BACKGROUND Snake envenomation is an underestimated pathology in sub-Saharan Africa associated with severe emergencies, and even death in case of late presentation. We herein present a case of severe envenomation managed at the surgical emergency department of the Yaoundé Central Hospital. CASE PRESENTATION We report a case of a 47-year-old female farmer with no relevant past history who sustained a snakebite by an Echis occellatus viper during an agricultural activity. Her initial management consisted in visiting a traditional healer who administered her some herbal remedies orally and applied a white balm on the affected limb. Due to progressive deterioration of her condition, she was rushed to our surgical department where she arrived 20 h after the snakebite incident. On admission she presented in a state of shock (suggestive of an anaphylactic shock), coagulopathy, renal impairment, and gangrene of the entire right upper limb. Emergency management consisted of fluid resuscitation, repeated boluses of adrenaline, a total of three vials of polyvalent anti-venom sera, promethazine, analgesics, corticosteroids, and administration of fresh frozen plasma. Within four hours of emergency department hospitalisation she developped signs of sepsis and persistent hypotension refractory to fluid resuscitation, suggestive of an associated septic shock. Management pursued with antiobiotherapy and administration of noradrenaline through an electric pump syringe to achieve a mean arterial blood pressure above 65 mmHg. The patient deceased at the 10th hour of hospitalisation in a state of circulatory collapse unresponsive to vasopressors, coagulopathy, renal failure, sepsis and gangrene of the right forearm. CONCLUSION The authors highlight this unusual presentation but equally pinpoint how late presentation to the emergency department, harmful tradition practices, poverty and cultural beliefs can adversely affect the prognosis of snakebite in our setting.

中文翻译：

---

急诊科晚期出现严重的蛇蝎毒化，并伴有休克，急性肾损伤和坏疽状态：一例病例报告。

背景技术蛇毒在撒哈拉以南非洲是一种被低估的病理，与严重的紧急事件有关，甚至在迟到的情况下也可能死亡。在此，我们介绍了由雅温得中心医院外科急诊科处理的严重毒死案。病例介绍我们报告了一例47岁的女性农民，该农民没有相关的过去历史，在农业活动中被Echis occellatus毒蛇毒蛇咬伤。她的最初管理包括拜访一位传统的治疗师，该医生口服给她一些草药，并在患肢上涂上白膏。由于病情的逐渐恶化，她被送往我们的外科部门，在蛇咬事件发生20小时后到达了那里。入院时，她表现为休克（提示过敏性休克），凝血病，肾功能不全和整个右上肢的坏疽。紧急处理包括液体复苏，反复推注肾上腺素，总共三个小瓶的多价抗毒血清，异丙嗪，镇痛药，皮质类固醇和新鲜冷冻血浆的管理。在急诊室住院的四个小时内，她出现了败血症和持续性低血压的迹象，使液体复苏难治，提示伴有败血性休克。进行抗生物疗法治疗和通过电动泵注射器给予去甲肾上腺素以达到平均动脉血压高于65 mmHg。该患者在住院的第10小时死于循环衰竭，对血管加压药，凝血病，肾功能衰竭，败血症和右前臂坏疽无反应。结论作者强调了这种不寻常的表现，但同样指出了在急诊中迟到，有害的传统习俗，贫穷和文化信仰如何对我们的环境中蛇咬的预后产生不利影响。