Snake Bite First Aid: Immobilization and Positioning to Slow Venom Spread

Immediate Field Management

1. Call 911 / activate EMS. Time = tissue.
2. Immobilize the bitten limb with a splint or sling. Minimize movement.
3. Keep limb at or slightly below heart level. Do NOT elevate above heart (increases venous/lymphatic return of venom).
4. Remove constricting items (rings, watch, tight clothing) before swelling.
5. Do NOT: Cut/suck, tourniquet, ice, electric shock, alcohol, caffeine, NSAIDs, capture snake.
6. Mark leading edge of swelling every 15 min with time.
7. Monitor vitals (mental status, airway, breathing, circulation).

Hospital Care

• Antivenom (CroFab / Anavip for North American crotalids) – indications: progressive swelling, coagulopathy, systemic signs.
• Labs: CBC, coag (PT/INR, fibrinogen, D-dimer), CMP, CK, UA.
• Wound care, tetanus, pain control (opioids; avoid NSAIDs if coagulopathy).
• Observation 18–24h for delayed toxicity.

Prevention

• Watch where you step/place hands.
• Wear boots in snake habitat.
• Don't handle snakes (even dead – reflex bite).

North American pit vipers (rattlesnake, copperhead, cottonmouth) cause 99% of envenomations. Coral snakes (elapid) require different antivenom.