Publication Date: September 2018 (Volume 20, Number 9)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 9/1/2021
Specialty CME Credits:: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME and 1 Pharmacology CME credits, subject to your state and institutional approval.
A 4-year-old boy is brought to your ED by his distraught parents. An hour ago, he was in the backyard by the pool, playing with what they thought was a toy. He started screaming, and when the mother moved closer, she saw a foot-long black, yellow, and red snake in his hand. She frantically pulled it off him and threw it into the bushes. She reports that she had to pull quite hard before it would release. The child has several small marks on the palm of his left hand. There is minimal redness, and no swelling is apparent. The dad took a picture of the snake with his phone and you can tell quickly that it was a coral snake. The child is asymptomatic currently, but the nearest pediatric ICU is over an hour away. You wonder: should you transfer this patient to the ICU or can you observe him in the ED—and should you start antivenom?
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?