of antivenom, and help physicians make more proper clinical judgments.