Abstract
BackgroundSnake envenomation is an underestimated pathology in sub-Saharan Africa associated with severe emergencies, and even death in case of late presentation. We herein present a case of severe envenomation managed at the surgical emergency department of the Yaoundé Central Hospital.Case presentationWe report a case of a 47-year-old female farmer with no relevant past history who sustained a snakebite by an Echis occellatus viper during an agricultural activity. Her initial management consisted in visiting a traditional healer who administered her some herbal remedies orally and applied a white balm on the affected limb. Due to progressive deterioration of her condition, she was rushed to our surgical department where she arrived 20 h after the snakebite incident. On admission she presented in a state of shock (suggestive of an anaphylactic shock), coagulopathy, renal impairment, and gangrene of the entire right upper limb. Emergency management consisted of fluid resuscitation, repeated boluses of adrenaline, a total of three vials of polyvalent anti-venom sera, promethazine, analgesics, corticosteroids, and administration of fresh frozen plasma. Within four hours of emergency department hospitalisation she developped signs of sepsis and persistent hypotension refractory to fluid resuscitation, suggestive of an associated septic shock. Management pursued with antiobiotherapy and administration of noradrenaline through an electric pump syringe to achieve a mean arterial blood pressure above 65 mmHg. The patient deceased at the 10th hour of hospitalisation in a state of circulatory collapse unresponsive to vasopressors, coagulopathy, renal failure, sepsis and gangrene of the right forearm.ConclusionThe authors highlight this unusual presentation but equally pinpoint how late presentation to the emergency department, harmful tradition practices, poverty and cultural beliefs can adversely affect the prognosis of snakebite in our setting.
Highlights
R Case presentation: We report a case of a 47-year-old female farmer with no relevant past history who sustained a A snakebite by an Echis occellatus viper during an agricultural activity
The patient deceased at the 10th hour of hospitalisation in a state of circulatory collapse unresponsive to vasopressors, coagulopathy, renal failure, sepsis and gangrene of the right forearm
R encountered in the management of snake envenomation in Cameroon [12]
Summary
The authors highlight this unusual presentation but pinpoint how late presentation to the emergency department, harmful tradition practices, poverty and cultural beliefs can adversely affect the prognosis. Case presentation A 47-year-old female farmer residing in a semi-rural area of Yaounde was brought to the emergency department of the Yaounde Central hospital of Cameroon with complaint of a bite on the pulp of her right thumb 20 h prior to presentation, while working in her farm by an Echis occellatus viper She killed and beheaded the snake (Fig. 1), imthumb. At 4 h of hospitalisation she had received 3 l of normal istration of one vial of anti-venous serum, within eight saline, but was still haemodynamically unstable with hour of the snake bite incident despite seeking tradpersistence of anuria. Her temperature rosed to 38.9°C. itional medicine before. R encountered in the management of snake envenomation in Cameroon [12]
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