Snake Bite First Aid: Evidence-Based Protocol & Critical Do's/Don'ts

Venomous snakebite is a time-critical medical emergency. U.S.: ~7,000-8,000 envenomations/year; 5-10 deaths. Correct pre-hospital care dramatically improves outcomes.

✅ IMMEDIATE ACTIONS (Do These)

1. CALL 911 / ACTIVATE EMS. Antivenom is only definitive treatment; hospital preparation takes time.
2. IMMOBILIZE bitten extremity at heart level (not above, not below). Splint if available.
3. REMOVE constricting items (rings, watches, tight clothing) before swelling.
4. MARK leading edge of swelling/tenderness every 15 min with pen (time-stamp).
5. PHOTOGRAPH snake if safe (distance >6 ft); do NOT attempt capture/kill.
6. NOTE time of bite, symptoms onset/progression.

❌ ABSOLUTE CONTRAINDICATIONS (Never Do These)

• Tourniquet/constriction band – causes compartment syndrome, limb loss.
• Incision & suction – removes <1% venom; causes necrosis, infection, nerve damage.
• Ice/cold packs – vasoconstriction concentrates venom; tissue damage.
• Electric shock – no evidence; causes burns, arrhythmias.
• Alcohol/NSAIDs/aspirin – worsens coagulopathy, hypotension.
• Herbal/folk remedies – delay definitive care.
• Oral suction – envenomates rescuer; introduces oral flora.

Hospital Management Preview

• Antivenom (CroFab/Anavip): Indicated for progressive swelling, coagulopathy, systemic signs. Dose: 4-6 vials initial; repeat until control.
• Labs: CBC, PT/INR, fibrinogen, D-dimer, BMP, CK, UA q6h x24h.
• Compartment Syndrome: Clinical diagnosis (pain out of proportion, paresthesia, pallor, pulselessness, pressure). Fasciotomy rarely needed if antivenom timely.

Snake Identification (U.S. Pitvipers vs. Coral)

Feature	Pitvipers (Rattlesnake, Copperhead, Cottonmouth)	Coral Snake
Head	Triangular, heat-sensing pits	Small, rounded, no pits
Pupils	Vertical (elliptical)	Round
Fangs	Long, hinged, folding	Short, fixed, anterior
Venom	Hemotoxic (tissue destruction, coagulopathy)	Neurotoxic (respiratory paralysis)
Antivenom	CroFab / Anavip	North American Coral Snake Antivenom (limited supply)

Mnemonic for coral snake: "Red touch yellow, kill a fellow; red touch black, venom lack" (U.S. only).