Instructions:

1. Read assigned case.

2. Ensure ABCs are secure given data you have.
3. Assess the patient’s history given data you have.
4. Here are a couple ways we can measure inflammation and erythema in snake bites (Measuring serial
circumferences at 3 specified locations is considered most objective way to measure swelling).

Could measure leading

edge of swelling
(more subjective)

5. Evaluate bite severity given data you have. Use one of the scoring tools as well as calculate a Snake Bite Severity
Score (SSS).
6. Decide whether antivenom is indicated.
7. What other medications may be indicated?
Case 1

Subjective: Patient is a 29 yo M presenting to the ED status post a snake bite to the dorsal aspect of the left hand. The
incident occurred approximately 1 hour ago, he had reached down to grab the snake he found under his wood pile. He
took a picture of the snake and has that on his phone. Patient appears in no apparent distress. You can see small fang
marks on his hand. There is currently no swelling, but the patient reports 3 out of 10 pain to the area only. He hands are
tremulous and he is anxious.

PMH: ADHD
Allergies: Amoxicillin, Pollen, Papaya
Home medications: Concerta

Vitals: BP 116/76 HR 97 RR 20 sPO2 99% on Room Air

Measurements: Circumference Hand 23 cm / Forearm 30 cm / Upper arm 39 cm

Repeat vitals/labs [taken after decision to treat or not treat]:

Vitals: BP 110/72 HR 79 RR 12 sPO2 100% on Room Air
Measurements: Circumference Hand 23 cm / Forearm 30 cm / Upper arm 39 cm
Labs: Same
Case 2

Patient is a 6 yo M presenting to the ED status post a snake bite to the pinky finger on his right hand. The incident
occurred less than an hour ago. He said it was making a ‘cool’ noise and wanted to pet it. They were camping at Brown
County State Park. The dad went to the location the 5 yo said he got bit and took a picture of the snake. The child is
anxious and crying, and keeps repeating that it hurts. His finger is purple in color compared to the rest of his fingers, and
he does have swelling and redness that extends slightly beyond his wrist.

PMH: None
Allergies: None
Home medications: None

Vitals: BP 99/59 HR 132 RR 32 sPO2 97% on Room Air

Measurements: Circumference Hand 16 cm / Forearm 18 cm / Upper arm 20 cm

Repeat vitals/labs [taken after decision to treat or not treat]:

Vitals: BP 100/60 HR 112 RR 20 sPO2 98% on Room Air
Measurements: Circumference Hand 16.5 cm / Forearm 18 cm / Upper arm 20 cm
Labs: Same
Case 3

Patient is a 84 yo F presenting to ED following snake bite to left ankle. Patient was gardening in some tall grass when she
had stepped backward and felt the bite. She ran away from her garden, but got her husband to go out and see what it
was. When he got to their driveway he snapped a picture of this. The patient is describing 9 out of 10 pain to the bite
site. The area is red and swollen midway up the calf. She has pitting edema of both extremities.

PMH: Diabetes, hypertension, congestive heart failure, COPD

Allergies: Doxycycline
Home medications: Glargine, metformin, carvedilol, furosemide, atorvastatin, aspirin, Symbicort

Vitals: BP 134/98 HR 101 RR 19 sPO2 94% on Room Air

Measurements: Circumference Foot 28 / Calf 40 / Thigh 60

Repeat vitals/labs [taken after decision to treat or not treat]:

Vitals: BP 126/91 HR 96 RR 14 sPO2 96% on Room Air
Measurements: Circumference Foot 29 / Calf 41 / Thigh 60
Labs: Same, except PT/INR as below