What is the treatment for a rattlesnake bite?

Treatment for Rattlesnake Bite

The definitive treatment for a rattlesnake bite is immediate transport to a hospital setting for antivenom administration, along with proper first aid that includes rest and immobilization of the affected limb and removal of constricting jewelry. 1

Immediate First Aid

• Call emergency services immediately - Antivenom is only available in hospital settings 1
• Rest and immobilize the bitten extremity to reduce venom spread 1
• Remove rings and other constricting jewelry from the affected limb to prevent complications from swelling 1

What NOT to Do (Harmful Practices)

• Do not apply ice to the bite site - unproven benefits and may cause tissue injury 1
• Do not use suction devices (with or without incision) - ineffective for venom removal and may cause tissue injury 1
  • This contradicts older recommendations from 1989 that suggested applying suction 2
• Do not apply electric shock - ineffective and potentially harmful 1
• Do not apply tourniquets - can worsen local tissue injury 1
• Do not use pressure immobilization bandaging - potentially harmful for North American snake bites 1

Hospital Management

1. Antivenom administration - The mainstay of treatment is Crotalidae polyvalent immune fab antivenom 3

   • Aggressive infusion may be required, with an average of 15-20 vials needed in severe cases 4
   • Studies show an average of 28.5 vials administered in a tertiary care setting 5
   • Be aware that immediate antivenin reactions occur in approximately 36% of patients 5

2. Medical assessment

   • Monitor for hematologic abnormalities, which are common:
     • Coagulopathy (60%)
     • Hypofibrinogenemia (49%)
     • Thrombocytopenia (33%) 5
   • Assess for local tissue damage and potential necrosis 3
   • Special attention to airway if bite is to face or tongue, as life-threatening obstruction can occur 6

3. Wound care

   • Local wound care is critical to avoid late complications 3
   • Hemorrhagic bullae formation occurs in 22% of cases, more frequently in upper extremities 5
   • Approximately 3.4% of cases may require surgical intervention 5

Special Considerations

• Pregnancy: Pregnant women should be treated similarly to non-pregnant individuals, including appropriate antivenom when indicated. However, the risk to the fetus appears higher with significant maternal systemic envenomation 1

• Severity assessment: The average hospitalization for rattlesnake bites is 2.5 days, with mortality being rare with proper treatment 5

Common Pitfalls

• Delayed treatment: Seek medical care immediately; the average time to presentation in studies was 1.7 hours 5
• Inadequate antivenom dosing: Underdosing antivenom can lead to increased tissue damage and systemic effects
• Following outdated first aid advice: Older recommendations for suction devices or tourniquets are now considered harmful 1, 2
• Failure to monitor for delayed complications: Hematologic abnormalities and tissue necrosis can develop over time