What is the appropriate treatment for a snake bite?

Snake Bite Treatment Protocol

The appropriate treatment for snake bite requires immediate medical attention with prompt administration of antivenom as the cornerstone of therapy, along with proper immobilization of the affected limb and avoiding harmful traditional practices. 1

Initial First Aid Measures

• DO:

  • Call emergency services immediately
  • Rest and immobilize the bitten extremity
  • Remove constricting jewelry
  • Keep the bite site at or below heart level

• DO NOT:

  • Apply ice
  • Use suction devices
  • Apply electric shock
  • Apply tourniquets
  • Use pressure immobilization bandaging (for North American pit vipers)

Medical Management

Assessment and Monitoring

1. Evaluate severity of envenomation based on:

   • Local tissue effects (swelling, pain, ecchymosis)
   • Systemic symptoms
   • Laboratory abnormalities (coagulation studies, CBC, renal function)

2. Monitor vital signs continuously, with particular attention to:

   • Respiratory status (hypoxia may require supplemental oxygen)
   • Cardiovascular stability
   • Neurological status

Antivenom Administration

1. Administer antivenom as soon as possible after envenomation

   • Initial dose: 4-6 vials for pit viper envenomation 1
   • Continue dosing until initial control is achieved (defined as cessation of local injury progression, resolution of systemic symptoms, and normalization of coagulation parameters)

2. Prior to administration:

   • Perform hypersensitivity testing
   • Have diphenhydramine and epinephrine readily available for potential anaphylactic reactions

Supportive Care

1. Wound management:

   • Clean the wound thoroughly
   • Administer broad-spectrum antibiotics
   • Update tetanus prophylaxis as needed

2. Pain management:

   • Provide appropriate analgesia

3. Fluid management:

   • Maintain adequate hydration
   • Monitor for renal involvement

Special Considerations

Coral Snake Bites

• Primarily neurotoxic with minimal local reaction
• Symptoms may be delayed up to 10-18 hours 2
• Requires specific coral snake antivenom (M. fulvius)
• May require respiratory support for 48-72 hours

Monitoring and Follow-up

• Monitor for recurrent coagulopathy for at least one week following treatment 1
• Long-term follow-up is essential as up to 41% of patients may show persistent renal involvement 1
• Risk of progression to chronic kidney disease in approximately 5-20% of cases 1

Common Pitfalls to Avoid

1. Delayed antivenom administration: Antivenom is most effective when given within four hours of the snakebite 3

2. Inappropriate first aid: Outdated techniques like incision and suction are contraindicated unless performed by experienced personnel within five minutes of the bite 4

3. Failure to recognize delayed symptoms: Particularly with coral snake bites, symptoms may not appear for several hours but can progress rapidly once they manifest 2

4. Inadequate monitoring: Continuous monitoring is essential as envenomation syndromes can be erratic and unpredictable 5

5. Premature discharge: Patients should be observed for at least 24-48 hours, even if initial symptoms appear mild

The mortality rate from snake bites can be significantly reduced with prompt medical intervention, particularly early respiratory support and antivenom administration 1. Consultation with a physician specialist experienced in envenomation management is strongly recommended.