What is the proper treatment for a snake bite in a wilderness setting?

From the Guidelines

The proper treatment for a snake bite in a wilderness setting is to keep the victim calm and immobile while seeking medical help as quickly as possible. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, emergency services should be activated for any person bitten by a venomous or possibly venomous snake.

Key Recommendations

• Move the person away from the snake to prevent additional bites
• Remove any jewelry or tight clothing near the bite site before swelling occurs, as recommended by the guidelines 1
• Keep the affected limb below heart level to slow venom spread
• Clean the wound gently with soap and water if available, but don't scrub or apply ice, as ice application is not generally recommended for the treatment of snakebite 1
• Cover with a clean, dry bandage
• Do not cut the wound, attempt to suck out venom, apply a tourniquet, or give the victim alcohol or caffeine, as these methods are potentially harmful 1
• Monitor vital signs and watch for symptoms like severe pain, swelling, nausea, or difficulty breathing

Important Considerations

• The use of suction, electric shock, tourniquets, and pressure immobilization bandaging is not recommended, as they are potentially harmful or ineffective 1
• The goal of wilderness treatment is to slow venom spread and get the victim to medical care, as definitive treatment typically requires hospital-based antivenom administration 1
• Transport by EMS allows delivery of supportive and stabilizing care before arrival at the hospital 1

From the Research

Immediate Response to Snake Bite

• Remain calm and still to prevent the venom from spreading [ 2 ]
• Remove any constricting items, such as watches or jewelry, as swelling may occur
• Keep the affected limb below heart level to reduce the flow of venom

Wound Care and Observation

• Clean the wound with soap and water, but do not use harsh or abrasive cleaners [ 3 ]
• Cover the wound with a sterile bandage to prevent infection
• Monitor the wound for signs of infection, such as redness, swelling, or increased pain

Use of Antivenom

• Crotalidae-Fab antivenin is used to treat many different pit viper envenomations, but its efficacy in preventing tissue loss from copperhead or cottonmouth snakebites remains unclear [ 2 ]
• Antivenom may not be effective in reversing neurologic venom effects, such as fasciculations or respiratory distress [ 4 ]
• The use of antivenom should be guided by a unified treatment algorithm, taking into account clinical and laboratory observations, indications for and dosing of antivenom, and management of complications [ 3 ]

Additional Considerations

• Pain control and patient comfort are important aspects of snakebite treatment, and may be achieved through the use of analgesics or other medications [ 2 ]
• Education and training of trauma physicians and nurses on snakebite wound management may help to decrease unnecessary use of antivenom medication [ 2 ]