Snake Bite Treatment
Immediately activate emergency services for any venomous or possibly venomous snake bite, rest and immobilize the affected extremity, remove constricting objects, and transport rapidly to a hospital for antivenom administration—avoid all traditional "field remedies" including tourniquets, ice, suction, incision, or electric shock as these are ineffective and potentially harmful. 1, 2
Immediate First Aid Actions
Call 911 immediately for any snake bite where the species is venomous or unknown—definitive treatment (antivenom) is only available in hospital settings and cannot be administered in the field. 1, 2
Rest and immobilize the bitten extremity to minimize systemic venom absorption, as walking or exertion for ≥10 minutes increases flow of subcutaneously injected substances and accelerates venom spread throughout the body. 1, 2
Remove all rings, watches, bracelets, and tight clothing from the affected limb immediately, as progressive swelling can cause these items to act as tourniquets and produce ischemic injury to the finger or limb. 1, 2
Minimize patient movement and exertion during transport—have the patient remain still and carry them if possible rather than having them walk, as physical activity increases lymphatic flow and venom absorption. 2, 3
Harmful Practices That Must Be Avoided
The 2024 American Heart Association guidelines explicitly recommend against several traditional snake bite treatments that persist in popular culture but cause harm: 1
Do NOT apply ice or cold packs—this has unproven benefit for venom neutralization and case reports document tissue injury from aggressive cryotherapy. 1, 2
Do NOT use suction devices (with or without incision)—systematic reviews show suction is ineffective at removing venom and may cause additional tissue injury at the bite site. 1, 2
Do NOT apply electric shock—systematic reviews of human experience and animal experiments demonstrate this is both ineffective and potentially harmful. 1, 2
Do NOT apply tourniquets—systematic reviews show tourniquets are ineffective at preventing venom spread and worsen local tissue injury and necrosis. 1, 2
Do NOT use pressure immobilization bandaging in North America—while this technique may have utility for neurotoxic snake bites in Australia, it worsens tissue injury with the cytotoxic venoms of North American pit vipers, and studies show even trained personnel have low rates of appropriate placement. 1, 2
Hospital-Based Definitive Treatment
Antivenom is the cornerstone and only definitive treatment for venomous snake bites and must be administered intravenously in a hospital setting where anaphylaxis can be managed. 1, 2, 4
Pit viper envenomation (rattlesnakes, copperheads, cottonmouths—responsible for >95% of US venomous bites) causes cytotoxic effects including tissue injury, swelling, pain, ecchymosis, coagulopathy, hypotension, and bleeding. 1, 3
Coral snake envenomation (Southeast and Southwest US) causes neurotoxic effects with paralysis developing within minutes to hours, minimal tissue injury, and requires monitoring for respiratory compromise with potential need for ventilatory support. 1, 3
Antivenom dosing depends on envenomation severity: mild cases may require up to 5 vials, moderate cases 10-15 vials, and severe cases 15-20 vials, with one vial sufficient to bind circulating venom but multiple vials needed to reverse clinical effects. 4, 5
Skin testing for hypersensitivity is mandatory before antivenom administration, and epinephrine plus diphenhydramine must be immediately available for potential anaphylactic reactions. 4, 2
Clinical Pearls and Pitfalls
The single most critical pitfall is delaying transport to attempt ineffective field interventions—transport by EMS allows delivery of supportive care en route and should not be delayed for any first aid measures beyond immobilization and removal of constricting items. 1, 2
Not all snake bites result in envenomation—approximately 20-25% of venomous snake bites are "dry bites" without venom injection, but all suspected venomous bites require hospital evaluation with serial laboratory testing and observation for at least 12 hours. 5
Antivenom is most effective when given within 4 hours of the bite, emphasizing the critical importance of rapid transport rather than field treatment attempts. 6
Approximately 8,000-10,000 people are treated for snake bites annually in the United States with an average of only 6 deaths per year, demonstrating that with appropriate hospital-based care, mortality is extremely low. 1, 3