What is the treatment for a viper snake bite?

Viper Snake Bite Treatment

The definitive treatment for viper snake bite is immediate activation of emergency services and administration of antivenom in a medical facility, while avoiding harmful first aid measures such as tourniquets, suction, ice, or electric shock. 1, 2

Initial Management

First Aid (Pre-Hospital)

• Call emergency services immediately for any venomous or potentially venomous snake bite 1, 2
• Rest and immobilize the bitten extremity to minimize venom spread 1, 2
• Remove rings and other constricting objects from the bitten extremity 1, 2
• Keep the bite site below heart level if possible 3
• Transport the victim to a medical facility as quickly as possible 1, 2

Do NOT:

• Apply ice (potentially harmful) 1, 2
• Use suction devices (ineffective and may cause tissue injury) 1, 2
• Apply electric shock (ineffective and potentially harmful) 1, 2
• Use tourniquets (potentially harmful) 1, 2
• Use pressure immobilization bandaging for North American pit vipers (potentially harmful) 1, 2

Hospital Management

Assessment

• Evaluate for signs of envenomation:
  • Local: pain, swelling, erythema, ecchymosis
  • Systemic: hypotension, coagulopathy, neurotoxicity, renal dysfunction 2
• Laboratory tests: complete blood count, coagulation studies, renal function, electrolytes 2

Treatment

1. Antivenom administration:

   • Antivenom is the definitive treatment for snake envenomation 1, 2
   • Initial dose of 4-6 vials for pit viper bites, with additional doses until initial control is achieved 2
   • Perform hypersensitivity testing before administration 4
   • Monitor for allergic reactions 5

2. Supportive care:

   • Wound management: clean with sterile normal saline 2
   • Pain control 5
   • Fluid resuscitation: aggressive fluid resuscitation with normal saline (initial rate 1000 ml/h, then taper by at least 50% after 2 hours) 2
   • Monitor and correct metabolic and hematologic complications 5

3. Management of complications:

   • Renal dysfunction: monitor electrolytes, acid-base status, creatinine, and BUN 2
   • Hyperkalemia: treat with IV calcium gluconate, insulin, and glucose; consider emergency dialysis if refractory 2
   • Coagulopathy: monitor coagulation parameters 2
   • Compartment syndrome: consider fasciotomy when edema impairs arterial perfusion 4

Special Considerations

• Severity of envenomation varies widely, from minimal local symptoms to severe systemic effects including shock and death 4
• Pit vipers account for 99% of venomous snake bites in the United States 5
• Venom composition varies by species, with some causing primarily local tissue destruction and others causing more systemic effects 3
• Thrombotic microangiopathy may develop following envenomation, requiring plasma exchange in some cases 6
• Early antivenom administration (within 3-6 hours) appears to reduce severity of renal damage 7

Common Pitfalls to Avoid

• Delaying emergency medical care while attempting first aid measures
• Using outdated first aid techniques like tourniquets, suction, or ice
• Underestimating the potential severity of envenomation
• Inadequate dosing of antivenom
• Failing to monitor for delayed complications such as serum sickness
• Not removing constricting jewelry from the affected limb

Remember that these recommendations are specific to snakebites occurring in North America. Snakes in other parts of the world have different venom effects and may require different management approaches 1, 2.