ACMT Toxicology Visual Pearls: Exotic Viper 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?
- Apply ice to the bites
- Measure compartment pressures in the right arm and forearm
- Perform a fasciotomy
- Remove the tourniquets and order hematologic studies
- Use a venom extractor to reduce venom burden

The seeds of the Suicide Plant, when ingested, may result in significant toxicity, including the ECG findings shown. Which kind of toxicity does it cause?
For the third consecutive year, we provide a quick summary of some important Emergency Medicine pharmacotherapy articles from the last 12 months. We have tried to focus on articles you may have missed, but are potentially high-impact for improving clinical practice in the ED. Without further ado, we present the 8 must-know EM pharmacotherapy articles of 2016.
Medical providers commonly encounter patients in the emergency department who state they are anticoagulated with warfarin, but they have no idea what dose they are taking. “I know that I take two pills of warfarin daily.” Dosing becomes critically important especially when continuing their medication as an inpatient, refilling their medications, or adjusting their outpatient dose because of an inappropriately high or low INR level. How can you determine the patient’s warfarin dose?