Rattlesnake Envenomation in a Venom-Naive Man With Significant Coagulopathy and Severe Oropharyngeal Edema Requiring Emergent Surgical Airway

Abstract

The majority of snakebite envenomation events in North America are attributed to rattlesnakes with pit-vipers responsible for nearly all envenomation events. Significant morbidity is associated with rattlesnake envenomation including local tissue destruction and coagulopathy. Severe oropharyngeal edema requiring emergent securing of airway has been reported in victims with no prior exposure to pit-vipers but is exceptionally rare. We present a case report of a venom-naive male in his early twenties who received a pit-viper bite to the right thumb, resulting in an anaphylactoid reaction complicated by severe oropharyngeal edema, coagulopathy, and persistent respiratory failure requiring prolonged ventilator support. This case highlights how anaphylactic and anaphylactoid reactions are nearly identical in presentation and may be associated with significant morbidity. Regardless of whether the underlying etiology is anaphylaxis or anaphylactoid, the management should focus on providing CroFab ® early in the clinical course.

Clinical and Evolutionary Implications of Dynamic Coagulotoxicity Divergences in Bothrops (Lancehead Pit Viper) Venoms

“…TEG is extremely useful for measuring blood coagulation parameters as a myriad of aspects are ascertained simultaneously, including amplitude (A) (strength of the clot) and reaction time (R) (time until clot formation), thus aiding in the diagnosis and treatment of patients admitted to hospital with coagulopathy. In fact, it has proven useful in guiding the management of coagulopathy in snakebite patients [ 63 ]. This technology has also gained traction in the scientific research world, in which researchers use it to test the coagulotoxic action of diverse snake venoms on fibrinogen and plasma, including Bothrops species [ 9 , 36 , 37 , 64 , 65 ].…”