Rattlesnake Bite First Aid: Evidence-Based Do's and Don'ts

Never cut, suck, tourniquet, ice, or apply electricity to a snakebite. These outdated measures increase tissue damage and mortality. Modern management is straightforward:

Immediate Actions (In Priority Order)

1. Call 911 / activate EMS immediately. Antivenom is the only definitive treatment.
2. Stay calm and minimize movement. Immobilize the bitten limb at or slightly below heart level.
3. Remove constricting items: Rings, watches, tight clothing before swelling progresses.
4. Mark the leading edge of swelling with time every 15-30 minutes to track progression.
5. Keep the patient supine with head slightly elevated if hypotensive.

Absolute Contraindications (What NOT To Do)

Hospital Management

• CroFab® or Anavip® (crotalid polyvalent immune Fab) — dosed by envenomation severity
• Coagulation monitoring (fibrinogen, platelets, PT/INR, D-dimer)
• Compartment syndrome surveillance
• Wound care, tetanus update, antibiotics if infected

Key Facts

• ~25% of bites are "dry" (no venom injected)—but treat all as envenomated
• Mortality <1% with timely antivenom in US
• Children and small adults at higher risk for severe envenomation
• Recurrent coagulopathy can occur days later—follow-up essential

Time is tissue. Rapid transport to antivenom-capable facility is the single most important intervention.

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Action	Why Harmful
Incision/suction	Increases tissue damage, infection risk, no venom removal
Tourniquet/constriction band	Concentrates venom → necrosis, compartment syndrome
Ice/cold packs	Vasoconstriction worsens local tissue injury
Electric shock	No evidence; causes burns, arrhythmias
Alcohol/NSAIDs/aspirin	Exacerbate coagulopathy, hypotension
Capture/kill snake	Risk of second bite; identification not required for antivenom