What is the immediate treatment for an adult patient with no significant medical history who has been bitten by a snake?

Immediate Management of Snakebites

Activate emergency medical services immediately and transport the victim to a hospital as quickly as possible, as antivenom—the only definitive treatment—is available only in medical facilities. 1, 2

Critical First Actions at the Scene

Universal Measures (All Snakebites)

• Remove all rings, watches, jewelry, and constricting objects from the bitten extremity immediately before swelling develops, as progressive edema can cause ischemic injury to digits and tissues 1, 2
• Completely immobilize the bitten extremity and keep it at or below heart level to minimize venom absorption through the lymphatic system 1, 2
• Keep the victim calm and minimize all physical exertion during transport, as walking or activity accelerates systemic venom absorption 1, 2
• Irrigate the wound with copious amounts of water for cleaning, though this does not remove venom 3, 1

Geographic and Venom-Specific Considerations

For North American pit viper bites (rattlesnakes, copperheads, cottonmouths):

• Do NOT apply pressure immobilization bandaging, as it may worsen local tissue injury by trapping cytotoxic venom at the bite site 1

For neurotoxic snakes (coral snakes, sea snakes, most non-North American species):

• Apply pressure immobilization bandaging with 40-70 mm Hg in the upper extremity or 55-70 mm Hg in the lower extremity around the entire length of the bitten limb to slow lymphatic dissemination of neurotoxic venom 3, 1, 4
• The bandage should be snug enough that a finger can barely slip underneath 1, 4

Absolutely Contraindicated Measures

These interventions are harmful and must be avoided:

• Do NOT apply tourniquets—they worsen local tissue injury without preventing systemic envenomation 1, 2
• Do NOT apply ice or cold therapy—it causes additional tissue damage 1, 2, 4
• Do NOT use suction devices (including commercial extractors or mouth suction)—they remove negligible venom (only 0.04%) and may aggravate the injury 3, 1, 2
• Do NOT use electric shock therapy—it is completely ineffective and potentially harmful 1, 2, 4
• Do NOT cut or incise the wound—this increases tissue damage without removing venom 2, 5

Critical Clinical Pitfalls to Avoid

• Never assume no envenomation based on absence of immediate pain or swelling, as neurotoxic bites cause life-threatening systemic toxicity despite minimal local findings 1, 4
• Do not delay transport to attempt any field interventions, as time to antivenom is the most important prognostic factor 1, 2
• Do not apply pressure immobilization techniques developed for neurotoxic snakes to North American pit viper bites, as this worsens cytotoxic tissue damage 1
• Failing to remove constricting items leads to ischemic injury as swelling progresses 1, 2

Hospital Management Essentials

• Antivenom is the only definitive treatment and should be administered as soon as possible 2, 6, 5
• Establish intravenous access before antivenom administration 2
• Have epinephrine readily available for potential anaphylactic reactions to antivenom 2, 5
• For neurotoxic envenomation, hospitalize for a minimum of 48 hours with continuous monitoring, as neurotoxicity onset can be delayed up to 13 hours 1, 4

Venom Type Recognition for Treatment Decisions

Hemotoxic/cytotoxic venom (most North American pit vipers):

• Causes progressive local tissue necrosis, coagulopathy, and thrombocytopenia 1
• Pressure immobilization is contraindicated 1

Neurotoxic venom (coral snakes, sea snakes):

• Causes minimal local injury but progressive paralysis and respiratory failure 1, 4
• Pressure immobilization is beneficial 1, 4