The following case was seen in the Jacobi ED and recently published by Drs. S.Ayala and M.Touger in conjunction with Drs. C.Birmingham and L.Nelson of the NYC Poison Control Center. Some case features have been altered to fit this format.
A 25-year-old man with a history of depression and bipolar disorder purchased a snake which, he was told, was “devenomated.” The next day, the man was bitten on his right hand, and within 3 hours he was discovered “shaking” and nearly apneic. His wife attempted rescue breathing, and when EMS arrived he was intubated due to severe respiratory distress. He was initially brought to a local hospital but was quickly transferred to the regional snakebite center for further management. Upon arrival, he was unresponsive and flaccid, with initial vital signs as follows:
Blood pressure, 156/103 mm Hg; heart rate, 112 beats/min; respiratory rate, 17 breaths/min; temperature, 35.9°C; Spo2, 100% on a ventilator.
The remainder of the physical examination was unremarkable except for the area of the bite: Two pinpoint puncture marks were visible on the dorsolateral portion of the patient’s right fifth digit, and his right upper extremity had mild to moderate edema.
Why did this patient become symptomatic if the snake was “devenomated”? How is the correct antivenom chosen?
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