What is the treatment approach for a patient bitten by a snake?

Treatment of Snake Bite

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

Immediate First Aid Actions

Do these immediately:

• Call 911 or activate emergency services for any venomous or possibly venomous snakebite 1
• Remove all rings, watches, jewelry, and constricting objects from the bitten extremity before swelling develops, as progressive edema can cause ischemic injury to digits and tissues 1, 2
• Immobilize the bitten extremity and keep it at or below heart level to minimize venom absorption through the lymphatic system 2, 3
• Minimize all physical exertion by the victim during transport, as walking or activity for ≥10 minutes significantly accelerates systemic venom absorption 1, 3

The rationale here is straightforward: movement increases lymphatic flow and drives venom systemically. A human experimental study demonstrated that walking for 10+ minutes increased flow of subcutaneously injected radiotracer, which directly translates to increased venom absorption. 1

Critical Interventions to AVOID

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

• Do NOT apply ice or cold therapy—it causes additional tissue injury without benefit 1, 3
• Do NOT use suction devices (with or without incision)—they remove negligible venom and may aggravate tissue injury 1, 2
• Do NOT apply tourniquets—they worsen local tissue injury without preventing systemic envenomation 1, 3
• Do NOT use electric shock therapy—it is completely ineffective and potentially harmful 1, 2
• Do NOT use pressure immobilization bandaging in North America—it may worsen tissue injury by trapping cytotoxic venom at the bite site, and >95% of North American snakebites involve cytotoxic venom from pit vipers 1, 3

The evidence against these interventions is robust. Systematic reviews of both human experience and animal experiments consistently show these methods are ineffective or harmful. 1 Additionally, studies demonstrate that even medical personnel have low rates of appropriate pressure immobilization bandage placement under ideal conditions, making this technique impractical and potentially dangerous. 1

Understanding North American Snake Venom Types

This distinction is critical for appropriate management:

• Pit vipers (rattlesnakes, copperheads, cottonmouths) cause >95% of venomous bites in North America and produce cytotoxic/hemotoxic venom that causes progressive local tissue necrosis, coagulopathy, thrombocytopenia, low blood pressure, bleeding, and muscle fasciculations 1, 3
• Coral snakes (Elapidae) in the Southeast and Southwest US produce neurotoxic venom causing minimal local injury but progressive paralysis and respiratory failure, with onset potentially delayed up to 13 hours 2, 4

Wounds from pit vipers are typically red, warm, tender, and swollen. 1 The key pitfall: never assume no envenomation based on absence of immediate pain or swelling, particularly with neurotoxic bites that cause life-threatening systemic toxicity despite minimal local findings. 3

Definitive Hospital Treatment

Antivenom is the cornerstone and only specific treatment for venomous snakebites: 2

• Antivenom is most effective when administered within 4 hours of the bite 5
• For pit viper envenomation, polyvalent antivenin (such as Crotalidae Polyvalent Immune Fab/CroFab) is administered based on severity of envenomation 4, 6
• For coral snake bites, North American Coral Snake Antivenin should be administered to all patients with confirmed or suspected neurotoxic envenomation showing any signs of neurotoxicity 4
• Patients with neurotoxic envenomation require hospitalization for minimum 48 hours with continuous monitoring, as neurotoxicity onset can be delayed up to 13 hours 3, 4

Transport by EMS allows delivery of supportive and stabilizing care (airway management, shock treatment, coagulation monitoring) before hospital arrival. 1

Common Pitfalls to Avoid

• Delaying transport to attempt ineffective field interventions—time to antivenom is the most important prognostic factor 3
• Failing to remove constricting items like rings—this leads to ischemic injury as swelling progresses 2, 3
• Excessive victim movement—this increases venom absorption through the lymphatic system 2, 3
• Applying pressure immobilization techniques developed for neurotoxic snakes to North American pit viper bites—this worsens cytotoxic tissue damage 1, 3