How To Treat A Snake Bite

Snakes are a marvel of nature in their ability to endure and adapt and to exploit climatic and environmental conditions encountered in the United States. They are an important part of the ecosystem and as outdoor enthusiasts share this environment, encounters do happen. Snakes use their bite for both acquiring prey and defense, and occasionally these bites will involve the outdoor adventurer. The treatment of these bites has drastically changed over the years, as some methods have even been shown to worsen the injury and different groups and experts promote various management strategies. The apparent lack of definitive snakebite care is fueled by the difficulty in doing prospective scientifically rigorous studies. The venomous snakes in the United States that one might encounter include rattlesnakes, copperheads, cottonmouths (water moccasins) and coral snakes. While there are other venomous species that produce bites in America, most of these are from occupational bites, such as a herpetologist from a zoo or a hobbyist who interacts with exotic venomous snakes. Non-venomous snakes are capable of producing bites also, but it is often difficult to determine with one-hundred percent certainty that it was not a venomous snake.

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According to the Centers for Disease Control there are between seven and eight-thousand venomous snakebites per year, with rattlesnake bites being the most common. Regarding the native species encountered in the United States that are venomous, the toxins can be classified into hemotoxins which effect blood and the blood clotting systems, or neurotoxins which effect primarily nervous system functions.  Although up to a quarter of snake bites from venomous species are dry bites, an outdoor enthusiast is unable to predict this outcome (Silveira, PV; Nishioka Sde A (1995). "Venomous snake bite without clinical envenoming ('dry-bite'). A neglected problem in Brazil.". (Trop Geogr Med. 47 (2): 82–85). Compounding the difficulty in determining if an envenomation occurred is the difficulty in distinguishing fang marks from a venomous species, and abrasion patterns that resemble fang marks in a non-venomous species.

The first thing to remember after being bitten by a snake; don't panic. Make sure a scene is secure and you and fellow travelers are not in a situation where the snake may strike at you again and leave an area where there may be additional snakes such as in a den location. If you are able to identify the snake, only do so if it can be accomplished from a safe distance. If the scene is controlled, one may consider taking a picture of the snake, but again, only if this can be done safely and with no significant delay in seeking medical treatment. If a venomous snakebite is at all a possibility, one should not have a delay in seeking medical care. If a hiker, mountain biker or camper is in a remote area and waiting for rescue services, extraction, or if other members of the party are retrieving a means of transportation or some scenario such as that, the wound can be cleaned with soap and water. Any rings or potentially tight clothing that may be in the area of the bite should be removed because once the swelling starts it may be difficult to remove the jewelry at a later time. During transport of the victim the edges of the swelling or redness may be marked with an ink pen or a marker, as this may provide some information for the treating doctor to make a judgment as to the progression of the symptoms and help in the decision making of giving antivenin and also helping the physician adjust the dosing of this medication. If the victim is unsure or even if the possibility of a venomous snakebite exists, regardless of whether or not symptoms are present, there should be no delay in seeking immediate healthcare, as the symptoms of snakebite can progress rapidly from mild to severe.

While there are things to do, there are things not to do. Pain medications such as Ibuprofen (which is a type of non-steroidal anti-inflammatory drug) and aspirin should not be given as these both have an effect on how well blood clots and could further exacerbate a snakebite injury. Likewise, ice should not be used as this could lead to cold injury and further disrupt the cell wall integrity of subcutaneous tissue. Tourniquets or constricting bands should generally not be used; however a trained physician may choose to employ this modality, particularly if there is a delay in procurement of antivenin.  The wound should not be sucked manually in an attempt to remove the venom. Controversy exists regarding the use of commercially made venom extractors. Some sources believe a commercially made venom extractor may be of benefit if it is placed on the bite within the first few minutes after injury and left on for approximately 30 minutes (Juckett G. Snakebite. In: Rakel RE, ed. Saunders Manual of medical practice. 2d ed. New York: Saunders, 2000:1525–8). Other well-designed studies demonstrate no significant removal of mock venom substances from human subcutaneous tissue (Alberts MB, Shalit M, LoGalbo F. Suction for venomous snakebite: a study of "mock venom" extraction in a human model. Ann Emerg Med. 2004;43:181-186). In addition to unproven efficacy, concentrated vacuum forces applied to a bite area may actually increase local tissue damage and could lead to delay in seeking medical care and therefore taken as a whole, it is not recommended. Furthermore, cuts or hash marks should never be used even if a commercially made venom extractor is employed.

As the victim is being transported they should try to remain calm, they need to keep a clear mind and avoid alcohol intake. While avoiding excess activity is recommended, there are some wilderness locations where it may be necessary to bring the victim to medical care. The extremity should be immobilized if possible, and the position in which to keep the extremity, does have some additional controversy. Elevating the arm or leg may decrease swelling but possibly introduce the venom quicker into the system. Keeping the extremity in a dependent, or position lower to the heart, may possibly delay the venom getting further into the system but will increase dependent edema, therefore a gravity neutral position, or with the extremity at heart level, may be the safest option. 

Once the victim arrives at a medically appropriate facility the decision to give antivenin, and at what dose, will be made by the physician; usually in conjunction with a poison control center. Additional resources the physician has at their disposal is; contacting a physician experienced in snakebite management, contacting a zoo with expertise in venomous snakes or to acquire vials of antivenin if it is not normally stocked in the hospital formulary, and the physician may also contact a herpetologist for expert advice in identification of the particular type of snake that induced the envenomation. The snake should not normally be brought in with emergency medical services as it is usually too risky to dispatch the snake and attempts to secure the snake may result in unacceptable time delays and even picking up a dead snake can result in reflex biting and result in a compound bite by the reptile. The physician will usually monitor an asymptomatic bite for eight to twelve hours to either make sure it was a dry bite or possibly a bite by a non-venomous snake. Prophylactic antibiotics are usually not indicated for snake bites and this may be important information if the bite victim is in a remote location enjoying an adventure and they are 100% certain it was a non-venomous bite and local care with soap and water is all that is needed. Iodines and peroxides are not recommended as this can produce further wound damage at the cellular level. The outdoor adventurer would also be wise to make sure their tetanus status is up-to-date before any bite from a non-venomous snake, or even a cut, scrape or puncture wound, forces them to leave their activity abruptly in order to seek medical attention for a tetanus update.

Venomous snakes live in diverse ecosystems in the United States and startling them is often times inadvertent and unavoidable. It would serve one well to review the indigenous snake species which are hazardous in the area they are planning their outdoor activity and understand terrain where snakes might be more common, such as deep grassy areas, under logs, rocky edges, or in holes. Flashlights are useful for night travel or if one is forced to search for tools or resources such as firewood. It is also a good idea to understand activities that make it harder to see snakes and a walking stick swished in the grass in front of a hiker or used to lift logs or rocks would be helpful both night and day.

Pure mechanical anti-bite measures are also useful, like wearing thick high-sided leather boots, loose fitting pant legs to try and thwart the bite from contacting the skin, and other common sense measures such as gloves if a person finds it necessary to pick up a log or put their hands in an area where snakes may inhabit. Do not harass, handle, or attempt to capture snakes in the wild, keep yourself safe and let nature be. Understanding the environment in which you are exercising (or just enjoying the natural beauty) not only enhances the experience, but also provides practical information including wildlife hazards in the area. Taking some simple precautions and applying common sense will go a long way in letting you hit the trail and come back happy and healthy, leaving only faint footprints behind. 

This article is for educational purposes and should not be relied upon as a substitute for medical advise from your physician. If you have a medical emergency, please call 911.

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