Where I am in Africa, it’s snake bite season. During the rainy season, there is tall grass covering much of the ground, conveniently hiding snakes that are constantly lurking, looking out for field mice and lizards. Families are out in their fields working on their corn crops until dark, and unfortunately some end up encountering snakes.
Carpet vipers (top) are the most aggressive snake in the area, so almost all bites are from them. Though their bite is small (second pic), it packs a punch if enough venom makes its way in. Some people end up with large necrotic wounds when their bites become infected.
Many snakes’ venom interferes with blood clotting. This patient came in with bloody sputum and stools 2 days after a bite. Soon after admission, her IV and IM puncture sites began to bruise and bleed. Her arm swelled so tightly we worried she would develop compartment syndrome.
Most patients recover the ability to clot after 1 or 2 vials of antivenom. Unfortunately, the hospital had run out of antivenom and was awaiting a shipment. The families of the 8-10 snakebite victims in the hospital were forced to borrow money from family and friends to buy their own antivenom at a local store for the equivalent of $75 per vial (considering most of these people live on $2-3 a day, this is a huge deal).
Tragically, the local antivenom was either ineffective or, as we suspect, was not antivenom at all, because after 5 vials this particular patient hemorrhaged internally and died. I was called in to see her just minutes before her death because she was gasping for breath. When I arrived, I found her skin to be several shades lighter than pictured above. She had died less than a minute before.