DISCHARGE RECOMMENDATIONS:  CONTROL  &  ASYMPTOMATIC  ALGORITHMS

1. If patients were ever symptomatic, they should be held for at least 48 hours after resolution of all signs and symptoms, and the following steps should be completed prior to discharge (Control Algorithm):

a. Repeat blood tests before releasing the patient to ensure resolution of coagulopathy.

b. Administer a booster dose of tetanus toxoid if needed.

c. Patients should be instructed to return if any new or worrying signs or symptoms develop.

d. Patients with significant hemotoxic envenomations require 2 weeks of bleeding precautions and serial labs showing normalization before return to duty!

e. If patient has polyphasic recurrence, restart treatment algorithm and timeline to discharge.

2. Serum sickness is characterized by flu-like symptoms ± rash that typically develops between 1 - 3 weeks after antivenom administration. It is rare with highly purified modern antivenoms but may occur more frequently with some of the second and third line antivenoms listed in this CPG.^94–97 Serum sickness may be uncomfortable but is not dangerous. Management is either symptomatic, or, in the case of significant discomfort, can be treated with oral antihistamines and/or oral steroids if needed.^{94,95,97–99}

3. If patients were asymptomatic for 6 hours, they can leave the clinic but should remain within 1 hour distance and must return every 6 hours for reassessment until hour 48 or snake ID confirmed as non-venomous by expert as detailed in the asymptomatic algorithm. Symptoms usually begin 6 hours after bite but may have delayed onset on the order of days.

Refer to the Asymptomatic Algorithm for detailed assessment intervals and disposition guidance.