What is the treatment for a snake bite?

Treatment for Snake Bite

Immediately activate emergency services and transport the patient to a hospital for definitive antivenom treatment, as this is the only effective therapy for venomous snake envenomation. 1

Immediate Field Management

Universal First Aid (All Snake Bites)

• Rest and completely immobilize the bitten extremity below heart level to minimize venom absorption through the lymphatic system 1
• Remove all rings, watches, and constricting jewelry immediately before swelling develops, as progressive edema can cause ischemic injury to digits 2, 1
• Minimize patient exertion during transport—walking or physical activity accelerates systemic venom absorption 2, 1
• Activate emergency medical services immediately as definitive antivenom treatment is only available in hospital settings 3, 1

Critical Geographic/Species Distinction for Pressure Immobilization

The American Heart Association guidelines make a crucial distinction based on snake type:

• DO apply pressure immobilization bandaging (40-70 mm Hg upper extremity, 55-70 mm Hg lower extremity) for:

  • Sea snakes 3
  • Coral snakes (neurotoxic elapids) 2
  • Other non-North American species with neurotoxic venom 3

• DO NOT apply pressure immobilization for North American pit vipers (rattlesnakes, copperheads, cottonmouths), as this may worsen local tissue injury from cytotoxic venom 1

What NOT to Do (Potentially Harmful Interventions)

• Do not apply ice or cold therapy—this is ineffective for venom removal and causes tissue injury 3, 1
• Do not use suction devices, incision, or mouth suction—these methods are ineffective at removing venom and may cause additional tissue damage 3, 1
• Do not apply tourniquets—systematic reviews demonstrate they worsen local tissue injury without preventing systemic envenomation 3, 1
• Do not use electric shock therapy—this is both ineffective and potentially harmful 3, 1

Hospital-Based Definitive Treatment

• Antivenom is the cornerstone of treatment and the only effective therapy for venomous snake envenomation 1, 4
• Administer antivenom intravenously based on envenomation severity:
  • Mild envenomation: up to 5 vials
  • Moderate envenomation: 10-15 vials
  • Severe envenomation: 15-20 vials 4
• Perform skin testing before antivenom administration to predict anaphylactic reactions, with diphenhydramine and epinephrine readily available 4
• Clean the wound and administer broad-spectrum antibiotics for all envenomation grades 4, 5
• Update tetanus prophylaxis as indicated 4, 5
• Hospitalize for minimum 48 hours with continuous monitoring, as neurotoxicity onset can be delayed up to 13 hours (particularly for coral snakes and sea snakes) 3, 2

Clinical Monitoring and Assessment

• Monitor continuously for signs of neurotoxicity: muscle weakness, ptosis, difficulty swallowing, respiratory distress, or altered mental status—particularly critical for coral snakes and sea snakes 3, 2
• Grade envenomation severity based on local tissue effects, systemic symptoms, and laboratory abnormalities within 30 minutes to one hour of the bite 4, 5
• Assess for coagulopathy with laboratory testing, as hematologic toxicity is a major manifestation of pit viper envenomation 6, 5

Critical Pitfalls to Avoid

• Never assume no envenomation based on absence of pain or swelling—coral snakes and sea snakes cause life-threatening systemic neurotoxicity despite minimal local findings 3, 2
• Do not delay transport to attempt ineffective field interventions—time to antivenom is the single most important prognostic factor 3, 2
• Do not discharge patients prematurely—neurotoxicity can be delayed up to 13 hours, requiring prolonged observation 2
• Do not confuse management strategies between snake types—pressure immobilization is beneficial for neurotoxic snakes but harmful for cytotoxic North American pit vipers 1
• Antivenom is most effective when administered within 4 hours of the bite, making rapid transport essential 7