What is the treatment for a venomous snake bite?

Treatment for Venomous Snake Bites

The mainstay of treatment for venomous snakebites is prompt transport to a medical facility for antivenom administration, which should be done in a hospital setting with monitoring for adverse reactions. 1

Immediate Care (First Aid)

• DO:

  • Call emergency services immediately 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
  • Apply a pressure immobilization bandage (40-70 mmHg for upper extremity, 55-70 mmHg for lower extremity) for most venomous snakes, but NOT for North American pit vipers 1

• DO NOT:

  • Apply suction to the bite area (no clinical benefit, may worsen injury) 1
  • Apply ice, use suction devices, apply electric shock, or use tourniquets 1

Hospital Management

Diagnosis and Assessment

• Perform complete blood count, coagulation studies, renal function tests, electrolytes 1
• Implement cardiac monitoring to assess for complications 1
• Monitor oxygen saturation and provide supplemental oxygen if hypoxic 1

Antivenom Administration

• Antivenom is indicated in all moderate and severe cases of envenomation and certain mild cases 1, 2
• Dosing depends on severity:
  • Mild cases: up to 5 vials 2
  • Moderate cases: 10-15 vials 2
  • Severe cases: 15-20 vials 2, 3
• Perform skin testing before administration to predict possible anaphylactic reactions 2
• Have diphenhydramine and epinephrine readily available in case of anaphylaxis 2
• Equine-derived antivenin is standard care, though sheep-derived antigen binding fragment (CroFab) is less allergenic 1

Additional Treatments

• Clean the wound thoroughly 2
• Administer broad-spectrum antibiotics 2
• Provide tetanus prophylaxis if needed 1, 2
• Manage pain appropriately 1
• Monitor for delayed reactions to antivenom, such as serum sickness 1

Special Considerations

Pregnant Patients

• Treat similarly to non-pregnant individuals, including appropriate antivenom when indicated 1
• Establish both maternal and fetal monitoring in a healthcare facility 1
• Use a multidisciplinary approach involving emergency medicine, obstetrics, and toxicology 1

Patients with Sickle Cell Disease

• Monitor closely for signs of vaso-occlusive crisis, which may be triggered by envenomation 1
• Ensure adequate hydration with appropriate fluids to prevent sickling 1

Potential Complications

• Vaso-occlusive crisis, acute chest syndrome (in sickle cell patients) 1
• Allergic reactions to antivenom, delayed serum sickness 1
• Coagulopathy and renal failure 1
• Local tissue necrosis (major clinical finding in most snakebite poisonings) 4
• Fasciotomy is rarely indicated, only in cases involving elevated intracompartment pressures 2

Common Pitfalls to Avoid

• Delaying transport to medical care (antivenom is most effective when given within four hours of the snakebite) 4
• Using outdated first aid measures like tourniquets, incision and suction, or cryotherapy 1, 5
• Underestimating the amount of antivenom needed for effective treatment 3
• Failing to perform skin testing before antivenom administration 2

The evidence clearly shows that rapid transport to a medical facility for antivenom administration is the most critical factor in reducing morbidity and mortality from venomous snake bites, with proper supportive care and monitoring for complications.