Envenomation syndromes following snakebites can include tissue reaction, coagulopathy, nephrotoxicity, and neurotoxicity. Cardiotoxicity is rare but usually presents with dysrhythmias. Myocardial infarction after envenomation has rarely been reported. We discuss a case of snake bite simulating ST-elevation myocardial infarction (STEMI). Our patient is a 49-year-old male who sustained a snake bite in his left hand. Patient had hemodynamic collapse requiring increasing pressor support; EKG and troponin results confirmed STEMI. Cardiac catheterization did not demonstrate any thrombosis, rather severe cardiomyopathy with left ventricular ejection fraction 20-25%. Even though our patient did not require any coronary intervention, an angiogram was warranted given the clinical presentation. Our case demonstrates severe cardiotoxicity following snake bite. Further research is warranted to study the mechanism behind such phenomena.

We observed a reduction in natriuretic peptides levels, LV wall thickness and improvement in LV ejection fraction, GLS and clinical stage in patients referred after 2017. We also noted a change in 2-year survival: 69% (before 2017) vs 81% (after 2017). Conclusion:The early recognition of the disease due to an increased clinicians' awareness and the advances in diagnostic workup are changing the clinical landscape of ATTR cardiomyopathy in Australia.

preparations of vasopressor therapies, 2 push-dose preparations and a peripheral continuous infusion. PDPs were prepared according to 2 techniques. The first is a "dirty" preparation utilizing a saline flush and cardiac epinephrine syringes, physically mixing the 2-in-1 syringe. The second method of preparation is a best practice according to the Institute for Safe Medication Practices (ISMP) and utilized bacteriostatic normal saline and cardiac epinephrine syringes for admixture. Norepinephrine infusions were compounded to have a final concentration of 4mg/ 250mL. Physicians (including both ED residents and attendings) were not asked to prepare an IV infusion, due to their limited familiarity with IV pumps. The timer was initiated on a count down and was stopped when the vasopressor therapy had been successfully administered through an IV line in a mannequin arm. After the completion of all 3 preparations, a survey was completed recording participants' professions, preferred method of preparation and years of job experience.Results: Overall 20 participants were included, 10 physicians, 6 registered nurses and 4 pharmacists. On average, a peripheral IV infusion took almost twice as long as either PDP preparation. Median preparation times for all professions were 58, 66 and 119 seconds (dirty, clean and IV respectively). Clean PDP took an average of 5 seconds longer to prepare when compared to dirty with dirty PDP being the preferred method of preparation by 55% of participants.Conclusions: The use of PDP can be considered in patients as a bridge to continuous infusion; however, it may be just as beneficial to start continuous infusion to prevent further decompensation, given the compounding time differences between PDP and continuous preparations. Although admixture instructions were provided, there remained variations in the preparation techniques of both PDP preparations. The potential for medication errors remains high, with variations in preparation techniques. This study has demonstrated further evidence for the need of institutional standardization of PDP preparations.