Antivenom Shortage Against the Clock - Toxicology clinical simulation case. A 34-year-old male bitten on the right index finger by a brightly banded coral...
Age: 34 • Gender: Male • Setting: Emergency Triage
Clinical Presentation & History
A 34-year-old male bitten on the right index finger by a brightly banded coral snake while gardening in South Florida. He arrives 55 minutes after the bite, alert, diaphoretic, and complaining of localized paresthesias with rapidly progressing distal limb weakness. The only effective coral snake antivenom (NACSA / Cor-Fab) is 90 miles away and supply is critically low across the state.
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
Triage & Initial Stabilization
Antivenom Logistics & Acquisition
Neurotoxic Crisis & Airway Decision
Antivenom Administration & ICU Disposition
High-Yield Clinical Pearls
North American coral snake (Micrurus fulvius) envenomation produces minimal local findings but delayed, potentially fatal neurotoxicity via presynaptic phospholipase A2 toxins.
Antivenom (NACSA / Cor-Fab) cannot reverse established postsynaptic blockade — it must be given before complete paralysis.
Avoid cut-and-suck, tourniquets, and empiric CroFab (ineffective for coral snakes); do NOT use succinylcholine for RSI due to hyperkalemia risk.
Early proactive intubation, mechanical ventilation, and ICU admission are the bridge to recovery; paralysis may persist 24–96 hours despite antivenom.
Test Your Clinical Reasoning in Real Time
Step into the active clinician role for this case. Order diagnostic tests, analyze live laboratory panels, and navigate branching clinical decisions with real-time feedback.