Immediate Snakebite Management
For any suspected venomous snakebite in North America, immediately activate emergency medical services (EMS) for rapid transport to a hospital, as antivenom administration is the definitive treatment and cannot be provided in the field. 1
Critical First Actions at the Scene
Call 911 immediately for any person bitten by a venomous or possibly venomous snake—do not delay transport attempting field interventions. 1, 2
Immediate Stabilization Steps
Remove all rings, watches, and constricting jewelry from the affected limb immediately before progressive swelling causes ischemic injury to digits. 1, 2, 3
Immobilize the bitten extremity completely and keep it at or below heart level to minimize venom absorption through the lymphatic system. 2, 3
Minimize patient exertion during transport—do not allow the victim to walk, as physical activity increases systemic venom absorption by up to 10 minutes of walking in experimental studies. 1, 2
Transport by EMS rather than private vehicle when possible, as this allows delivery of supportive care and monitoring en route to the hospital. 1
What NOT to Do: Harmful Interventions to Avoid
The 2024 American Heart Association guidelines explicitly classify these interventions as potentially harmful: 1
Do NOT apply ice or cryotherapy—this causes additional tissue injury without benefit. 1
Do NOT apply tourniquets—systematic reviews show they are ineffective and worsen local tissue injury. 1
Do NOT use suction devices (with or without incision)—they do not remove venom and may cause tissue damage. 1
Do NOT apply electric shock therapy—this is ineffective and potentially harmful. 1
Do NOT use pressure immobilization bandaging for North American snakebites—over 95% of US envenomations involve pit vipers with cytotoxic venom, and this technique may worsen tissue injury. 1, 3 Note: Pressure immobilization is only appropriate for non-North American species like coral snakes or exotic snakes, but proper application is difficult even for trained personnel. 1
Species-Specific Clinical Recognition
Pit Vipers (95%+ of US bites)
Rattlesnakes, copperheads, and cottonmouths cause: 1, 2
- Immediate local findings: Pain, swelling, redness, warmth, and tenderness at the bite site developing within 30 minutes 2, 4
- Progressive edema spreading proximally from the bite 4
- Potential systemic effects: Hypotension, bleeding, coagulopathy, muscle fasciculations 1, 4
Coral Snakes (<1% of US bites)
These cause neurotoxic envenomation with: 2, 4
- Minimal to no local tissue injury at the bite site—absence of pain or swelling does NOT rule out serious envenomation 4, 3
- Progressive paralysis developing within minutes to hours 2, 4
- Respiratory compromise that can develop rapidly, requiring urgent antivenom 4
Critical Pitfall to Avoid
Never assume no envenomation based on lack of local symptoms—coral snakes and exotic species can cause minimal local findings despite life-threatening systemic toxicity. 3 All suspected snakebite victims require hospital evaluation and monitoring for 12-48 hours, as neurotoxicity onset can be delayed. 3
Hospital Destination
Transport to a facility capable of administering antivenom (CroFab for pit vipers) and providing intensive monitoring, as approximately 8,000-10,000 snakebite injuries occur annually in the US with an average of 6 deaths per year. 2