What is the treatment for a venomous snake bite?

Treatment for Venomous Snake Bites

Emergency services should be activated immediately for any person bitten by a venomous or possibly venomous snake, as the definitive treatment is antivenom which is only available in hospital settings. 1

First Aid Measures

Recommended Actions:

1. Call emergency services immediately - This is the most critical first step for any venomous snake bite 1
2. Rest and immobilize the bitten extremity - Minimize patient exertion to reduce venom spread 1
3. Remove rings and other constricting objects from the bitten extremity to prevent complications from swelling 1

Harmful Practices to Avoid:

• Do not apply ice - Ice application has unproven benefits and may cause tissue injury 1
• Do not use suction devices - Suction is ineffective for venom removal and may cause tissue injury 1
• Do not apply electric shock - This is ineffective and potentially harmful 1
• Do not use tourniquets - These can worsen local tissue injury 1
• Do not use pressure immobilization bandaging - This is potentially harmful for North American snake bites 1

Hospital Management

Once the patient reaches medical care, treatment should follow this algorithm:

1. Stabilize airway, breathing, and circulation 2

2. Comprehensive evaluation for:

   • Hematologic abnormalities (particularly monitoring platelet count)
   • Neurologic manifestations
   • Renal function
   • Cardiovascular status 3

3. Antivenom administration:

   • CroFab is the most commonly used antivenom in the US
   • Indicated for any grade of envenomation
   • Has lower incidence of allergic reactions compared to older antivenoms 3

4. Supportive care:

   • Tetanus prophylaxis
   • Antibiotics if infection is present
   • Wound care 3

5. Observation period:

   • Minimum 8 hours for all snake bite victims
   • Minimum 24 hours for any evidence of envenomation 3

Clinical Manifestations to Monitor

Local Effects:

• Swelling and pain that spreads gradually from the bite site
• Tissue damage at the bite site

Systemic Effects:

• Decreasing platelet count (can drop to <100,000/mm³)
• Severe cases may present with vomiting, cyanosis, loss of consciousness, and hypotension
• Some venoms can cause thrombotic microangiopathy with microangiopathic hemolytic anemia and acute kidney injury 4
• Rare cardiac complications including arrhythmias such as atrial fibrillation 5

Common Pitfalls to Avoid

1. Delaying emergency care - Time to antivenom administration is critical for outcomes
2. Using outdated first aid techniques - Tourniquets, incision, and suction are strongly discouraged 2
3. Failing to monitor for delayed complications - Some effects may not appear immediately
4. Underestimating the severity - All venomous snake bites should be considered medical emergencies
5. Inadequate follow-up - Patients with significant envenomation are at risk for long-term complications, particularly chronic kidney disease 4

Remember that snake venoms vary widely by species and geographic location. The recommendations above are specific to North American venomous snakes (primarily pit vipers such as rattlesnakes, copperheads, and cottonmouths). Different approaches may be needed for snake bites in other parts of the world 1, 6.