What is the management of a snake bite?

From the Guidelines

The management of a snake bite requires immediate medical attention by activating emergency services for any person bitten by a venomous or possibly venomous snake. First, move away from the snake and keep the affected limb immobilized and positioned below heart level. Call emergency services immediately. Remove any constricting items like jewelry or tight clothing near the bite, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. Clean the wound gently with soap and water if available. Do not apply tourniquets, cut the wound, attempt to suck out venom, apply ice, or give the victim alcohol or pain medications, as these methods are potentially harmful and of unproven benefit 1.

Key Recommendations

• Activate emergency services for any person bitten by a venomous or possibly venomous snake 1
• Rest and immobilize the bitten extremity and minimize exertion by the person who was bitten if it does not delay access to emergency medical care 1
• Remove rings and other constricting objects from the bitten extremity 1
• Avoid using suction, electric shock, tourniquets, or pressure immobilization bandaging to treat snake bites, as they are potentially harmful 1

At the hospital, treatment typically involves antivenom administration if a venomous snake is identified. Supportive care includes pain management, tetanus prophylaxis, antibiotics if infection develops, and monitoring for complications like compartment syndrome or coagulopathy. The severity of snake bites varies based on the snake species, amount of venom injected, bite location, and victim's size and health status. Prompt medical treatment significantly improves outcomes, as delaying care can lead to tissue damage, organ failure, or death in severe cases, highlighting the importance of seeking immediate medical attention as emphasized in the 2024 guidelines 1.

From the Research

Management of Snake Bite

• The management of a snake bite involves immediate transportation to the nearest emergency department 2.
• Incision and suction are contraindicated unless performed by experienced personnel within five minutes of the bite, or unless transport of the patient to definitive medical care will take more than 30 minutes 2.
• Cryotherapy is contraindicated, and all bites should be graded for severity of envenomation 2.
• The wound should be cleaned, and broad-spectrum antibiotics administered, with tetanus status determined and tetanus toxoid administered if necessary 2, 3.

Antivenin Administration

• Antivenin is indicated in certain mild cases and in all moderate and severe cases of envenomation 2, 4.
• Patients with a mild case of envenomation may require up to five vials of antivenin, while patients with moderate bites may require 10 to 15 vials, and patients with severe bites may require 15 to 20 vials 2.
• Antivenin is effective only when administered intravenously, and skin testing to predict the possibility of anaphylactic reaction is mandatory before administration 2, 4.
• Diphenhydramine and epinephrine should be readily available in case of anaphylaxis 2.

First Aid Measures

• The pressure immobilization technique is the only evidence-based first aid technique with effectiveness on venom spread 5.
• However, additional studies suggest that proper application of this technique is not feasible for laypeople, and evidence concerning other first aid measures, such as the application of a tourniquet, suggests avoiding the use of these techniques 5, 6.
• The practical recommendation for the treatment of snakebite in a first aid setting is to immobilize the victim, while awaiting the emergency services 5, 6.