The American journal of emergency medicine
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There are 5000-10,000 snake envenomations annually in the United States. Fortunately, few are fatal. In this study we review the epidemiology of fatal snakebites. ⋯ Death following envenomation from a native U.S. snake is unlikely, particularly if medical attention is sought promptly. Rattlesnake envenomations are more likely to be fatal than bites from other species. Intentionally engaging with a venomous snake raises the risk of incurring a fatal bite, as does concurrent alcohol or drug use. Age less than 12 years old does not appear to be a risk factor for a fatal outcome, while elderly patients may have a slightly increased risk of death.
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Screening for acute myocardial infarction (AMI) in patients with ventricular pacemakers (VP) is a diagnostic challenge. We report a case where application of the Modified Sgarbossa criteria (mSC) would have immediately identified AMI in a patient with a VP and merited strong advocacy for emergent cardiac catheterization. A 94-year-old male with VP presented to the emergency department (ED) after he had burning sensation in his chest. ⋯ This case report highlighted the benefits of applying mSC to patients with VP, which to authors knowledge remains unvalidated. A significant benefit of mSC is that they are unweighted, thus any positive criteria is suggestive of AMI. While the first EKG yielded an oSC score <3, applying the unweighted mSC to the EKG revealed ≤-0.25 ST/S ratio discordant changes in leads III, aVF, I and aVL would have merited strong advocacy for emergent cardiac catherization.