What are the immediate actions and management strategies for a snake bite?

Snake Bite Management

Immediate activation of emergency services is essential for any person bitten by a venomous or possibly venomous snake, as antivenom is the definitive treatment and is only available in healthcare settings. 1, 2

Immediate Actions for Snake Bite

• Call emergency services immediately for any venomous or potentially 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 to prevent damage from progressive 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 2

Harmful Practices to Avoid

• Do NOT apply ice to a snakebite 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 from pit vipers 1, 2

Types of Venomous Snakes in North America

• Pit vipers (Crotalinae) account for more than 95% of venomous bites in North America 1

  • Include rattlesnakes, copperheads, and cottonmouths
  • Venom causes tissue injury, hypotension, bleeding, and muscle fasciculations
  • Wounds are typically red, warm, tender, and swollen 1

• Coral snakes (Elapidae) are found in the Southeast and Southwest US 1

  • Venom is primarily neurotoxic and can cause paralysis within minutes to hours
  • These bites do not typically cause significant tissue injury 1

Hospital Management

• 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 3
• Hospitals should perform a hazard vulnerability assessment to determine appropriate stocking levels of antivenom 3
• Epinephrine should be readily available for treatment of 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 pressure immobilization techniques developed for neurotoxic snakes on cytotoxic snake bites (which predominate in North America) 2

Special Considerations

• Approximately 8,000-10,000 people are treated for snakebites annually in the US 1
• Most snakebites occur during warmer months and involve the extremities 1
• First aid recommendations 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