What is the treatment for a snake bite?

Treatment of Snake Bite

Immediately activate emergency services for any person bitten by a venomous or possibly venomous snake, as this is a Class I recommendation and definitive treatment with antivenom is only available in healthcare settings. 1, 2

Immediate First Aid Actions

Do these actions while awaiting emergency transport:

• Rest and immobilize the bitten extremity to reduce systemic venom absorption through the lymphatic system—this is reasonable if it does not delay transport to emergency care 1, 2
• Remove all rings, watches, and constricting objects from the affected extremity immediately to prevent ischemic injury as swelling progresses 1, 2
• Minimize physical exertion by the victim to slow venom distribution 1, 2
• Transport the victim to a medical facility as quickly as possible since antivenom cannot be administered in the field 2

Harmful Practices That Must Be Avoided

The 2024 American Heart Association and American Red Cross guidelines explicitly warn against several traditional "treatments" that are potentially harmful:

• Do NOT apply ice or immerse in cold water—this has unproven benefit and may cause additional tissue injury 1, 2
• Do NOT use suction devices (with or without incision)—these are ineffective for venom removal and cause tissue damage 1, 2
• Do NOT apply electric shock—this is ineffective and potentially harmful 1, 2
• Do NOT apply tourniquets—these worsen local tissue injury and necrosis 1, 2
• Do NOT use pressure immobilization bandaging in North America—while this technique may be appropriate for neurotoxic snakes in other parts of the world, it worsens tissue injury with the cytotoxic venoms of North American pit vipers 1, 2

A critical pitfall is delaying transport to attempt any of these ineffective field treatments. 2

Hospital-Based Definitive Treatment

Antivenom is the cornerstone and only definitive treatment for venomous snakebites: 2, 3

• Initial dosing: 10 vials of antivenom is the recommended starting dose, offering practical single-dose administration without increasing adverse reaction risk 3
• Antivenom must be administered intravenously after hypersensitivity testing 3, 4
• Have epinephrine immediately available (0.3-0.5 mg IM in adults, 0.01 mg/kg up to 0.3 mg in children) for potential anaphylactic reactions 3
• Moderate envenomations may require 10-15 vials total, while severe cases may need 15-20 vials 4
• Antivenom is most effective when given within 4 hours of the bite 5

Additional hospital management includes:

• Grading severity of envenomation based on local tissue effects (pain, edema, ecchymoses) and systemic symptoms 4, 5
• Laboratory monitoring for coagulopathy and other systemic effects 6
• Wound cleaning and broad-spectrum antibiotics 4
• Tetanus prophylaxis as indicated 4, 5
• Airway management and ventilatory support for neurotoxic envenomation (coral snakes) 3

Special Considerations for Coral Snakes

Coral snake bites require specific management because they produce primarily neurotoxic effects rather than local tissue injury, with paralysis potentially developing within minutes to hours 1, 2. All coral snake envenomations must be treated vigorously with coral snake-specific antivenom 7.

Key Clinical Pitfalls

• Failing to recognize that not all bites result in envenomation—approximately 20-25% of venomous snake bites are "dry bites" without venom injection 4, 7
• Overtreatment causing more morbidity than the bite itself, particularly with unnecessary surgical interventions 7
• Assuming skin testing reliably predicts anaphylaxis to antivenom—while it has some value, allergic reactions can still occur despite negative testing 8
• Using excessive movement or allowing the victim to walk, which accelerates venom absorption 2