Snake Bite Treatment
Immediately activate emergency services for any venomous or possibly venomous snake bite, as rapid transport to a hospital for antivenom administration is the definitive treatment and cannot be provided in the field. 1, 2, 3
Immediate Field Management
The priority in the field is rapid transport with minimal intervention, as antivenom is only available in hospital settings and represents the cornerstone of treatment. 3
Actions to Take:
Rest and immobilize the bitten extremity to reduce systemic venom absorption through the lymphatic system. 1, 2, 3
Remove all rings, watches, and constricting objects from the affected limb immediately to prevent ischemic injury as swelling progresses. 1, 2, 3
Minimize patient exertion during transport, as walking and physical activity increase subcutaneous flow and accelerate systemic venom absorption. 2
Transport the victim to a medical facility as quickly as possible, ideally within 4 hours of the bite when antivenom therapy is most effective. 3, 4
Critical Interventions to AVOID
These commonly attempted field treatments are ineffective and potentially harmful:
Do NOT apply ice or immerse in cold water - this has unproven benefit and may cause additional tissue injury. 1, 3
Do NOT use suction devices (with or without incision) - these are ineffective for venom removal and may cause tissue damage. 1, 3, 5
Do NOT apply tourniquets - these worsen local tissue injury and necrosis. 1, 3
Do NOT use pressure immobilization bandaging in North America, as this technique is potentially harmful with cytotoxic pit viper venoms that predominate in the US. 1, 2, 3
Do NOT apply electric shock therapy - this is ineffective and potentially harmful. 1, 3, 6
Hospital-Based Definitive Treatment
Antivenom Administration:
The initial dose is 10 vials of antivenom for most pit viper envenomations, which provides adequate treatment without increasing adverse reaction risk. 7
Antivenom should be administered intravenously after hypersensitivity testing. 7, 5
Have epinephrine readily available (0.3-0.5 mg IM in adults, 0.01 mg/kg up to 0.3 mg in children) for potential anaphylactic reactions. 2, 7
Mild envenomations may require up to 5 vials; moderate cases 10-15 vials; severe cases 15-20 vials. 5
Supportive Care:
Administer broad-spectrum antibiotics and update tetanus prophylaxis. 4, 5
Provide pain medication and plasma expanders as needed. 4
Monitor for cardiac, hematologic, neurologic, renal, and pulmonary toxicity. 4
Species-Specific Considerations
Pit Vipers (Rattlesnakes, Copperheads, Cottonmouths):
Cause cytotoxic effects: tissue injury, swelling, pain, ecchymosis, coagulopathy, hypotension, and potential bleeding. 2
Represent 99% of venomous snakebites in the US. 4
Treated with CroFab antivenom. 2
Coral Snakes:
Cause neurotoxic effects: paralysis within minutes to hours with minimal tissue injury. 1, 2, 3
Require monitoring for respiratory compromise and potential ventilatory support. 2, 7
Found primarily in Florida and the Southwest (Texas, New Mexico, Arizona). 1, 2
Common Pitfalls
Delaying transport to attempt ineffective field interventions - the only definitive treatment is hospital-based antivenom. 3
Failing to remove constricting items early - rings and jewelry become impossible to remove as swelling progresses, leading to ischemic injury. 3
Excessive patient movement - this increases venom absorption through increased lymphatic flow. 3
Applying techniques designed for neurotoxic snakes to cytotoxic bites - pressure immobilization may worsen tissue damage with North American pit vipers. 3
Epidemiology
Approximately 8,000-10,000 snakebite injuries are treated annually in US emergency departments, with an average of 6 deaths per year, emphasizing that with proper hospital care, mortality is extremely low. 2, 3