What is the protocol for managing a snake bite?

Snake Bite Management Protocol

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 snake bite management. 1, 2

Immediate First Aid Measures

• Activate emergency services (call 911) 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
• Transport the victim to a medical facility as quickly as possible, as definitive treatment (antivenom) is only available in healthcare settings 2, 3

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 from pit vipers 1, 2

Medical Management in Healthcare Settings

• Antivenom is the cornerstone of treatment for venomous snakebites 2, 3
• The recommended initial dose of Anti-Snake Venom (ASV) for treating a snake bite is typically 10 vials 4
• Administer ASV intravenously after appropriate testing for hypersensitivity 4, 5
• Hospitals should perform a hazard vulnerability assessment to determine appropriate stocking levels of antivenom, especially in areas endemic for venomous snakes 4

Special Considerations

• Most snakebites in North America (>95%) are caused by crotaline snakes (pit vipers), specifically rattlesnakes, copperheads, and cottonmouths 1
• Pit viper venom causes tissue injury and may also cause low blood pressure, bleeding, and muscle fasciculations leading to paralysis 1
• 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

Pitfalls to Avoid

• Delaying transport to a medical facility to attempt first aid measures that are ineffective 2, 6
• 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 pressure immobilization techniques developed for neurotoxic snakes on cytotoxic snake bites, which predominate in North America 1, 6
• Attempting to capture or kill the snake, which may lead to additional bites 2

Algorithm for Snake Bite Management

1. Immediate actions:

   • Call emergency services (911) 1
   • Keep victim calm and minimize movement 1
   • Remove constricting items (rings, jewelry, tight clothing) 1
   • Position bite site at or below heart level 2

2. During transport to medical facility:

   • Continue to immobilize the affected limb 1
   • Monitor vital signs if possible 7
   • Note time of bite and any developing symptoms 7

3. At medical facility:

   • Assessment for signs of envenomation (swelling, ecchymosis, pain) 3, 7
   • Laboratory tests (complete blood count, coagulation studies, metabolic panel) 7
   • Antivenom administration if indicated 4, 5
   • Monitoring for compartment syndrome and other complications 7