EM:CRAP was created to fill a gaping void in free online access medicine: where is the easy readily, possibly low-quality EMcrap? Join us in this somewhat pointless journey as we intrepidly investigate celebrity medical emergencies, the hottest new EM fads, and such.
White rapper Mike Posner, looking very much like your typical bearded homeless ER patient, presented to a Colorado ER after being bitten by a rattlesnake 3 days ago.
“That venom is no joke!” he posted on Instagram Thursday. “I got to the hospital and got the anti-venom in time.”
Mike claims it was a baby rattlesnake who apparently thought his shoes (or rather bare feet) made too much noise. The hirsute rhymesmith is currently on a tour in which he walks sin huaraches across the whole country.
We here are breathlessly waiting to know whether he got the AnaVIP treatment (Very Infected Person) or if they went with CroNotSoFab.
CroFab (Crotalidae Polyvalent Immune Fab [Ovine])
CroFab has slicker marketing but is more expensive and burdensome to administer. Each CroFab vial takes 5-10 minutes to reconstitute, and you have to land on a dose somewhere between 4 and 12 vials to load. It is somewhat hard to try to argue clinically whether someone needs more or less as the course of the bite’s progression is hard to predict, and then we don’t really know whether bigger people need more, or if it’s more about how much venom got into the bite. Each CroFab vial costs about $3,198.
Anavip (Crotalidae Immune F(ab)2)
Anavip has an upfront dose of 10 vials, which only take 1 minute to reconstitute. They do suggest repeating the initial 10 vial dose until control is gained. The late dosing is 4 vials if symptoms re-emerge. Each vial costs about $1,220.
In a head-to-head trial, late coagulopathy was observed in 11/37 patients in the CroFab group and 4/39 patients in the Anavip group ( 29.7% vs. 10.3%, p < 0.05).
Based on a review of Anavip at my institution, we found the following benefits: faster time to administration, lower incidence of prolonged and delayed-onset coagulopathy, and cost savings of over $25,000 per patient based on mean doses administered in clinical trials.
In clinical trials, average number of CroFab vials per patient was 14.2 while average number of Anavip vials per patient was 16.1.
Are you more of a CroFabber or AnaVIP? At my institution, we were on the CroFab side but switched to Anavip because of cost savings and quicker administration times.
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