PLACE LABEL HERE
CROFAB (crotalidae polyvalent immune fab)
ADULT and PEDIATRIC
ORDERS
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
Indication: CroFab (crotalidae polyvalent immune fab) is indicated for envenomation resulting from Crotalids
such as rattlesnakes, moccasins, cottonmouths, and copperheads.
1.
Contact local poison control center: 404-616-9000 or 1-800-222-1222
2.
Labs: CBC, PT/INR, PTT,CMP, Fibrinogen if not already done
3.
Place reference marks for measuring circumference of affected extremity to envenomation site.
Measure q 15 min and trace leading edge of swelling with skin markers.
4.
Remove rings and constrictive items
5.
Vital signs: q hr until control of envenomation achieved
6.
Immobilize the affected extremity at or below the level of the heart
MEDICATIONS (Avoid aspirin and other anticoagulants for Crotalidae bites):
7.
Obtain IV access in unaffected limb (2 sites are possible)
8.
IV Fluids: _______________________________________________ at _____________ ml/hr
9.
CroFab (crotalidae polyvalent immune fab) Initial Dose (same dose for adults and pediatrics):
 4 vials  5 vials  6 vials
Mixed in 250 ml NS. Infuse slowly at 25 ml/hr for 10 min and monitor for signs of acute reaction.
If no signs of an allergic reaction increase rate to 250 ml/hr to infuse remainder over 60 min.
If all signs/symptoms of envenomation have not ceased after 1 hr of completion, notify physician.
Physician may repeat additional bolus dose (4-6 vials) until initial control achieved (call pharmacy if
additional bolus vials are needed).
10.
 Maintenance Dose: After initial control, give CroFab 2 vials in 250 ml NS IV q 6 hrs x 3 doses
11.
> 7 years of age: Tetanus Diphtheria IM x 1 dose OR 6 weeks-6 year: Adacel (T-dap) IM x 1 dose
PRN MEDICATIONS (If > one drug is ordered for the same indication, clinical assessment will be used per policy 520-06)
12.
Severe pain: (Adults):
 Morphine 1-4 mg IV q 3 hrs prn
(Pediatrics):  Morphine ___ mg (0.1-0.2 mg/kg/dose) q 2 prn
13.
Moderate Pain (Adults):
 Lortab (HYDROcodone/acetaminophen) 5/500 mg 1-2 tabs or 10/500 mg 1 tab po q 4 hrs prn

/325 mg 1-2 tabs or 10/325 mg 1 tab po q 4 hrs prn
Moderate pain (Pediatrics): 
 Lortab (HYDROcodone/acetaminophen)
 < 2 y/o: ____ mg (0.1 – 0.2 mg/kg/dose, max 1.25 mg) po q 3 hrs prn
 2-12 y/o: 5 mg po prn q 3 hrs prn
 > 12 y/o: 10 mg po prn q 3 hrs prn

  Tylenol (acetaminophen 120 mg/5 ml) with codeine elixir (12 mg/5 ml) ____ ml po q 4 hr prn
14.
Nausea:
(Adults)
Zofran (ondansetron) 4 mg IV or po q 6 hrs prn
(Pediatrics, > 10 kg)
Zofran (ondansetron) 4 mg ODT prn x 1 dose
(Pediatrics, 5-10 kg)
Zofran (ondansetron) 1 mg ODT prn x 1 dose
15.
Itching:(Adults):
Benadryl (diphenhydrAMINE) 25 -50 mg IV x 1 dose
(Pediatrics, 6-12 y/o)
Benadryl (diphenhydrAMINE) 12.5-25 mg x 1 dose
(Pediatrics, up to 6 y/o)
Benadryl (diphenhydrAMINE) 6.25-12.5 mg x 1 dose
______________
Date
___________________
Time
_________________________________
Physician Signature
__________
PID Number
Send copy to pharmacy
*2-32532*
FORM 2-32532 INITIATED 07/2012
Page 1 of 1
PLACE LABEL HERE
CROFAB (crotalidae polyvalent immune fab)
ADULT and PEDIATRIC
ORDERS
Reference Page
Snakebite Severity Score
Criterion
Points
Pulmonary Symptoms
No symptoms/signs
Dyspnea, minimal chest tightness, mild or vague discomfort, or respirations of 20-25 breaths/minute
Moderate respiratory distress (tachypnea, 26-40 breaths/minute; accessory muscle use)
Cyanosis, air hunger, extreme tachypnea, or respiratory insufficiency/failure
Cardiovascular System
No symptoms/signs
Tachycardia (100-124 BPM), palpitations, generalized weakness, benign dysrhythmia, or hypotension
Tachycardia (126-175 BPM),or hypotension with SBP>100
Tachycardia (>175 BPM), hypotension with SBP<100, malignant dysrhythmia, or cardiac arrest
Local Wound
No symptoms/signs
Pain, swelling, or ecchymosis within 5-7.5 cm of bite site
Pain, swelling, or ecchymosis involving less than half the extremity (7.5-50 cm from bite site)
Pain, swelling, or ecchymosis involving half to all of extremity (50-100 cm from bite site)
Pain, swelling, or ecchymosis extending beyond affected extremity (more than 100 cm from bite site)
Gastrointestinal System
No symptoms/signs
Pain, tenesmus, or nausea
Vomiting or diarrhea
Repeated vomiting, diarrhea, hematemesis, or hematochezia
Hematologic symptoms
No symptoms/signs
Coagulation parameters slightly abnormal: PT<20 seconds, PTT <50 seconds, Platelets 100-150K, or
fibrinogen 100-150 mcg/ml
Coagulation parameters abnormal: PT < 20-25 seconds, PTT <50-75 seconds; Platelets 50-100K, or
fibrinogen 50-100 mcg/ml
Coagulation parameters abnormal: PT<50-100 seconds, PTT <75-100 seconds, Platelets 20-50 K, or
fibrinogen < 50 mcg/ml
Coagulation parameters markedly abnormal, with serious bleeding or the threat of spontaneous
bleeding; unmeasurable PT or PTT, Platelets <20 K, or undetectable fibrinogen
Central Nervous System
No symptoms/signs
Minimal apprehension, headache, weakness, dizziness, chills, or paresthesia
Moderate apprehension, headache, weakness, dizziness, chills, paresthesia, confusion, or
fasciculation in area of bite site
Severe confusion, lethargy, seizure, coma, psychosis, or generalized fasciculation
0
1
2
3
0
1
2
3
0
1
2
3
4
0
1
2
3
0
1
2
3
4
0
1
2
3
Total Points
Snakebite Severity
Score
Minimal: 0-3
Moderate: 4-7
Severe: 8-20
Not Part of Permanent Medical Record.
FORM 2-32532 INITIATED 07/2012
Reference Page
Page 1 of 1