Clinical Practice and Cases in Emergency Medicine

This report describes a patient envenomated by a Brothrops atrox, common fer-de-lance viper, in the remote rainforest of eastern Ecuador and without access to definitive care for 7 days. Antivenom was not administered; by the time of presentation to a hospital, he had suffered myonecrosis of his lower leg, which was treated with debridement and eventual skin graft. The ramifications of this long evacuation demonstrate the need for more accessible health services and educational outreach.