What is the management of a snake bite?

Management of Snake Bite

The definitive treatment for snake bite is antivenom, which requires immediate activation of emergency services and transport to a medical facility, as antivenom is not available in first aid settings. 1, 2

Immediate First Aid Measures

DO:

• Call emergency services immediately for any venomous or potentially venomous snake bite 2
• Rest and immobilize the bitten extremity to minimize venom spread 1, 2
• Remove rings and other constricting jewelry from the affected limb to prevent complications from swelling 1, 2
• Keep the victim calm to reduce heart rate and slow venom circulation
• Position the bite site at or below heart level

DO NOT:

• Apply ice (may cause tissue injury) 1
• Use suction devices (ineffective and may cause tissue injury) 1
• Apply electric shock (ineffective and potentially harmful) 1
• Apply tourniquets (ineffective and may worsen local tissue injury) 1, 2
• Use pressure immobilization bandaging for North American pit vipers (may worsen tissue injury) 1
• Allow the victim to engage in physical activity that could increase venom absorption 2

Hospital Management

Initial Assessment and Stabilization

1. Assess vital signs and establish IV access
2. Perform complete blood count, coagulation studies, renal function tests, and electrolytes 2
3. Initiate cardiac monitoring to assess for hemolysis, anemia, coagulopathy, and acute kidney injury 2

Antivenom Administration

• Antivenom is the cornerstone of treatment for venomous snake bites 1, 2
• Initial dose typically includes 4-6 vials administered as soon as possible after envenomation 2
• Additional doses may be required until initial control of symptoms is achieved 2
• Prior to administration, patients should be tested for hypersensitivity to antivenom 3
• Be alert for allergic reactions, especially in patients previously treated with antivenom 4

Fluid Management

• Initiate aggressive fluid resuscitation with normal saline (initial rate of 1000 ml/h, then taper by at least 50% after 2 hours) 2
• Avoid potassium-containing balanced salt fluids due to risk of hyperkalemia 2
• Monitor for hyperkalemia, which requires urgent treatment if severe (>6.5 mmol/L or ECG changes) 2

Wound Care

• Clean the wound with sterile normal saline 2
• Remove superficial debris if present 2
• Avoid deep debridement unless absolutely necessary 2
• Consider antibiotic prophylaxis, especially for high-risk wounds 2, 3

Monitoring and Follow-up

• Continue monitoring for at least 24 hours after antivenom administration
• Monitor for delayed reactions, including serum sickness
• Elevate the affected limb if swelling persists 2
• Arrange long-term follow-up, as up to 41% of patients may show persistent renal involvement 2

Common Pitfalls to Avoid

1. Delayed seeking of medical care: Antivenom is most effective when administered within 4 hours of the bite 3
2. Inappropriate first aid: Outdated techniques like tourniquets and incision/suction should be avoided 5, 6
3. Inadequate monitoring: Snake envenomation can cause progressive symptoms affecting multiple organ systems 7
4. Failure to recognize allergic reactions to antivenom: These can be severe and require immediate intervention 4
5. Underestimating the severity: Even seemingly minor bites can progress to serious envenomation 7

In North America, most venomous bites (>95%) are from pit vipers (rattlesnakes, copperheads, cottonmouths), which cause tissue injury, hypotension, bleeding, and potentially neurotoxicity 1, 2. The management approach should be guided by the type of snake involved, clinical presentation, and local resources.