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Patient case: Snake Bite

Patient case: Snake Bite

Discussion

A 28-year-old man is brought to the emergency department by his friends after being bitten on the lower leg by a snake while hiking in a remote forested area. He describes feeling an immediate sharp pain at the bite site, followed by swelling and redness that have rapidly worsened over the past hour. He also reports dizziness and nausea.

On examination, he appears anxious and diaphoretic. His vital signs show a blood pressure of 95/60 mmHg, heart rate of 110 bpm, and respiratory rate of 22 breaths per minute. The affected leg is swollen, with two visible puncture wounds surrounded by erythema and ecchymosis. There is evidence of progressive tissue necrosis, and he complains of muscle weakness. Laboratory tests reveal prolonged coagulation times and thrombocytopenia.

Given the patient’s symptoms and clinical findings, snake envenomation is suspected. He is administered intravenous fluids, pain management, and appropriate antivenom therapy. He is closely monitored in the intensive care unit for potential complications, including shock, coagulopathy, and respiratory failure. Over the next few days, his condition stabilizes, and the swelling gradually subsides with supportive care.

Questions
1. What is the most likely cause of this patient’s symptoms?

a) Allergic reaction to an insect bite

b) Bacterial cellulitis

c) Snake envenomation

d) Deep vein thrombosis

2. Which of the following clinical findings suggests severe envenomation?

a) Localized swelling with no systemic symptoms

b) Progressive tissue necrosis, thrombocytopenia, and coagulopathy

c) Mild pain and erythema around the bite site

d) Fever and generalized rash

3. What is the most appropriate immediate management for this patient?

a) Tourniquet application to limit venom spread

b) Surgical excision of the bite wound

c) Administration of intravenous fluids, pain control, and antivenom

d) Application of ice to the bite area

4. Which of the following is the best way to prevent complications from snake bites?

a) Sucking out the venom and cutting the bite site

b) Immobilizing the limb and seeking medical help immediately

c) Running away quickly to reduce venom spread

d) Taking herbal remedies immediately after a bite

Reveal answers

Answers

1. Answer: c) Snake envenomation

The patient’s history of a snake bite, rapid swelling, tissue necrosis, and systemic symptoms (hypotension, coagulopathy) strongly suggest venomous snake envenomation.

2. Answer: b) Progressive tissue necrosis, thrombocytopenia, and coagulopathy

Severe envenomation can cause systemic effects, including shock, bleeding disorders, and local tissue destruction, requiring urgent medical intervention.

3. Answer: c) Administration of intravenous fluids, pain control, and antivenom

The mainstay of treatment for venomous snake bites includes supportive care, wound management, and antivenom therapy when indicated. Tourniquets and ice application can worsen the condition and should be avoided.

4. Answer: b) Immobilizing the limb and seeking medical help immediately

Keeping the affected limb immobilized at heart level and seeking immediate medical care minimizes venom spread and improves outcomes. Cutting the wound or sucking venom is ineffective and harmful.