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Few doctors working in the accident and emergency (A&E) department will have had experience in the management of adder (Vipera Berus) bites. While such events are uncommon, and rarely fatal, prompt correct management undoubtedly helps in reducing mortality and morbidity. Various isolated case reports (Watson & Harland, 1977; Gerard & Pugh, 1982; Jones & Clegg, 1985) and larger reviews (Reid, 1976; Pesson & Irestedt 1981; Hawley, 1988, 1990) have appeared in non A&E related journals. Following our own recent experience we felt it timely to report our case and review the management.