Snake Bites (cont.)
What is appropriate first aid for poisonous snake bites?
If someone is bitten by a poisonous snake, the bitten
area should be immobilized and the victim transported to a hospital as quickly
as possible. The bitten area should be washed with soap and water. A wide
constriction bandage (tourniquet) may be applied two to four inches upstream of the
bitten area (if on an extremity) so long as the pressure is not too tight (one
or two fingers should be able to slide under the band). Overly tight tourniquets
should never be used as these can block arterial blood flow to the affected area and worsen tissue damage.
Incising (cutting) and suctioning the bite area has not
been shown to be beneficial, but a venom extractor (found in commercial snake
bite kits) may be helpful if it
is applied to the area within five minutes of the bite and left in place for 30
minutes. A 2004 study of mock venom extraction using a suction device, however, questioned the validity of venom extractors and suggested that their use is unlikely to be effective.
Ice or cooling packs should never be applied to the area as these may result
in greater harm, and incisions of the bitten area are also potentially harmful
and have no benefit.
Most importantly, any victim of a venomous snake bite should be evaluated in
an emergency medical care facility as soon as possible.
How are poisonous snake bites treated?
Treatment of poisonous snake bites involves thorough cleansing of the wound
and observation of the victim to determine whether symptoms suggestive of
evenomation develop over time. In most cases of poisonous snake bites, an
antivenin (also called antivenom) is given,
preferably by intravenous administration. For rattlesnake, cottonmouth, and
copperhead (pit viper) bites, Antivenin (Crotalidae) Polyvalent (ACP) equine
(horse)-derived antivenin was the standard treatment in emergency
departments for many years. ACP, however, is known to cause a number of
potentially severe allergic reactions because of its equine origin. In 2000 the
U.S. FDA approved the sheep-derived antivenin CroFab which appears to have a lower incidence of associated allergic reactions, although clinical trials comparing the two have not been performed.
References: Juckett, G and Hancox JG.
Venomous Snakebites in the United States: Management Review and Update. American
Family Physician 65(7), 2002.
FDA
Consumer Magazine. For Goodness Snakes- Treating and Preventing Poisonous Snake
Bites. Revised 2002.
Lavonas EJ; Gerardo CJ; O'Malley G; Arnold TC; Bush SP; Banner W Jr; Steffens M; Kerns WP 2nd. Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite. Ann Emerg Med 2004 Feb;43(2):200-6.
Alberts MB; Shalit M; LoGalbo F. Suction for venomous snakebite: a study of "mock venom" extraction in a human model. Ann Emerg Med 2004 Feb;43(2):181-6.
Last Editorial Review: 5/1/2009
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