Management of Neurotoxic Snake Bite
Immediate activation of emergency services is essential for any person bitten by a venomous or possibly venomous snake, as antivenom is the cornerstone of treatment and only available in healthcare settings. 1, 2
Immediate First Aid Measures
- Activate emergency services immediately for any venomous or potentially venomous snake bite 1, 2
- Rest and immobilize the bitten extremity to minimize exertion and reduce systemic venom absorption 2
- Remove rings and other constricting objects from the bitten extremity to prevent damage from swelling 1, 2
- Transport the victim to a medical facility as quickly as possible for definitive treatment 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 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
Hospital Management
Antivenom Administration
- Antivenom is the definitive treatment for venomous snakebites 2, 3
- The recommended initial dose is 10 vials administered intravenously after appropriate hypersensitivity testing 4
- Low-dose antivenom protocols (150 ml) have been shown to be as effective as high-dose protocols (300-1600 ml) for severe neurotoxic envenomation, suggesting that excessive dosing may not be necessary 5
Supportive Care
- Ensure airway management and ventilatory support if needed, especially critical for neurotoxic envenomation which can cause respiratory paralysis 4, 6
- Have epinephrine readily available for treatment of potential anaphylactic reactions to antivenom 4
- Monitor for development of locked-in syndrome, a rare but serious neurotoxic presentation that requires prompt recognition and management 6
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
- Neurotoxic envenomation can progress rapidly to respiratory failure, requiring mechanical ventilation 5, 6
- Hospital preparedness is essential - facilities should perform hazard vulnerability assessments to determine appropriate stocking levels of antivenom 4
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 can increase venom absorption through the lymphatic system 2
- Inadequate training in snake bite management, particularly regarding appropriate use of antivenom and management of adverse reactions 7
- Using techniques developed for neurotoxic snakes on cytotoxic snake bites, which predominate in North America 2