Treatment of Snakebite
The definitive treatment for snakebite is antivenom, which should be administered in a medical facility after immediate activation of emergency services for any person bitten by a venomous or possibly venomous snake. 1
Immediate First Aid Measures
- Activate emergency services immediately for any person bitten by a venomous or possibly venomous snake 1
- Rest and immobilize the bitten extremity and minimize exertion by the victim to reduce systemic absorption of venom 1
- Remove rings and other constricting objects from the bitten extremity to prevent damage from swelling 1
- Transport the victim to a medical facility as quickly as possible, as definitive treatment (antivenom) is only available in healthcare settings 1
Harmful Practices to Avoid
- Do NOT apply ice to a snakebite wound as it has unproven benefits and may cause tissue injury 1
- Do NOT use suction devices (with or without incision) as they are ineffective for venom removal and may cause tissue injury 1
- Do NOT apply electric shock as it is ineffective and potentially harmful 1
- Do NOT apply tourniquets as they can worsen local tissue injury 1
- Do NOT use pressure immobilization bandaging in North America, as it may worsen tissue injury with cytotoxic venoms (which account for 95% of North American snake envenomations) 1
Medical Management
- Antivenom is the cornerstone of treatment for venomous snakebites 1
- Comprehensive evaluation should include assessment for hematologic, neurologic, renal, and cardiovascular abnormalities 2
- Grading the severity of envenomation (I through IV) guides antivenom administration 2, 3
- Patients with mild envenomation may require up to 5 vials of antivenom, moderate cases 10-15 vials, and severe cases 15-20 vials 3
- Antivenom must be administered intravenously after appropriate testing for hypersensitivity 3, 4
- CroFab (Crotalidae Polyvalent Immune Fab) is a newer, less allergenic sheep-derived antivenom that has largely replaced traditional equine-derived products 2, 5
Special Considerations
- Coral snake bites (Elapidae) in the Southeast and Southwest US produce primarily neurotoxic effects rather than tissue injury and require specific management 1
- Fasciotomy is rarely indicated and should only be performed in cases with confirmed elevated compartment pressures 3, 5
- Most snakebites occur during warmer months and involve the extremities 1
- Approximately 8,000-10,000 people are treated for snakebites annually in the US, with most caused by pit vipers (rattlesnakes, copperheads, and cottonmouths) 1, 4
Pitfalls to Avoid
- Delaying transport to a medical facility to attempt first aid measures that are ineffective 1, 2
- Applying outdated treatments like suction devices, which remove minimal venom and may worsen injury 1, 2
- Failing to remove constricting items like rings, which can lead to ischemic injury as swelling progresses 1
- Excessive movement of the victim, which can increase venom absorption through the lymphatic system 1
- Using pressure immobilization techniques developed for neurotoxic snakes on cytotoxic snake bites, which predominate in North America 1