What is the appropriate treatment for a snake bite?

Snake Bite Treatment Protocol

The appropriate treatment for a snake bite includes calling emergency services immediately, immobilizing the bitten extremity, removing constricting jewelry, and prompt administration of antivenom such as CroFab (4-6 vials) as soon as possible after envenomation. 1

Immediate Actions

• Call emergency services immediately
• Keep the victim calm and minimize movement
• Immobilize the bitten extremity
• Remove constricting jewelry or clothing
• Position the affected limb at or below heart level

What NOT to Do

• Do NOT apply ice
• Do NOT use suction devices
• Do NOT apply electric shock
• Do NOT use tourniquets
• Do NOT use pressure immobilization bandaging (for North American pit vipers) 1

Medical Management

Initial Assessment

• Document time of bite and onset of symptoms
• Mark the advancing edge of swelling/erythema every 15-30 minutes
• Monitor vital signs continuously
• Perform baseline laboratory tests:
  • Complete blood count
  • Coagulation studies
  • Renal function tests
  • Electrolytes
  • Cardiac monitoring 1

Antivenom Administration

1. Administer antivenom (such as CroFab) as soon as possible

   • Initial dose: 4-6 vials intravenously
   • Continue until initial control is achieved (when local injury progression stops, systemic symptoms resolve, and coagulation parameters normalize) 1
   • Perform hypersensitivity testing before administration

2. Monitor the patient for at least 1 hour after initial dose

   • Watch for signs of allergic reaction
   • Have diphenhydramine and epinephrine readily available 2

Supportive Care

• Provide pain management
• Administer tetanus prophylaxis if needed
• Consider broad-spectrum antibiotics for wound infection
• Maintain adequate hydration
• Monitor for renal complications 1

Follow-up Care

• Monitor for recurrent coagulopathy for at least one week
• Schedule long-term follow-up as persistent renal involvement may occur in up to 41% of patients
• Be aware that 5-20% of cases may progress to chronic kidney disease 1

Special Considerations

• Mortality from snake bites can be significantly reduced with prompt medical intervention
• Early respiratory support is critical as respiratory failure can occur within 12-30 hours if untreated
• Fasciotomy is rarely indicated and should only be performed when compartment syndrome is confirmed 2
• Treatment in specialized centers or consultation with experts is recommended for complex cases 1

The evidence strongly supports immediate medical attention rather than traditional remedies or delayed care. The older practice of incision and suction is now contraindicated unless performed by experienced personnel within five minutes of the bite and only when medical care is more than 30 minutes away 3, 2. The most recent guidelines from the American College of Emergency Physicians emphasize the critical importance of antivenom administration as the cornerstone of treatment 1.