Snakebite Management Guidelines

Immediate Actions

The American College of Cardiology recommends activating emergency medical services immediately and transporting the victim to a medical facility as quickly as possible, as antivenom is available only in hospital settings 1
Remove all constricting objects from the bitten extremity immediately before swelling develops, as progressive edema can cause ischemic injury to digits and tissues 1
Immobilize the bitten extremity and keep it at or below heart level to minimize venom absorption through the lymphatic system 1
Minimize all physical exertion by the victim during transport, as walking or activity accelerates systemic venom absorption 1

For North American snakebites, do not use pressure immobilization bandaging, as it may worsen local tissue injury by trapping cytotoxic venom at the bite site 1, 2
For neurotoxic snakes, pressure immobilization with 40-70 mm Hg in the upper extremity or 55-70 mm Hg in the lower extremity is reasonable to slow lymphatic dissemination of neurotoxic venom 3, 4, 2
The bandage should be snug enough that a finger can barely slip underneath, applied around the entire length of the bitten limb 3, 4

Do not apply ice or cold therapy, as it causes additional tissue injury 1
Do not use suction devices, as they remove negligible venom amounts and may aggravate the injury 3, 1
Do not apply tourniquets, as they worsen local tissue injury without preventing systemic envenomation 1
Do not use electric shock therapy, as it is completely ineffective and potentially harmful 1

Irrigating the wound with copious amounts of water is reasonable for cleaning but does not remove venom 3, 2
For neurotoxic envenomation, hospitalize for a minimum of 48 hours with continuous monitoring, as neurotoxicity onset can be delayed up to 13 hours despite minimal local findings 2

Never assume no envenomation based on absence of immediate pain or swelling, as neurotoxic bites cause life-threatening systemic toxicity despite minimal local findings 4, 2
Do not delay transport to attempt ineffective field interventions, as time to antivenom is the most important prognostic factor 4
Do not apply pressure immobilization techniques developed for neurotoxic snakes to North American pit viper bites, as this worsens cytotoxic tissue damage 1, 2
Failing to remove constricting items leads to ischemic injury as swelling progresses 1

Hemotoxic/cytotoxic venom causes progressive local tissue necrosis, coagulopathy, and thrombocytopenia, and pressure immobilization is contraindicated 2
Neurotoxic venom causes minimal local injury but progressive paralysis and respiratory failure, and pressure immobilization is beneficial 2