What is the treatment for a snake bite?

Treatment of Snake Bite

For snake bite treatment, immediately activate emergency services, rest and immobilize the bitten extremity, remove constricting objects, and transport the victim to a medical facility as quickly as possible for definitive antivenom therapy. 1

Immediate First Aid Measures

• Activate emergency services immediately for any person bitten by a venomous or possibly venomous snake 2, 1
• Rest and immobilize the bitten extremity to minimize systemic absorption of venom 2, 1
• Remove rings and other constricting objects from the bitten extremity to prevent damage from swelling 1
• Transport the victim to a medical facility as quickly as possible, as definitive treatment (antivenom) is only available in healthcare settings 1

Harmful Practices to Avoid

• DO NOT apply ice to a snakebite wound as it has unproven benefits and may cause tissue injury 2, 1
• DO NOT use suction devices (with or without incision) as they are ineffective for venom removal and may cause tissue injury 1, 3
• DO NOT apply electric shock as it is ineffective and potentially harmful 2, 1
• DO NOT apply tourniquets as they can worsen local tissue injury 2, 1
• DO NOT use pressure immobilization bandaging in North America, as it may worsen tissue injury with cytotoxic venoms 2, 1

Medical Management

• Antivenom is the cornerstone of treatment for venomous snakebites and should be administered in a medical facility 1, 4
• Severity of envenomation should be graded to determine appropriate antivenom dosing 5:
  • Mild cases may require up to 5 vials of antivenom
  • Moderate cases may require 10-15 vials
  • Severe cases may require 15-20 vials
• Antivenom is most effective when administered within four hours of the snakebite 4
• Skin testing for hypersensitivity to antivenom is mandatory before administration 5, 6
• Have diphenhydramine and epinephrine readily available in case of anaphylactic reaction 5
• Additional supportive care includes:
  • Wound cleaning and broad-spectrum antibiotics 5
  • Tetanus prophylaxis as needed 5
  • Pain management 4

Special Considerations

• Coral snake bites (Elapidae) in the Southeast and Southwest US produce primarily neurotoxic effects rather than tissue injury and require specific coral snake antivenom 1, 7
• Most snakebites occur during warmer months and involve the extremities 1
• Approximately 8,000-10,000 people are treated for snakebites annually in the US, with most caused by pit vipers (rattlesnakes, copperheads, and cottonmouths) 1, 4

Pitfalls to Avoid

• Delaying transport to a medical facility to attempt ineffective first aid measures 1
• Failing to remove constricting items like rings, which can lead to ischemic injury as swelling progresses 1
• Excessive movement of the victim, which can increase venom absorption through the lymphatic system 1
• Using outdated treatments like incision and suction, which are contraindicated unless performed by experienced personnel within five minutes of the bite 5, 3
• Patients who have received antivenom previously may develop allergic reactions upon second exposure, requiring careful monitoring 6