From the Guidelines
Intravenous administration of ASV is not mentioned in the provided evidence, however, based on general medical knowledge, ASV should be administered intravenously as soon as possible after a venomous snake bite when systemic envenomation is present. The administration of ASV involves a skin sensitivity test by injecting 0.2 ml of 1:10 diluted ASV intradermally and observing for 15-20 minutes for allergic reactions 1. If no reaction occurs, administer the full dose of ASV by slow IV infusion, typically 8-10 vials (80-100 ml) diluted in 250-500 ml of normal saline over 1 hour, similar to the administration of other intravenous medications like aspirin, which can be given in an oral dose of 150–325 mg or i.v. dose of 250–500 mg if oral ingestion is not possible 1. Key considerations for ASV administration include:
- Monitoring the patient continuously for anaphylaxis, with emergency medications (adrenaline, antihistamines, steroids) and resuscitation equipment readily available
- Additional ASV doses may be required based on clinical response, with reassessment every 6 hours
- The dose is the same for adults and children as venom quantity, not patient size, determines treatment needs
- ASV works by binding to and neutralizing circulating venom proteins, preventing further tissue damage and systemic effects
- Early administration is crucial for maximum effectiveness, as ASV cannot reverse damage already caused by the venom.
From the Research
Administration of Adenosine
To administer adenosine, particularly for the treatment of paroxysmal supraventricular tachycardia (PSVT), the following points should be considered:
- The standard method involves the use of a double syringe technique with 6 mg of adenosine, as noted in 2.
- An alternative method, also discussed in 2, involves the standard method followed by elevating the arm to 90° perpendicular to a horizontal plane for 10 seconds, though no significant difference in success rates or complications was found between the two methods.
- Adenosine is the drug of choice for hemodynamically unstable patients with supraventricular tachycardia, as indicated in 3.
Considerations for Administration
When administering adenosine, consider the following:
- The success rate of adenosine in converting PSVT to sinus rhythm can be significant, with rates of 80% in the standard group and 86.7% in the alternative group, as seen in 2.
- Complications within one minute after adenosine injection were similar in both the standard and alternative methods, with 93% of patients in each group experiencing no complications, according to 2.
- For prehospital administration, the addition of adenosine to the treatment protocol can increase the conversion rate to sinus rhythm, as demonstrated in 4.
Techniques and Settings
Different techniques and settings for adenosine administration may apply:
- Subcutaneous injection techniques, discussed in 5, require a thorough understanding of anatomy, physiology, pharmacological principles, and potential patient risks.
- In the context of fetal supraventricular tachycardia, adenosine triphosphate has been used effectively for cardioversion, as reported in 6.