You are working in a rural ER in a mountain resort town. A family of four is brought in because they have headache, nausea and malaise without syncope or chest pain. Following a thorough history and physical examination you quickly note the cause of the illness is carbon monoxide (CO) poisoning from a faulty heat generator. The closest HBO chamber is 300 miles away.

A 28-year-old emergency physician is bitten by a diamondback rattlesnake on the right middle finger. He applies a tourniquet and arrives to the hospital approximately four hours after envenomation.

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.