What is the proper treatment for a snake bite?

Proper Treatment for Snake Bite

The proper treatment for a snake bite is to immediately activate emergency services, rest and immobilize the bitten extremity, remove constricting objects like rings, and avoid harmful practices such as applying ice, using suction, applying electric shock, or using tourniquets. 1, 2

Immediate First Aid Measures

• Activate emergency services immediately for any person bitten by a venomous or possibly venomous snake, as definitive treatment (antivenom) is only available in healthcare settings 1, 2
• Rest and immobilize the bitten extremity to minimize venom absorption and reduce systemic spread 1, 2
• Minimize physical exertion by the victim, as activity can increase venom absorption through the lymphatic system 2
• Remove rings and other constricting objects from the bitten extremity to prevent damage from progressive swelling 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 as it has unproven benefits and may cause additional 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 systematic reviews show it is ineffective and potentially harmful 1
• Do NOT apply tourniquets as they can worsen local tissue injury according to systematic reviews of human and animal studies 1, 2
• Do NOT use pressure immobilization bandaging in North America, as it may worsen tissue injury with cytotoxic venoms common in North American snakes 1, 2

Hospital-Based 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 administered intravenously 3
• Hospitals should perform a hazard vulnerability assessment to determine appropriate stocking levels of antivenom 3
• Skin testing for hypersensitivity is mandatory before antivenom administration 4
• Have epinephrine and diphenhydramine readily available in case of anaphylactic reactions 3, 4
• Administer broad-spectrum antibiotics and update tetanus prophylaxis as needed 4

Special Considerations

• Most snakebites in North America are caused by pit vipers (rattlesnakes, copperheads, and cottonmouths), which cause tissue injury, low blood pressure, bleeding, and potentially muscle fasciculations 1, 2
• Coral snake bites (found in Southeast and Southwest US) produce primarily neurotoxic effects rather than tissue injury and require specific management 1, 2
• Severity of envenomation should be graded to guide treatment intensity 4
• Fasciotomy is rarely indicated and should only be performed in cases with confirmed elevated intracompartment pressures 4

Common Pitfalls to Avoid

• Delaying transport to attempt ineffective first aid measures 2
• Excessive movement of the victim, which increases venom absorption 2
• Using techniques developed for neurotoxic snakes on cytotoxic snake bites, which predominate in North America 2
• Failing to recognize that a second exposure to antivenom within a short period may cause allergic reactions even if the first administration was well-tolerated 5
• Overtreatment can cause significant morbidity; treatment should be guided by the severity of envenomation 6