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ACMT Toxicology Visual Pearls: Exotic Viper Envenomation


exotic snake envenomation

A man was bitten twice on the dorsal radial aspect of his right hand while feeding his pet West African Bush Viper. The patient immediately tied multiple tourniquets around his right arm before presenting to the emergency department. During examination he is complaining of swelling and severe pain in his right upper extremity, but has no other complaints. What are the appropriate next steps in managing this patient?

  1. Apply ice to the bites
  2. Measure compartment pressures in the right arm and forearm
  3. Perform a fasciotomy
  4. Remove the tourniquets and order hematologic studies
  5. Use a venom extractor to reduce venom burden

Reveal the Answer
The American College of Medical Toxicology (ACMT) hosts this Toxicology Visual Pearls series
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American C. Abstracts from the 2017 American College of Medical Toxicology (ACMT) Annual Scientific Meeting. J Med Toxicol. 2017;13(1):3-46. [PubMed]
Gold B, Dart R, Barish R. Bites of venomous snakes. N Engl J Med. 2002;347(5):347-356. [PubMed]
Hall E. Role of surgical intervention in the management of crotaline snake envenomation. Ann Emerg Med. 2001;37(2):175-180. [PubMed]
Tanen D, Danish D, Grice G, Riffenburgh R, Clark R. Fasciotomy worsens the amount of myonecrosis in a porcine model of crotaline envenomation. Ann Emerg Med. 2004;44(2):99-104. [PubMed]
Alberts M, Shalit M, LoGalbo F. Suction for venomous snakebite: a study of “mock venom” extraction in a human model. Ann Emerg Med. 2004;43(2):181-186. [PubMed]
Bryan Judge, MD, FACMT

Bryan Judge, MD, FACMT

Associate Professor of Emergency Medicine
Michigan State University College of Human Medicine
Bryan Judge, MD, FACMT

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