What are the immediate steps for managing a snake bite?

Immediate Management of Snake Bites

Emergency services should be activated immediately for any person bitten by a venomous or possibly venomous snake. 1, 2

Initial First Aid Steps

• Call emergency services (911) immediately for any suspected venomous snake bite 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 before swelling develops 1, 2
• Minimize physical exertion by the victim to reduce systemic absorption of venom 1, 2
• Transport the victim to a medical facility as quickly as possible for definitive treatment (antivenom) 1, 2

Harmful Practices to Avoid

• Do NOT apply ice to the bite wound - this has unproven benefits and may cause tissue injury 1, 2
• Do NOT use suction devices (with or without incision) - these are ineffective for venom removal and may cause additional tissue injury 1, 2
• Do NOT apply electric shock - this is ineffective and potentially harmful 1, 2
• Do NOT apply tourniquets - these can worsen local tissue injury 1, 2
• Do NOT use pressure immobilization bandaging in North America - this may worsen tissue injury with cytotoxic venoms common in the US and Canada 1, 2

Considerations for Different Snake Types

• Most venomous bites in North America (>95%) are from pit vipers (rattlesnakes, copperheads, cottonmouths) 1
• Pit viper venom causes tissue injury, low blood pressure, bleeding, and potentially muscle paralysis 1
• Coral snake bites (found in Southeast and Southwest US) produce primarily neurotoxic effects rather than tissue injury 1, 2
• Different management approaches may be needed for snakes in other parts of the world 1

Hospital Management

• Antivenom is the cornerstone of treatment for venomous snakebites 2, 3
• The recommended initial dose of Anti-Snake Venom (ASV) is typically 10 vials for most pit viper envenomations 3
• Hospitals in areas with venomous snakes should perform hazard vulnerability assessments to ensure appropriate stocking of antivenom 3
• Epinephrine should be readily available to treat potential anaphylactic reactions to antivenom 3

Common Pitfalls to Avoid

• Delaying transport 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 increases venom absorption 1, 2
• Using outdated first aid techniques like tourniquets, incision, suction, or ice application 1, 2

Remember that the definitive treatment for snake bite is antivenom, which is only available in medical facilities. First aid measures should focus on limiting venom spread while expediting transport to emergency care 1, 2.