MedBugs: SAQ #243

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Case: Snake envenomation with collapse

A 62-year-old woman collapses after a snake bite in southern NSW. She is first seen at a peripheral hospital and has an episode of collapse with no pulse.

1. State the immediate management including drug doses. 4 marks

On arrival at a regional hospital, her GCS 15, mild bleeding from tongue and posterior pharyngeal wall.

2. List 4 elements of examination or investigations you would perform and what abnormality do you anticipate may be present in an envenomed patient 8 marks

3. List two absolute indications for immediate antivenom administration prior to pathology test results 1 mark

Her coagulation profile returns: PT >120 sec and APTT 150 sec

4. What is the diagnosis? List 2 species of snake that could have envenomed this patient. 3 marks

5. List 2 delayed complications and features that could occur with snake envenomation and treatment in this patient. 2 marks

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