What is the appropriate treatment for a snake bite?

Snake Bite Treatment

For snake bite treatment, immediately call emergency services, rest and immobilize the bitten extremity, and remove constricting jewelry, while avoiding harmful interventions such as ice application, suction, electric shock, tourniquets, or pressure immobilization bandaging. 1, 2

Initial Management

Immediate Actions

• Call emergency services immediately for any venomous or potentially venomous snake bite 1
• Rest and immobilize the bitten extremity to minimize venom spread 1
• Remove rings and other constricting objects from the bitten extremity 1
• Position the victim to minimize movement while awaiting emergency services 2

Harmful Practices to AVOID

• DO NOT apply ice (potentially harmful and unproven benefit) 1
• DO NOT use suction devices (ineffective and may cause tissue injury) 1
• DO NOT apply electric shock (ineffective and potentially harmful) 1
• DO NOT use tourniquets (can worsen local tissue injury) 1
• DO NOT use pressure immobilization bandaging for North American pit viper bites (potentially harmful) 1, 2
• DO NOT make incisions at the bite site 1

Hospital Management

Assessment and Monitoring

• Grade the severity of envenomation based on local and systemic symptoms 3
• Monitor for:
  • Local effects: pain, swelling, ecchymosis
  • Systemic effects: coagulopathy, neurotoxicity, cardiovascular effects
  • Laboratory abnormalities: complete blood count, coagulation studies, renal function 2

Definitive Treatment

• Antivenom administration is the mainstay of treatment 4
  • Indicated in all moderate and severe cases of envenomation
  • May be indicated in certain mild cases
  • Most effective when given within four hours of the bite 4
  • Initial dose typically 4-6 vials, with additional doses until initial control is achieved 2
  • Skin testing for hypersensitivity is mandatory before administration 3
  • Have diphenhydramine and epinephrine readily available for possible anaphylactic reactions 3

Wound Care

• Clean the wound with sterile normal saline 2
• Remove superficial debris if present 2
• Consider broad-spectrum antibiotics 3
• Verify tetanus immunization status and administer tetanus toxoid if needed 3

Special Considerations

Coral Snake Bites

• Primarily neurotoxic with little local tissue reaction 5
• Symptoms may be delayed for up to 10-18 hours 5
• Progression can be rapid once symptoms appear, potentially leading to respiratory paralysis 5
• Specific antivenin (M. fulvius) is the definitive treatment 5

Monitoring for Complications

• Watch for development of:
  • Compartment syndrome (rare, fasciotomy only if confirmed elevated compartment pressures) 3
  • Acute kidney injury 2, 6
  • Respiratory compromise 2
  • Coagulopathy 6

Common Pitfalls to Avoid

1. Delaying medical care - Time is critical; seeking traditional healers or waiting for symptoms to develop increases mortality 6

2. Improper first aid techniques - Many traditional methods (suction, tourniquets) are harmful rather than helpful 1, 7

3. Underestimating severity - Even seemingly minor bites can progress to severe envenomation; all suspected venomous snake bites require medical evaluation 1

4. Inadequate monitoring - Symptoms can evolve over hours; continuous monitoring for at least 24-48 hours is essential for venomous bites 5

5. Failure to identify the snake - While not essential for treatment, information about the snake can help guide management (but never risk additional bites to capture or photograph the snake) 1