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Critical care
The use of rotational thromboelastometry to guide management following Bitis nasicornis envenoming
  1. Charles Nye1,
  2. David Griffith Lalloo2 and
  3. Timothy Hooper3
  1. 1Neurology Department, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
  2. 2Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
  3. 3Department of Critical Care, NHS Highland, Inverness, UK
  1. Correspondence to Dr Charles Nye; charles.nye{at}nhs.net

Abstract

A man in his thirties presented following Bitis nasicornis envenoming. His coagulation was assessed using rotational thromboelastometry (ROTEM). It identified a subtle abnormality, not detected using standard laboratory assessments of coagulation, and influenced ongoing management. The abnormality resolved following treatment with antivenom. There are few documented cases of using ROTEM to assess patients following haemotoxic envenoming. This case highlights some of the potential benefits and limitations of doing so.

  • Poisoning
  • Travel medicine
  • Adult intensive care
  • Intensive care
  • Toxicology

https://doi.org/10.1136/bcr-2023-258319

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    Footnotes

    • X @charlie_nye

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: In accordance with the principles ICMJE Recommendations 2018 Charlie Nye (Lead Author) wrote the original draft of the report, as well as the created the figures and carried out the analysis, and interpretation of the patient data. Carried out multiple revisions. CN agreed to be accountable for all aspects of the work, actively participating in addressing any queries related to accuracy or integrity. TH made significant contributions to the case report by critically reviewing and evaluating the manuscript’s content and making revisions. He brought expertise to the interpretation of clinical implications based on his experience with ROTEM and Critical care. He ensured clear presentation of medical information. DGL made significant contributions to the case report by critically reviewing and evaluating the manuscript’s content and making revisions. He brought expertise to the background information and the reports clinical implications based on his experience with Snake bites and antivenom. The following authors gave final approval of the manuscript: CN, TH, DGL.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.