Polyvalent ASV (systemic envenoming), ASV — repeat, Adrenaline (before ASV, optional), Adrenaline (ASV reaction), Atropine + Neostigmine (neurotoxic; less useful in krait), Amoxicillin-clavulanate (necrosis / infection only), Td (after coagulopathy corrected)
Advice and when to refer
First aid: Keep still, splint the limb, remove rings; no tourniquet, cutting or sucking; 20-minute whole blood clotting test on arrival and every 6 h (MoHFW 2017, latest)
Investigations
First visit
20-minute whole blood clotting test (20WBCT) — On arrival — blood that does not clot means venom-induced coagulopathy.
CBC, creatinine, urine routine (colour) — Bleeding, kidney injury, myoglobin or haemoglobin in urine.
ECG — Baseline.
Only if indicated
PT/INR, APTT, fibrinogen — Where available, alongside 20WBCT.
Single-breath count / SpO₂ — Ptosis or neurotoxic signs.
Serum potassium, CK — Myotoxic bite (sea snake, Russell’s viper).
Follow-up and monitoring
20WBCT every 6 h — Until clotting is normal on two tests; repeat ASV if still abnormal at 6 h.
Urine output and creatinine — Daily for Russell’s viper bites (kidney failure).
Locked
The adult dose for each drug
The child dose, where the card gives one
Indian brand names for each drug, with a link to buy
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.