Case #13

HISTORY

The patient is a 25 year old male from Indiana who calls the paramedics to his trailer home after sustaining a bite to his left hand from his pet Diamondback Rattlesnake 2 hours prior.

PHYSICAL EXAM

• General: The patient is intoxicated and laughing while clutching a bottle of tequila in his right hand.
• HEENT: PERRL, mouth missing 5 teeth
• Neck: Supple
• Lungs: CTA
• Ht: RRR S1S2 no murmurs
• Abd: Soft nontender
• Ext: Moderate to severe swelling, blistering and ecchymosis from the hand to the elbow with diminished pulse distally
• Neuro: Grossly intact (although difficult exam secondary to patient's intoxicated state)
• Skin: Multiple tattoos including: a bald eagle on one arm, a skull and cross bones on the other, coiled snake on the back, and valentine's heart with the name "WANDA" on his chest.

Toxin and Discussion References