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Challenges of managing snakebite envenomation in a deployed setting
  1. Christopher Johnson1,2,
  2. J Rimmer3,
  3. G Mount4,
  4. I Gurney5 and
  5. E D Nicol6,7
  1. 1School of Anaesthetics and Intensive Care Medicine, Northern Deanery, Newcastle upon Tyne, UK
  2. 2201 (Northern) Field Hospital (V), Royal Army Medical Corps, Newcastle upon Tyne, UK
  3. 3Gastroenterology Department, Southwest Peninsular Deanery, Derriford Hospital, Plymouth, UK
  4. 4US Army Medical Corps, Internist, 10th Combat Support Hospital, Bastion Role 3, Helmand Province, Afghanistan
  5. 5Emergency Medicine Department, Frimley Park Hospital, , Camberley, UK
  6. 6Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  7. 7Faculty of Medicine, Imperial College, London, UK
  1. Correspondence to Dr E D Nicol, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; e.nicol{at}


Snake bite envenomation causes a significant health burden globally, especially in austere or resource poor settings. This case series describes envenomation in two adults and two children presenting to the Role 3 Medical Treatment Facility in Camp Bastion, Afghanistan. Each case has similarities with respect to the coagulopathy of envenomation but differs in terms of time delay to presentation and response to treatment, including reactions to antivenom. We discuss the challenges and ethical dilemmas in delayed-presentation snakebite, the diagnosis and treatment of coagulopathy and the role of antivenom and surgical debridement.


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