What is the treatment for a 30-year-old female with a snake bite?

Treatment of Snake Bite in a 30-Year-Old Female

Immediately activate emergency services and transport the patient to a hospital for definitive antivenom therapy, while resting and immobilizing the bitten extremity during transport. 1

Immediate First Aid Actions

Call 911 or activate emergency medical services immediately for any snake bite from a venomous or possibly venomous snake—this is the single most important action, as definitive treatment (antivenom) is only available in healthcare settings. 1

During Transport to Hospital:

• Rest and immobilize the bitten extremity to reduce systemic venom absorption through the lymphatic system—walking or exertion for ≥10 minutes increases flow of subcutaneously injected substances and accelerates venom spread. 1

• Remove all rings, watches, bracelets, and constricting jewelry from the affected extremity immediately, as swelling will progress rapidly and can cause ischemic injury if constricting items remain in place. 1

• Minimize patient exertion during transport—have the patient remain as still as possible and avoid walking if EMS transport is available. 1

Critical Interventions to AVOID

These traditional "treatments" are harmful and should never be performed: 1

• DO NOT apply ice or cold packs—this has no proven benefit for snake envenomation and case reports demonstrate tissue injury from cryotherapy. 1

• DO NOT use suction devices (with or without incision)—suction removes only negligible amounts of venom and may cause additional tissue injury. 1

• DO NOT apply electric shock—systematic reviews show this is completely ineffective and potentially harmful. 1

• DO NOT apply tourniquets—these worsen local tissue injury and are ineffective at preventing systemic envenomation. 1

• DO NOT use pressure immobilization bandaging for North American snake bites—while this technique may have utility for neurotoxic snakes in other parts of the world, it can worsen tissue injury from the cytotoxic venom of pit vipers (which cause >95% of venomous bites in the US). 1

Hospital-Based Definitive Treatment

Antivenom Administration:

• Antivenom is the cornerstone of treatment and should be administered based on clinical severity of envenomation, not simply because a bite occurred. 1, 2

• Initial dosing: 10 vials of antivenom is the recommended starting dose for significant envenomation, offering practical single-dose administration without increasing adverse reaction risk. 2

• Timing is critical: Antivenom is most effective when administered within 4 hours of the bite, though it can still provide benefit beyond this window. 3

Clinical Assessment for Antivenom:

Patients are candidates for antivenom if they develop within 30-60 minutes: 3

• Progressive pain and swelling at the bite site
• Ecchymoses (bruising) spreading from the wound
• Systemic symptoms (hypotension, bleeding, fasciculations)
• Abnormal laboratory findings (coagulopathy, thrombocytopenia)

Supportive Care:

• Hypersensitivity testing before antivenom administration 2
• Epinephrine readily available (0.3-0.5 mg IM for adults) for potential anaphylactic reactions to antivenom 2
• Tetanus prophylaxis 3
• Broad-spectrum antibiotics for wound infection prevention 3
• Pain management 3
• Monitoring for complications including coagulopathy and acute kidney injury 4

Snake Species Considerations in North America

Pit Vipers (>95% of US venomous bites): 1

• Rattlesnakes, copperheads, cottonmouths
• Cause cytotoxic effects: tissue injury, swelling, pain, ecchymosis, coagulopathy, hypotension, bleeding
• Wounds are red, warm, tender, and swollen
• Treated with CroFab antivenom

Coral Snakes (<5% of US venomous bites): 1

• Found in Southeast and Southwest US
• Cause neurotoxic effects: paralysis developing within minutes to hours
• Minimal to no tissue injury at bite site
• Require monitoring for respiratory compromise and potential ventilatory support

Common Pitfalls to Avoid

• Delaying hospital transport to attempt ineffective first aid measures—the only effective treatment is hospital-based antivenom. 1

• Failing to remove jewelry early—once significant swelling develops, ring removal may require cutting and can result in finger ischemia. 1

• Excessive patient movement—this accelerates venom absorption through increased lymphatic flow. 1

• Assuming "dry bites" are safe—approximately 20-25% of venomous snake bites do not result in envenomation, but all require medical evaluation as symptoms can be delayed. 5

Epidemiology and Prognosis

• Approximately 8,000-10,000 snake bite injuries are treated annually in US emergency departments (roughly 1 per hour). 5

• Average of 6 deaths per year in the US from snake bites. 5

• Most bites occur during warmer months and involve the extremities (arms/hands 47%, legs/feet 46%). 5

• With appropriate antivenom therapy, the vast majority of patients survive, though some may develop long-term complications including chronic kidney disease requiring follow-up. 4