Tracheal intubation prevented with administration of Fab antivenom after severe crotaline envenomation.
BACKGROUND
Crotaline snake envenomations are common, but severe crotaline envenomations are infrequent. Death from severe envenomation is usually from upper airway edema and respiratory failure. Published reports of severe respiratory compromise and anaphylactoid reactions are rare. Currently, FabAV (Crotalidae polyvalent immune Fab [Ovine] [CroFab]) is the mainstay of crotaline envenomation treatment; however, FabAV has been approved for only mild and moderate envenomations.


METHODS
We describe a case of a male with severe systemic effects and airway compromise after crotaline envenomation. The patient's systemic effects and upper airway edema substantially improved after antivenom infusion and before epinephrine administration. Endotracheal intubation was averted, clinical deterioration was avoided, and improvement occurred after prompt FabAV use.


CONCLUSIONS
Fab antivenom likely prevented endotracheal intubation in our case of severe crotaline envenomation.
Bebarta
Vikhyat S
VS
Department of Emergency Medicine, Wilford Hall Medical Center, San Antonio, Texas, USA.
Ferre
Robinson M
RM
Peck
Michael
M
D000328:Adult; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments / Q000008:administration & dosage / Q000627:therapeutic use*; D007442:Intubation, Intratracheal; D008297:Male; D012909:Snake Bites / Q000150:complications / Q000628:therapy*; D017819:Viperidae
D000997:Antivenins; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments