What is the immediate management for a snakebite?

Immediate Management of Venomous Snakebites

The immediate management of a snakebite should include calling emergency services, immobilizing the affected limb, removing constricting jewelry, and avoiding harmful interventions such as tourniquets, ice application, or wound incision/suction. 1

Initial Assessment and First Aid

1. Call emergency services immediately 1

   • This is the most critical first step for all suspected venomous snakebites

2. Rest and immobilize the bitten extremity 1

   • Keep the affected limb below heart level to reduce venom spread
   • Immobilization helps limit systemic venom distribution

3. Remove rings and other constricting jewelry from the affected limb 1

   • This prevents complications from potential swelling

4. Apply pressure immobilization bandage (40-70 mmHg for upper extremity, 55-70 mmHg for lower extremity) 1

   • Important exception: Do NOT use pressure immobilization for North American pit viper bites

5. Avoid harmful interventions that have no clinical benefit and may worsen injury: 1, 2

   • Do NOT apply ice
   • Do NOT use suction devices (except possibly venom extractor within first 5 minutes) 3
   • Do NOT apply electric shock
   • Do NOT apply tourniquets
   • Do NOT make incisions into the bite
   • Do NOT attempt mouth suction

Hospital-Based Management

Once at a medical facility, management should include:

1. Laboratory assessment 1

   • Complete blood count
   • Coagulation studies
   • Renal function tests
   • Electrolytes

2. Monitoring 1

   • Cardiac monitoring
   • Oxygen saturation (provide supplemental oxygen if hypoxic)
   • Signs of hemolysis, anemia, coagulopathy, and acute kidney injury

3. Antivenom administration 1, 3

   • The mainstay of treatment for venomous snakebites
   • Should be administered in a hospital setting with monitoring for adverse reactions
   • Options include:
     • Equine-derived antivenin (traditional standard of care)
     • Sheep-derived antigen binding fragment ovine (CroFab) - less allergenic
   • Most effective when given within four hours of the snakebite 4

4. Supportive care 1

   • Pain management
   • Prophylactic antibiotics if indicated for wound infection
   • Tetanus prophylaxis if needed

Severity Assessment

Snakebite severity can be graded to guide treatment: 2, 3

1. No intoxication ("dry" bite)
2. Mild intoxication (local edema and pain)
3. Moderate intoxication (pain, edema spreading beyond bite zone, systemic signs)
4. Severe intoxication (shock, severe coagulopathy, massive edema)

Special Considerations

• Compartment syndrome: Rarely develops but requires close monitoring of the extremity via serial physical examination and measurement of compartment pressure 5
• Pregnant patients: Should receive similar treatment to non-pregnant individuals, including appropriate antivenom when indicated 1
• Patients with sickle cell disease: Require close monitoring for vaso-occlusive crisis triggered by envenomation 1

Common Pitfalls to Avoid

• Delayed seeking of medical attention: Antivenom is most effective when administered within 4 hours 4
• Inappropriate first aid: Traditional methods like suction, incision, and tourniquets can worsen outcomes 1, 2
• Underestimating severity: Even seemingly minor bites can progress to serious envenomation 6
• Overlooking hypersensitivity: Patients must be tested for hypersensitivity before receiving antivenin 4