VENOMOUS SNAKE BITES



I. First aid for all snake bits
  1. Bandage and immobilize area of bite
  2. Get to hospital for antivenin treatment, though about 25% of snakebites do not involve envenomation
    1. Antivenin can cause allergic reactions-Have epinephrine and H1/H2 blockers on hand
  3. Constriction bands (enough to restrict venous and lymphatic, but not arterial, flow) may be helpful for Elapidae bites but not in Crotalidae bites (see below)
  4. Ice, tourniquet and "incise and suck" are no longer recommended approaches (may do more harm than good)
  5. Wound infection after snakebites is not common

II. Crotalidae (rattlesnakes, copperheads, and cottonmouths)
  1. Venom causes localized tissue destruction
  2. Can see thrombocytopenia, hyperkalemia, elevated CK levels (from rhabdomyolysis), and renal failure
  3. Give antivenin if there is worsening local injury, abnormal lab tests, change in mental status, or vital signs are unstable

III. Elapidae (coral snakes)
  1. Venom causes neurotoxicity
  2. Full toxicity may not occur immediately after bite and may not be easily reversed once sx appear
  3. Pts should be admitted for observation and given antivenin