What is the treatment for a snake bite?

Snake Bite Treatment

The definitive treatment for snake bite is antivenom, which should be administered in a hospital setting as soon as possible after envenomation, with immediate activation of emergency services for any person bitten by a venomous or possibly venomous snake. 1

Immediate First Aid

1. Call emergency services immediately (Class I, Level C-EO) 2, 1
2. Rest and immobilize the bitten extremity to minimize venom spread (Class IIa, Level C-LD) 2, 1
3. Remove rings and other constricting objects from the bitten extremity (Class IIa, Level C-EO) 2, 1
4. Keep the affected limb below heart level to minimize venom absorption 1

DO NOT:

• Apply ice (potentially harmful) 2, 1
• Use suction devices (potentially harmful) 2, 1
• Apply electric shock (potentially harmful) 2, 1
• Use tourniquets (potentially harmful) 2, 1
• Make incisions in the wound 3
• Perform mouth suction 3
• Apply pressure immobilization bandaging for North American pit vipers (potentially harmful) 2, 1

Hospital Management

The cornerstone of treatment in the hospital setting includes:

Antivenom Administration

• Initial dose of 4-6 vials as soon as possible after envenomation 1
• Additional doses until initial control of symptoms is achieved 1
• In the US, available antivenins include:
  • Crotalidae Polyvalent Immune Fab (CroFab) - preferred due to fewer adverse reactions 3, 4
  • Antivenin Crotalidae Polyvalent (ACP) 3
• In Europe, polyvalent antiserum against Viperidae family snakes is available 3

Monitoring and Supportive Care

• Monitor vital signs: respiratory rate, blood pressure, heart rate 1
• Laboratory assessment: complete blood count, coagulation studies, renal function tests, electrolytes 1
• Cardiac monitoring for potential cardiotoxic effects 1
• Wound care: clean with sterile normal saline and remove superficial debris 1
• Elevate the affected limb if swelling persists 1

Fluid Management

• Aggressive fluid resuscitation with normal saline (initial rate 1000 ml/h) 1
• Taper by at least 50% after 2 hours 1
• Avoid potassium-containing balanced salt fluids due to hyperkalemia risk 1

Severity Assessment

Intoxication severity is classified as:

1. No intoxication ("dry" bite)
2. Mild intoxication (local edema and pain)
3. Moderate intoxication (pain, edema spreading beyond bite zone, systemic signs)
4. Severe intoxication (shock, severe coagulopathy, massive edema) 3

Special Considerations

• Compartment syndrome: Rarely develops due to edema and tissue necrosis. Monitor via serial physical examination and compartment pressure measurement 4
• Renal complications: Monitor for hyperkalemia and renal dysfunction, which may require urgent treatment 1
• Hypersensitivity reactions: Antivenins may cause severe reactions due to their protein nature 3

Important Clinical Pitfalls

1. Delayed treatment: Antivenin therapy is most effective when given within four hours of the snakebite 5
2. Inappropriate use of tourniquets: Can lead to limb ischemia and potentially amputation 6
3. Underestimating severity: Even seemingly minor bites can progress to severe envenomation
4. Overuse of antivenin: For common adder bites (in countries like Lithuania and Great Britain), antivenin should be limited to life-threatening conditions due to the risk of dangerous reactions 3

Remember that the definitive treatment for venomous snakebites is antivenin administration in a hospital setting, and proper first aid focuses on minimizing venom spread while avoiding harmful interventions that were once commonly practiced.