Immediate Management of Snake Bite with Hypertensive Urgency
Initial Management
- Activate emergency services immediately for any person bitten by a venomous or possibly venomous snake 1
- Rest and immobilize the bitten extremity to reduce systemic absorption of venom 1
- Remove rings and other constricting objects from the bitten extremity to prevent damage from swelling 1
- Transport the victim to a medical facility as quickly as possible, as definitive treatment (antivenom) is only available in healthcare settings 1
- Do NOT apply ice to a snakebite wound as it has unproven benefits and may cause tissue injury 1
- Do NOT use suction devices (with or without incision) as they are ineffective for venom removal 1
- Do NOT apply tourniquets as they can worsen local tissue injury 1
- Do NOT use pressure immobilization bandaging in North America, as it may worsen tissue injury with cytotoxic venoms 1
Antivenom Administration
- Administer Anti-Snake Venom (ASV) as the cornerstone of treatment for venomous snakebites 2
- The recommended initial dose is 10 vials administered intravenously after appropriate testing for hypersensitivity 2
- Hospitals should have at least 12 vials of Anti-Snake Venom available for most pit viper envenomations in North America 2
- Have epinephrine readily available for treatment of potential anaphylactic reactions to antivenom 2
Management of Hypertensive Urgency
- For patients with hypertensive urgency (severe hypertension without evidence of acute organ damage), careful BP reduction is needed 3
- IV labetalol is recommended as first-line therapy for severe hypertension in the setting of snake bite 4
- Nicardipine is an alternative option for blood pressure control 4
- Reduce mean arterial BP by no more than 25% within the first hour 5
- Then, if stable, aim for BP of 160/100-110 mmHg within the next 2-6 hours 5
- Avoid excessive falls in pressure that may precipitate renal, cerebral, or coronary ischemia 5