What are the guidelines for managing a snake bite?

Guidelines for Management of Snake Bite

Emergency services should be activated immediately for any person bitten by a venomous or possibly venomous snake, as this is the most critical first step in management. 1, 2

Immediate First Aid Measures

• Activate emergency services immediately for any person bitten by a venomous or possibly venomous snake 1, 2
• Rest and immobilize the bitten extremity to minimize venom spread through the lymphatic system 1, 2
• Remove rings and other constricting objects from the bitten extremity to prevent damage from swelling 1, 2
• Minimize exertion by the victim to reduce systemic absorption of venom 1, 2
• Transport the victim to a medical facility as quickly as possible, as definitive treatment (antivenom) is only available in healthcare settings 1, 2

Harmful Practices to Avoid

• Do NOT apply ice to a snakebite wound as it has unproven benefits and may cause tissue injury 1, 2
• Do NOT use suction devices (with or without incision) as they are ineffective for venom removal and may cause tissue injury 1, 2
• Do NOT apply electric shock as it is ineffective and potentially harmful 1, 2
• Do NOT apply tourniquets as they can worsen local tissue injury 1, 2
• Do NOT use pressure immobilization bandaging in North America, as it may worsen tissue injury with cytotoxic venoms 1, 2

Medical Management in Hospital Setting

• Antivenom is the cornerstone of treatment for venomous snakebites 2, 3
• The recommended initial dose of Anti-Snake Venom (ASV) is 10 vials administered intravenously after appropriate testing for hypersensitivity 3
• Patients should undergo comprehensive evaluation for hematologic, neurologic, renal, and cardiovascular abnormalities 4
• Ensure airway management and ventilatory support if needed, especially for neurotoxic envenomation 3

Special Considerations

• Most snakebites in North America (>95%) are caused by pit vipers (rattlesnakes, copperheads, and cottonmouths) 1, 2
• Coral snake bites (Elapidae) in the Southeast and Southwest US produce primarily neurotoxic effects rather than tissue injury and require specific management 1, 2
• Approximately 8,000-10,000 people are treated for snakebites annually in the US 1, 2
• These guidelines are specific to snakebites occurring in the United States and Canada; snakes in other parts of the world have different venom effects and may require different first aid measures 1

Common Pitfalls to Avoid

• Delaying transport to a medical facility to attempt ineffective first aid measures 2
• Failing to remove constricting items like rings, which can lead to ischemic injury as swelling progresses 1, 2
• Excessive movement of the victim, which can increase venom absorption through the lymphatic system 1, 2
• Using outdated first aid techniques such as incision, suction, ice application, or electrical current application 1, 4
• Using pressure immobilization techniques developed for neurotoxic snakes on cytotoxic snake bites, which predominate in North America 1, 2