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BITE, SNAKE
About Your Diagnosis
In North America, snakebites can be one of four types. The first type is from
nonpoisonous snakes such as rat snakes. These bites require only simple medical
attention. The second type of snakebite is from coral snakes. These snakes have
a special type of venom that affects the nervous system. Coral snakebite
treatment requires hospitalization. The third type of snakebite is from the pit
vipers: rattlesnakes, copperheads, and water moccasins. These snakes usually
inject venom when they bite, and emergency evaluation is required. The fourth
type of snakebite is from imported snakes from other areas. Although rare, they
also require emergency evaluation.
Living With Your Diagnosis
Your doctor can usually tell from the appearance of the bite or the snake (if
captured) if your bite was from a poisonous or nonpoisonous snake. Fortunately,
the pit vipers do not inject venom (envenomate) in about 25% of bites. The signs
of envenomation are intense pain, swelling, and discoloration at the bite site.
Swelling and pain that extend toward the body from the bite site usually
indicate higher degrees of envenomation. Bites from the coral snake and some of
the exotic snakes may have no symptoms for the first few hours, and then sudden
and rapid paralysis may occur. If you are released without hospitalization, then
your doctor is confident that either the snake was nonpoisonous, or no venom was
injected during the bite.
Treatment
Wound care is the emphasis of treatment after discharge. The wound should be
inspected and cleaned with soap and water at least once a day. Old dressings
that adhere to the wound can be removed by soaking with water for several
minutes. Hydrogen peroxide can be used to remove clotted blood and debris. After
cleansing, allow the wound to dry, then apply an antibiotic ointment as
suggested by your doctor. Keep the wound covered with a dry, clean dressing.
Change the dressing with each cleansing and more often if it becomes wet or
fluid soaks through. If another bite occurs in the future, the following
emergency treatments may be beneficial:
- Remain calm and limit movements. Keep activity to a minimum.
- Keep the bitten area still and below the level of the heart.
- Do not attempt to cut the bite or suck poison from the bite with your
mouth. Both can cause further injury and increase the risk of infection.
Neither has been shown to be effective.
- Seek emergency care as soon as possible.
- Do not risk further bites by capturing the snake.
- If there will be a delay before treatment, a constriction band (such as a
shoestring) placed near the bite between the bite and the body may be
helpful. It should be loose enough to allow a finger to be introduced snugly
under the band.
- Ice is of no proven benefit. Heat should not be used.
- If there is any question of the possibility of envenomation, emergency
medical care must be obtained.
The DOs
- Make sure you have an up-to-date tetanus shot.
- Clean and inspect the wound daily. Report concerns promptly.
- Take all your antibiotics as directed (if prescribed).
- Keep your follow-up appointment.
The DON'Ts
- Don't attempt to find the snake. More bites are likely to result.
- Don't ignore your symptoms. If in doubt, call and ask.
- Don't immerse your wound in dirty water.
When to Call Your Doctor
- If you have increasing pain, swelling, discoloration, or bleeding at the
wound or in the wounded extremity.
- If you have fever, shortness of breath, become sweaty, or feel bad.
- If you have bleeding from the nose or gums or easy bruising.
- If the wound appears infected (redness, swelling, pain, streaking, pus
drains, bad odor).
For More Information
Identification of venomous snakes. (From Rosen P [ed]: Emergency Medicine,
ed 4 St Louis, 1998, Mosby.)
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