A 62-year-old woman entered the emergency department (ED) with a chief complaint of a snake envenomation to the left foot about one hour ago while hiking in a southwestern mountain trail. She reports the snake was small and tan and she did not see a rattle. The patient has no medical problems and states the pain in 2/10 and only present at the left foot.


On physical examination, the patient is in no acute distress. Her vital signs were as follows: temperature, 99.° F; pulse, 110 and regular; and blood pressure 100/65 mm Hg. Pulse oximetry on room air showed 100% saturation. Respiratory, cardiopulmonary, abdominal and neurological examinations were normal. Her left foot revealed 2 puncture marks at the left lateral mid foot with very mild swelling that did not ascend past the ankle. Skin was red and tender at the bite site and no neurological were present. No lymph node tenderness was present.

The patient had a WBC count of 12,100; hemoglobin, fibrinogen and platelet counts were normal.

At this point, the leading diagnoses dry bite from a rattlesnake or non-venous snake bite. The patient was discharged to home after the wound was cleaned and dressed. Tetanus status was updated and the patient was given a 7 day course of cephalaxin and told to see her physician in 5-7 days as needed.

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