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Snakebite First Aid: Identification, Immediate Care, and Medical Treatment
Snakebite Basics
Of ~3,500 snake species, ~600 are venomous. In the U.S., venomous families are Viperidae (rattlesnakes, copperheads, cottonmouths) and Elapidae (coral snakes). Worldwide, Viperidae and Elapidae dominate envenomations.
Prevention
- Know local venomous species & habitats.
- Wear boots, long pants, gaiters in snake terrain.
- Stay on trails; avoid tall grass, rock piles, logs.
- Use a light at night; don't reach into unseen spaces.
- Never handle "dead" snakes—reflex bites occur.
Immediate First Aid (DO / DON'T)
| DO | DON'T |
|---|---|
| Call 911 / activate EMS immediately | Apply tourniquet |
| Keep victim calm, still, supine | Cut wound / suck venom |
| Immobilize bitten limb at heart level | Apply ice / cold packs |
| Remove constricting items (rings, watch) | Use electric shock / stun gun |
| Mark leading edge of swelling q15min | Give alcohol, caffeine, NSAIDs |
| Note snake appearance (photo if safe) | Attempt to capture/kill snake |
| Apply pressure immobilization bandage (elapids) | Elevate limb above heart |
Pressure immobilization (broad elastic bandage + splint) is recommended for neurotoxic elapid bites; controversial for viperids—follow local protocol.
Hospital Management
- ABCs, IV access, labs (CBC, coags, fibrinogen, CK, renal, LFTs, type & screen).
- Antivenom indications: systemic signs, coagulopathy, progressive swelling, neurotoxicity.
- US: CroFab (crotalidae polyvalent immune Fab) or Anavip; coral snake antivenom (limited supply).
- Monitor for anaphylaxis, serum sickness (days-weeks later).
- Wound care: debridement if necrotic; tetanus update.
- Compartment syndrome monitoring (intracompartmental pressure).
Special Situations
- Pediatric: Higher venom/body-weight ratio → more severe.
- Pregnancy: Antivenom still indicated; monitor fetus.
- Exotic pets: Contact regional poison center for specific antivenom.
Follow-Up
Outpatient wound checks, repeat labs (coags, CK), physical therapy for residual weakness, psychological support for PTSD.
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