What is the management of a hemolytic snake bite?

Management of Hemolytic Snake Bite

For hemolytic snake bite management, immediately activate emergency services, rest and immobilize the bitten extremity, remove constricting objects, and transport the victim to a medical facility for definitive treatment with antivenom, which is the cornerstone of therapy. 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 exertion and reduce systemic absorption of venom 2
• Remove rings and other constricting objects from the bitten extremity to prevent damage from swelling 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

Medical Management

Antivenom Administration

• Antivenom is the cornerstone of treatment for venomous snakebites 2, 3
• The recommended initial dose is 10 vials administered intravenously after appropriate testing for hypersensitivity 4
• Hospitals should have at least 12 vials of antivenom available for most pit viper envenomations in North America 4

Managing Hemolytic Effects

• For snake bite-associated thrombotic microangiopathy (TMA) with hemolysis, therapeutic plasma exchange may be considered as an adjunctive therapy 5
• Monitor for signs of microangiopathic hemolytic anemia, thrombocytopenia, and renal failure which may indicate TMA 5

Managing Adverse Reactions to Antivenom

• Have epinephrine readily available for treatment of anaphylactic reactions to antivenom 4, 6
• Acute reactions to antivenom typically occur within an hour of administration and range from mild to severe systemic anaphylaxis 7
• Delayed serum sickness reactions may occur 5-14 days after antivenom administration and can be treated with steroids and antihistamines 6, 7

Laboratory Monitoring

• Perform comprehensive laboratory evaluation including:
  • Complete blood count to assess for hemolysis and thrombocytopenia 8
  • Coagulation studies to identify coagulopathy 3, 8
  • Renal function tests to monitor for acute kidney injury 8, 5
  • Peripheral blood smear to look for schistocytes indicating microangiopathic hemolysis 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, 2
• Ensure airway management and ventilatory support if needed, especially for neurotoxic envenomation 4
• Progressive venom injury (worsening local injury, coagulation abnormality, or systemic effects) is the general indication for antivenom administration 3

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 2
• Overlooking thrombotic microangiopathy as a cause of post-envenomation renal failure 5
• Excessive movement of the victim, which can increase venom absorption through the lymphatic system 2