ARDS secondary to Tiger snake bite

Case contributed by Assoc Prof Craig Hacking

Presentation

Day 2 in ICU post Tiger snake bite. Worsening ventilation, increasing FIO2.

Patient Data

Age: 30-35 years
Gender: Male

ETT, NGT and right jugular CVL are well positioned.

Diffuse hazy and coalescent airspace opacification bilaterally with a predominance in the lower and mid zones (which has increased from the initial daily CXRs).

Case Discussion

The patient was treated for ARDS and made a slow recovery, spending 10 days in ICU. This was despite antivenom which was given in the emergency department 1 hour after the bite.

Tiger snake envenomation can cause 1:

  • consumptive coagulopathy (VICC, venom-induced consumptive coagulopathy) which is the most common effect
  • myotoxicity
  • neurotoxicity

ARDS in this case is probably multifactorial due to all these effects (at least this is what was hypothesized by the ICU physicians and toxicologists).

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