Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section V: Environmental Medicine

Case Study 10: College Trip

S: An 18-year-old male was bitten on the left forearm by a 4-foot snake that he was attempting to capture and bring back to camp. In the ensuing confusion, the snake escapes. The man is unable to describe it other than being dark in color and very fast. He complains of pain in the mid left forearm and of feel- ing very faint. Despite a stiff headwind on the lake, the patient is carried to a canoe for evacuation to the marina. Unfortunately, the paddlers are intoxicated and become lost in the darkness. They return to camp two hours later, unsure of where they had been. The patient is reevaluated by a Wilderness First Responder who had remained sober. The patient, now calm and alert, reports no allergies and is not taking any medication. He has no history of significant medical problems and had eaten dinner 4 hours ago, which included a six-pack of beer. There was no other recent trauma or illness. O: The patient is awake but subdued, with normal mental status. He has two small puncture wounds on his left forearm. There is minimal swelling extending 7 cm proximal to the bite, but no discoloration. The area is mildly tender to the touch. Distal CSM is intact. There are no other injuries. Vital signs at 10:15 pm: BP: unavailable, Pulse: 80, Resp: 16, Temp: appears normal, Skin W/D/P, C: Awake and oriented. A: 1. Pit viper strike A’: Local and systemic effects of the toxin 2. Dark, windy A’: Hazardous evacuation P: 1. Rings and watch removed from the arm. Continued monitoring. 2. Keep overnight in camp, evacuate in daylight Discussion: The decision to stay in camp was based on the low risk of further serious problems from the snakebite and the high risk of waterborne evacuation in the dark. Proceeding with evacuation in the morning was appropriate, even though symptoms had not progressed. Problems with blood coagulation and compart- ment syndrome can develop later and should be monitored. A bite is also considered a high-risk wound. Scene A college vacation trip to the shores of Lake Powel in Utah. It is early evening, the sky is clear, and the temperature is about 20°C with winds of 25 knots from the south. The camp is located approxi- mately 7 miles by water from the marina at Bullfrog.