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Recurrent coagulopathy after rattlesnake bite requiring continuous intravenous dosing of antivenom.

Hwang CW, Flach FE - Case Rep Emerg Med (2015)

Bottom Line: His presentation was complicated by significant glossal and oropharyngeal edema requiring emergent cricothyrotomy.His clinical course rapidly improved with the administration of snake antivenom (FabAV); the oropharyngeal and upper extremity edema resolved within several days.Envenomation may result in latent venom release from soft tissue depots that can last for two weeks.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, University of Florida College of Medicine, 1329 SW 16th Street, P.O. Box 100186, Gainesville, FL 32610-0186, USA.

ABSTRACT
Context. Snakebite envenomation is common and may result in systemic coagulopathy. Antivenom can correct resulting laboratory abnormalities; however, despite antivenom use, coagulopathy may recur, persist, or result in death after a latency period. Case Details. A 50-year-old previously healthy man presented to the emergency department after a rattlesnake bite to his right upper extremity. His presentation was complicated by significant glossal and oropharyngeal edema requiring emergent cricothyrotomy. His clinical course rapidly improved with the administration of snake antivenom (FabAV); the oropharyngeal and upper extremity edema resolved within several days. However, over the subsequent two weeks, he continued to have refractory coagulopathy requiring multiple units of antivenom. The coagulopathy finally resolved after starting a continuous antivenom infusion. Discussion. Envenomation may result in latent venom release from soft tissue depots that can last for two weeks. This case report illustrates the importance of close hemodynamic and laboratory monitoring after snakebites and describes the administration of continuous antivenom infusion, instead of multidose bolus, to neutralize latent venom release and correct residual coagulopathy.

No MeSH data available.


Related in: MedlinePlus

Fang marks located on the patient's right upper extremity with local tissue damage, edema, ecchymoses, and mottling.
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fig2: Fang marks located on the patient's right upper extremity with local tissue damage, edema, ecchymoses, and mottling.

Mentions: His right upper extremity was noted to have fang marks 2.5 cm apart in the first dorsal webspace (Figure 2). There was severe amount of edema over the palmar and dorsal surface of the right hand extending proximally to the wrist with mottling and ecchymoses of the right hand. The compartments remained compressible, capillary refill remained brisk, and oxygen saturation remained 95–99% SpO2 in all five fingers. Orthopedic surgery was consulted by the emergency physicians for the evaluation of progressive swelling and potential compartment syndrome; no surgical intervention was performed as the patient maintained a radial pulse by Doppler signal and brisk capillary refill.


Recurrent coagulopathy after rattlesnake bite requiring continuous intravenous dosing of antivenom.

Hwang CW, Flach FE - Case Rep Emerg Med (2015)

Fang marks located on the patient's right upper extremity with local tissue damage, edema, ecchymoses, and mottling.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4309308&req=5

fig2: Fang marks located on the patient's right upper extremity with local tissue damage, edema, ecchymoses, and mottling.
Mentions: His right upper extremity was noted to have fang marks 2.5 cm apart in the first dorsal webspace (Figure 2). There was severe amount of edema over the palmar and dorsal surface of the right hand extending proximally to the wrist with mottling and ecchymoses of the right hand. The compartments remained compressible, capillary refill remained brisk, and oxygen saturation remained 95–99% SpO2 in all five fingers. Orthopedic surgery was consulted by the emergency physicians for the evaluation of progressive swelling and potential compartment syndrome; no surgical intervention was performed as the patient maintained a radial pulse by Doppler signal and brisk capillary refill.

Bottom Line: His presentation was complicated by significant glossal and oropharyngeal edema requiring emergent cricothyrotomy.His clinical course rapidly improved with the administration of snake antivenom (FabAV); the oropharyngeal and upper extremity edema resolved within several days.Envenomation may result in latent venom release from soft tissue depots that can last for two weeks.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, University of Florida College of Medicine, 1329 SW 16th Street, P.O. Box 100186, Gainesville, FL 32610-0186, USA.

ABSTRACT
Context. Snakebite envenomation is common and may result in systemic coagulopathy. Antivenom can correct resulting laboratory abnormalities; however, despite antivenom use, coagulopathy may recur, persist, or result in death after a latency period. Case Details. A 50-year-old previously healthy man presented to the emergency department after a rattlesnake bite to his right upper extremity. His presentation was complicated by significant glossal and oropharyngeal edema requiring emergent cricothyrotomy. His clinical course rapidly improved with the administration of snake antivenom (FabAV); the oropharyngeal and upper extremity edema resolved within several days. However, over the subsequent two weeks, he continued to have refractory coagulopathy requiring multiple units of antivenom. The coagulopathy finally resolved after starting a continuous antivenom infusion. Discussion. Envenomation may result in latent venom release from soft tissue depots that can last for two weeks. This case report illustrates the importance of close hemodynamic and laboratory monitoring after snakebites and describes the administration of continuous antivenom infusion, instead of multidose bolus, to neutralize latent venom release and correct residual coagulopathy.

No MeSH data available.


Related in: MedlinePlus