Snakebite management in Iran: Devising a protocol

Background: Snakebite in Iran has been a health concern. However, management of snakebite is not standardized and varies from center to center. Th is 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. Th e protocol was then discussed and amended within a focus group comprised of medical toxicologists and internal medicine specialists. Th e amended version was fi nally discussed with expert physicians specialized in diff erent areas of medicine, to be optimized by supplementing other specifi c considerations. Results: During a one-year process, the protocol was fi nalized. Th e fi nal 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. Th e 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.