Rattlesnake Envenomation

Case Summary:

The patient in this case is a three year old boy brought in by his 17-year-old mom after he came inside from playing around the campsite, holding his arm, and crying inconsolably. Due to his age and distress, he is unable to provide further information regarding what happened. 

Learners will examine the patient and note vital signs significant for tachycardia, mild hypotension, right arm swelling and two small puncture wounds to the extremity concerning for a snake envenomation. They should mark the area of swelling, start an IV in the unaffected extremity, check labs/coags, elevate the arm to 60 degrees, and administer pain control. Once pain control is given, Carlos will confirm that he was bitten by a snake and that his face feels ‘tingly’. He will note that the snake sounded like a ‘bee buzzing’. 

Edema will progress and the learners will need to recognize that antivenom is indicated, order it, and administer in conjunction with toxicology/poison control and a pharmacist. For junior learners, the case ends with disposition to the PICU. 

For senior learners, the patient goes on to have an anaphylactoid reaction to the antivenom, necessitating treatment with epinephrine, slowed infusion rate, and/or cessation of infusion in conjunction with discussion with poison control.


The following slides are deliberately “view only” (since they are the master slides). To use them – you simply need to copy and paste the slides you would like to use into your own, new Google Slides Document.

How can you make your Virtual Resus Room using these slides?
  1. Click on link for Room
  2. This will open in a new tab as a “View Only” Google Slide document
  3. Google Slide -> File -> Make a copy -> Entire presentation
  4. Copy document pops up. Name case. Press Ok.
    • Name slide set something generic like “Room A” so it doesn’t contain spoilers when you share with your learners!
  5. This will open new tab as your editable Google Slide document
  6. File -> Version History -> Name Current Version -> “Unused Room”
    • This will save this untouched version of the room before the case starts (See “Resetting Room after Case” in “Running the Sim”:)
Case Written By:

Melissa Joseph MD, Elizabeth Sanseau MD, MS, Anita Thomas MD MPH, Nick Brandehoff MD, Julie Augenstein MD, Megan Shuster PharmD, Gunjan Tiyyagura MD MHS, Marc Auerbach MD. Virtual Room developed by Melissa Joseph and Sarah Foohey.

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