(533) From Venom to Victory: Overcoming Critical Envenomation With Antivenom

Introduction: Each year, 1.8 to 2.7 million people worldwide suffer venomous snakebites, resulting in 80,000 to 138,000 deaths. Snake envenomation is a rapidly progressing disease with life-threatening complications. While there is a low annual mortality rate of around five deaths, morbidity remains high. Snakebites can lead to long-term physical effects like amputation, paralysis, disability, as well as psychological implications. Awareness of available antivenom is crucial, and a multidisciplinary approach improves patient outcomes. Prompt administration of antivenom has shown to enhance recovery. However, a recent systematic review indicated only 56% of healthcare workers possess sufficient knowledge of snakebite management, underscoring the need for increased education.

Description: 50-year-old female with systolic heart failure presented to the ED following a snakebite that occurred hours prior. She experienced right ankle pain, confusion, vomiting, and required intubation. Despite prompt antivenom administration, DIC and shock ensued. The limb developed diminished pulses, but CT imaging indicated viable arterial flow. In conjunction with Orthopedic surgery and Toxicology after failure to improve with Anavip loading and maintenance doses of CroFab were started. Subsequently her coagulopathy and hemodynamics stabilized within 24 hours, vasopressors were off shortly after. She was extubated, and discharged without surgical intervention however, function of her ankle and foot was limited.

Discussion: In antivenom selection, Anavip is an equine antivenom for North American pit viper envenomation, while CroFab is a sheep-derived antivenom for crotalid envenomation caused by rattlesnakes, copperheads, cottonmouths, and water moccasins. In this case, based on the patient's location and worsening shock, the toxicologist concluded a diamondback rattlesnake bite was the culprit and administered CroFab. Effective communication among the healthcare teams was crucial. The venom response team promptly provided the necessary antivenom, educated the team on administration, and emphasized avoiding surgery for misdiagnosed limb compromise due to fragile, bleeding-prone tissue. Timely antivenom administration controlled venom toxicity, preserved our patients' limbs, and prevented life-threatening coagulopathy.