Can a person survive a bite from a copperhead (Agkistrodon contortrix) snake?

From the Guidelines

Yes, you can survive a copperhead bite with proper medical treatment. If bitten by a copperhead snake, seek emergency medical care immediately by calling 911 or going to the nearest hospital. While waiting for help, keep the bite area below heart level, remove any jewelry or tight clothing near the wound, clean the bite with soap and water if possible, and remain calm to slow venom spread. Do not apply tourniquets, cut the wound, attempt to suck out venom, or apply ice, as these methods are ineffective and may cause tissue injury, as stated in the 2024 American Heart Association and American Red Cross guidelines for first aid 1. At the hospital, treatment typically involves monitoring, pain management, and possibly antivenom (CroFab) if symptoms are severe.

Most copperhead bites are not fatal to healthy adults, as their venom is less potent than other pit vipers like rattlesnakes, according to the 2024 American Heart Association and American Red Cross guidelines for first aid 1. However, without proper treatment, bites can cause significant tissue damage, extreme pain, swelling, and in rare cases, more serious complications. Children, elderly individuals, and those with compromised immune systems face higher risks from copperhead bites. It is essential to seek prompt medical attention, as the definitive treatment for snake bite is antivenom, which is not available for use in the first aid setting, as mentioned in the 2024 American Heart Association and American Red Cross guidelines for first aid 1.

Some key points to consider when treating a copperhead bite include:

• Removing any constricting jewelry or clothing near the wound, as swelling may cause damage to the affected area 1
• Keeping the bite area below heart level to reduce venom spread
• Cleaning the bite with soap and water if possible
• Remaining calm to slow venom spread
• Avoiding ineffective and potentially harmful treatments, such as tourniquets, suction, or ice application 1

From the FDA Drug Label

The term crotalid is used to describe the Crotalinae subfamily (formerly known as Crotalidae) of venomous snakes which includes rattlesnakes, copperheads and cottonmouths/water moccasins. CROFAB was effective in neutralizing the venoms of 10 clinically important North American crotalid snakes in a murine lethality model Two premarketing prospectively defined, open label, multi-center trials were conducted in otherwise healthy patients 11 years of age or older who had experienced minimal or moderate North American crotalid envenomation that showed evidence of progression Both clinical trials excluded patients with Copperhead envenomation

Survival from a copperhead bite depends on various factors, including the severity of the envenomation and the promptness of treatment.

• Crotalid envenomation can be managed with CROFAB, which has been shown to be effective in neutralizing the venoms of several North American crotalid snakes.
• However, copperhead envenomation was excluded from the clinical trials, and therefore, the efficacy of CROFAB in treating copperhead bites is not directly supported by the available data 2 2.
• It is essential to note that survival from a copperhead bite is possible with proper medical treatment, but the severity of the envenomation and the individual's overall health play a significant role in determining the outcome.
• Medical attention should be sought immediately if a copperhead bite occurs, as prompt treatment can help prevent serious complications and improve outcomes.

From the Research

Survival and Treatment of Copperhead Bites

• The majority of copperhead snakebites are not life-threatening, with fewer than 10 deaths occurring annually in the US, and most of these deaths are due to rattlesnake envenomations 3.
• A study of 142 snakebites, including 88 copperhead bites, found that the most common presenting symptoms were pain and swelling, and 85% of the copperhead bites were grade 1 envenomations, which do not require antivenom or surgical intervention 3.
• Another study found that signs, symptoms, and impaired function typically last 7-14 days after copperhead envenomation, and several tools, such as the DASH and LEFS, appear responsive and useful in studying recovery from pit viper envenomation 4.

Use of Antivenom and NSAIDs

• The use of antivenom in copperhead snakebites is not always necessary, and its administration is associated with a large increase in the odds of hospital admission, even when controlling for bite severity 5.
• A study found that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in copperhead snakebite patients appears safe, with no significant difference in bleeding outcomes or coagulation laboratory values between patients who received NSAIDs and those who did not 6.

Management and Outcome

• The current management of copperhead snakebites involves observation, pain control, and laboratory testing, with a declining role for surgical management 7.
• A study of copperhead snakebites in Ohio found that the frequency of antivenom use did not significantly increase between 2006 and 2016, and further education may be needed to increase its use for copperhead snakebites 5.