A 62-year-old male presented thirty minutes after being bitten by a snake in his garden. He stated that he thinks his finger was bitten twice. The patient presented with pain and swelling of his right hand and forearm.
The patient sustained a snake bite to his right index finger with significant edema and pain extending to his right wrist. Several areas of swelling were marked on the patient’s skin with timestamps and originally were contained to the dorsum of the hand. Labs were without abnormality, and the patient was not hypotensive.
The edema spread proximally to the right wrist and Crotalidae polyvalent immune fab (CroFab) was administered per hospital guidelines (six vials initially). The patient made a full recovery and was discharged home forty-eight hours after.
Cottonmouth snakes appear differently as juveniles; however, they are part of the subfamily Crotalinae and envenomation can still occur with significant symptoms.
CroFab should be administered for hypotension, altered mental status, the progression of swelling beyond bite site, or significant laboratory abnormalities including thrombocytopenia, elevated INR, or fibrinogen less than one hundred mg/dL .
Ruha AM et al. Late hematologic toxicity following treatment of rattlesnake envenomation with crotalidae polyvalent immune Fab antivenom. Toxicon. 2011;57:53–59. PMID: 20920517
Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2020 SAEM Annual Meeting | Copyrighted by SAEM 2020 – all rights reserved. View other cases from this series on ALiEM.