Rattlesnake Bite Treatment
The mainstay of treatment for rattlesnake bites is prompt transport to a hospital for antivenom administration, along with proper first aid that includes rest and immobilization of the affected limb, removal of constricting jewelry, and avoidance of harmful interventions such as tourniquets, ice, or suction devices. 1
Immediate First Aid
DO:
- Call emergency services immediately
- Keep the victim calm and minimize movement
- Immobilize the bitten extremity to reduce venom spread
- Remove rings, watches, and other constricting items before swelling occurs
- Position the bite site at or below heart level
DO NOT:
- Apply ice (worsens tissue damage)
- Use suction devices (no clinical benefit, may worsen injury)
- Apply electric shock (dangerous and ineffective)
- Apply tourniquets (can cause tissue damage)
- Use pressure immobilization bandaging for North American pit vipers 1
Hospital Management
Antivenom Administration
Antivenom is the definitive treatment for rattlesnake envenomation and should be administered in a hospital setting with appropriate monitoring:
- Crotalidae Fab antivenom (CroFab) is the preferred treatment in the US as it's less allergenic than older equine-derived products 1, 2
- Dosing is based on severity of envenomation:
- Moderate to severe cases typically require 15-20 vials initially 3
- Additional doses may be needed based on clinical progression
Clinical Assessment
Monitor for signs of envenomation:
- Local effects: progressive swelling, ecchymosis, pain
- Systemic effects: coagulopathy, hypotension, nausea, vomiting
- Laboratory abnormalities: thrombocytopenia, elevated PT/PTT, decreased fibrinogen
Laboratory Monitoring
- Complete blood count
- Coagulation studies (PT, PTT, fibrinogen)
- Renal function tests
- Electrolytes
- Urinalysis (check for hematuria/myoglobinuria) 1
Special Considerations
Airway Management
Bites to the face or neck require special attention due to risk of airway compromise. Early intubation may be necessary if significant swelling threatens the airway 4
Wound Care
- Clean wound with antiseptic
- Elevate extremity to reduce swelling
- Monitor for compartment syndrome
- Administer tetanus prophylaxis if needed 1
Potential Complications
- Coagulopathy
- Renal failure
- Allergic reactions to antivenom
- Delayed serum sickness (7-14 days after antivenom)
- Tissue necrosis requiring surgical debridement 1, 5
Common Pitfalls to Avoid
- Delayed treatment: Antivenom is most effective when administered within 4 hours of the bite 5
- Underestimating severity: Even small rattlesnakes like the Western Pygmy can cause significant envenomation requiring hospitalization 6
- Outdated first aid: Older recommendations for constriction bands, incision, and suction are no longer supported by current guidelines 1, 7
- Inadequate antivenom dosing: Insufficient initial dosing can lead to progression of symptoms and poorer outcomes 3
- Failure to test for antivenom hypersensitivity: Always perform sensitivity testing before administering antivenom 5
Remember that while rattlesnake bites are rarely fatal with proper treatment, they can cause significant morbidity including tissue necrosis, so prompt medical attention is essential.