Posted by Andy Jagoda MD in: What's Your Diagnosis , trackback
Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got last month’s case on Less-Lethal Law Enforcement Weapons: Clinical Management of Associated Injuries in the Emergency Department right.
Case Presentation: Terrestrial Envenomations in Pediatric Patients: Identification and Management in the Emergency Department
An 8-year-old boy presents after a rattlesnake bite on his right ankle…
- The boy was hiking with his parents when he was bitten by a rattlesnake. He says the pain began almost instantly.
- On examination in the ED, he has edema extending from the mid-foot to proximal to the knee. The calf compartments are soft. Ecchymosis is noted as well as oozing from the 2 puncture wounds.
- You order laboratory studies and wonder if antivenom administration is warranted.
The patient’s laboratory test results were as follows: hemoglobin, 17.5 g/dL; platelets, 52×109/L; prothrombin time, 58 seconds; and fibrinogen, <5 mg/dL. The patient was administered 6 vials of Crofab® antivenom; however, despite the initial loading dose of antivenom, the edema progressed, although there was some improvement in the laboratory parameters when they were checked again.
Because of the worsening edema, an additional 6 vials of antivenom were administered, and edema progression halted. Subsequent laboratory values were improved. The patient was admitted overnight for serial examinations, follow-up laboratory tests, and additional antivenom therapy. After discharge, he was seen twice in follow-up and did not develop any evidence of recurrent thrombocytopenia or coagulopathy. The patient made a full recovery.
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