What are the immediate steps for managing a snake bite?

Immediate Management of Snake Bites

For snake bite management, immediately call emergency services, rest and immobilize the bitten extremity, and remove constricting jewelry from the affected limb. 1 These initial steps are crucial for reducing venom spread and preventing complications while arranging rapid transport to a medical facility.

Initial First Aid Steps

1. Call emergency services immediately 1, 2
2. Rest and immobilize the bitten extremity to reduce venom spread 1
3. Remove rings and other constricting jewelry from the affected limb to prevent complications from swelling 1
4. Apply a pressure immobilization bandage (40-70 mmHg for upper extremity; 55-70 mmHg for lower extremity) to reduce venom spread, EXCEPT for North American pit viper bites 1
5. Transport the victim to the nearest emergency department as quickly as possible 2

What NOT to Do

• Do not apply suction to the bite area - this has no clinical benefit and may worsen injury 1
• Do not apply ice - this is potentially harmful 1
• Do not use electric shock - this is an unproven and potentially harmful method 1
• Do not apply tourniquets - these can cause tissue damage 1
• Do not apply pressure immobilization bandaging for North American pit viper bites 1

Hospital-Based Management

Once at a medical facility, management includes:

Monitoring and Assessment

• Complete blood count, coagulation studies, renal function tests, electrolytes, and cardiac monitoring 1
• Oxygen saturation monitoring with supplemental oxygen if hypoxic 1

Treatment

• Antivenom administration - the mainstay of treatment for venomous snakebites 1

  • Administered in a hospital setting with monitoring for adverse reactions
  • Equine-derived antivenin is standard of care, though sheep-derived antigen binding fragment ovine (CroFab) is less allergenic
  • Skin testing has poor predictive value for identifying allergic reactions

• Pain management 1

• Tetanus prophylaxis if needed 1, 3

• Prophylactic antibiotics if indicated for wound infection 1, 3

Special Considerations

• Pregnant women should be treated similarly to non-pregnant individuals, including appropriate antivenom when indicated 1
• Patients with sickle cell disease require close monitoring for vaso-occlusive crisis and adequate hydration 1
• Monitor for delayed reactions to antivenom, such as serum sickness 1

Common Pitfalls to Avoid

• Delaying transport to medical care - rapid transport is critical for effective treatment 2
• Performing incision and suction - outdated methods that can worsen tissue damage 1, 3
• Delaying antivenom administration - most effective when given within four hours of the bite 4
• Unnecessary fasciotomy - rarely indicated and only when there are elevated intracompartment pressures 3

Remember that 99% of venomous snakebites in the United States are from pit vipers, but the initial management principles apply to all types of snake bites 2.