Should you give antivenom again? — ED Management of North American Snake Envenomations April 11, 2019

Posted by Andy Jagoda, MD in: What's Your Diagnosis , trackback

Case Recap:
A 26-year-old man arrives to the ED via private vehicle with his arm in a makeshift sling. He reports that his pet rattlesnake bit him on his right index finger about 45 minutes ago. His hand and wrist are swollen. He reports that he has no past medical history besides his 3 previous visits for snakebites. He reports having a “reaction” to the snakebite antidote during his last visit. You wonder whether the patient is immune . . . or should you give antivenom again?

Case Conclusion:
The 26-year-old man with 3 prior rattlesnake bites was at risk for significant morbidity related to this fourth snakebite, including impaired use of his dominant hand. Additionally, his initial lab values showed a developing coagulopathy. You decided to administer 6 vials of antivenom, but you ordered pretreatment with IV corticosteroids and antihistamines. You moved the patient to your resuscitation area for administration of antivenom and admitted him to the ICU for continued monitoring; fortunately, there were no side effects with the initial dose of antivenom.

Did you get it right?

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Comments »

1. Khaled Rtemi - April 12, 2019

antibodies against the venom still circulating why we should give !!

2. Dr Suvasish Chakraberty - April 13, 2019

i will give the anti-venom under adrenaline , steroid cover

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