06-03-2009, 01:56 PM
A 19-year-old man is enjoying his usual state of good health while traipsing about behind his farmhouse with friends during a weekend get together that has included substantial consumption of alcoholic libations. Unfortunately the merry group comes upon a snake that produces an interesting rattling sound as they approach. Predictably the snake does not retreat when the young man kicks at it and soon afterward the man is at the emergency department (ED) with severe pain and edema of lower left extremity centered around two puncture wounds in his gastrocnemius. 12 vials of Crotalidae polyvalent antivenin are administered over the next 12 hours and the man is released the following day with intact neurovascular function of the envenomated limb and mostly resolved localized edema. One week later the patient returns to the ED with complaints of headache, fever, joint pain and muscle aches. Vital signs are temperature 103°F (39.5°C), blood pressure (BP) 115/70 mm Hg, heart rate 108 beats per minute and respiration rate 15 breaths per minute. Physical examination is contributory for a generalized lymphadenopathy, warmth, swelling, pain and decreased range of motion of the shoulders, hips, and knees and a red purpuric rash with serpiginous borders on the dorsolateral aspects of the hands and feet terminating at the palmar and plantar junctions. Screening laboratory tests are pending. What treatment will most likely improve the patient's presumptive condition?
A. Aspirin and intravenous (IV) immunoglobin
B. Crotalidae polyvalent immune Fab Ovine (CroFab)
C. Diphenhydramine and oral prednisone
D. Epinephrine and Ibuprofen
E. IV normal saline fluid bolus
A. Aspirin and intravenous (IV) immunoglobin
B. Crotalidae polyvalent immune Fab Ovine (CroFab)
C. Diphenhydramine and oral prednisone
D. Epinephrine and Ibuprofen
E. IV normal saline fluid bolus