What are the immediate steps for managing a snake bite?

Immediate Management of Snake Bites

The immediate steps for managing a snake bite include activating emergency services, resting and immobilizing the bitten extremity, removing constricting objects, and avoiding harmful interventions such as ice application, suction, electric shock, tourniquets, and pressure immobilization bandaging (for North American pit vipers). 1, 2

Initial Response

1. Call emergency services immediately

   • This is a Class I recommendation with Level C-EO evidence 1
   • Antivenom is the definitive treatment and is only available in hospital settings 1, 2

2. Rest and immobilize the bitten extremity

   • Reasonable to minimize exertion by the victim (Class IIa, Level C-LD) 1
   • Reduces venom circulation and spread 2
   • Avoid walking or other physical activity that could increase venom absorption 1

3. Remove rings and other constricting objects

   • Swelling can cause rings to constrict and damage tissues (Class IIa, Level C-EO) 1, 2
   • This prevents further injury as swelling progresses

Harmful Interventions to AVOID

• Do not apply ice - May cause tissue injury and is of unproven benefit 1, 2
• Do not use suction devices - Ineffective for venom removal and may cause tissue injury 1, 2
• Do not apply electric shock - Ineffective and potentially harmful 1, 2
• Do not use tourniquets - Can worsen local tissue injury 1, 2
• Do not use pressure immobilization bandaging for North American pit viper bites - Mixed results and potential for harm 1, 2
  • Note: For neurotoxic snake bites (not North American pit vipers), properly performed pressure immobilization may be considered 2

Important Considerations

• These recommendations are specific to snakebites occurring in the United States and Canada involving indigenous snakes 1
• Snakes in other parts of the world have different venom effects and may require different first aid measures 1
• Approximately 99% of venomous bites in North America are caused by pit vipers (rattlesnakes, copperheads, and cottonmouths) 3

Clinical Pearls

• The goal is to get the victim to definitive medical care as quickly as possible
• Balance the need to minimize exertion with avoiding delay to care 1
• Even medical personnel have a low rate of appropriate pressure immobilization bandage placement 1
• Pit viper venom causes tissue injury and may also cause low blood pressure, bleeding, and muscle fasciculations leading to paralysis 1

Hospital Management

Once at the hospital, treatment will typically include:

• Antivenom administration - the mainstay of treatment 2, 3
• Wound cleaning and care 2
• Laboratory tests to assess for coagulopathy and other systemic effects 2
• Supportive care including pain control and fluid management 2

Remember that the definitive treatment for snake bite is antivenom, which is not available for use in the first aid setting. The primary goal of first aid is to safely get the victim to medical care where antivenom can be administered.