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Treating Snakebite: Keep It Simple

If one believes any of the lore on treating snakebites, then you have a bewildering number of options.

Should I pack the limb in ice or apply ice only on the bite? Should I use a stun gun or jumper cables from my car battery to run electricity through the bite? Perhaps I should slather it with meat tenderizer, use a tourniquet, hope my special black rock absorbs venom or resort to incision and suction, a la John Wayne in the film True Grit

If you believe the credible medical advice, as I do, my choices are clear and simple; stay safe, stay calm, immobilize the bitten limb and take the patient to a physician.

As cirriculum director for the Wilderness Medical Instituate of NOLS (National Outdoor Leadership School), I know that we all want to do something to help the snakebite victim, but in reality, if they have been given a dose of venom by the snake, they need antivenom. Nothing else will be helpful, and the litany of unproven or discredited treatments include several that can harm the patient. If you’re a person who likes action, this isn’t very exciting, but it’s as effective as any other field management. 
  • Stay safe; there is no need to experience a second bite attempting to identify the snake. 
  • Stay calm; envenomation is not a given in snakebite.
  • Immobilize the limb, but avoid compression or constriction of the extremity.
  • Document the signs and symptoms you observe, which may help the physician evaluate the need for antivenom.
  • Transport the patient to a hospital/physician.
In North America, I’ll wash the wound to prevent local wound infection. In Australia, I won’t do this as it prevents the surface assay to determine the species of snake.

A wide elastic bandage (pressure immobilization bandage), wrapped distal to proximal as tight as an ankle wrap, is recommended by some experts for North American coral snake bites and Australian Elapids, but this treatment is controversial. Not controversial are the various mechanical suction devices, which don’t work. 

I like the advice of safety, calmness and transport.  It makes my choices clear and simple, and it’s best for my patient.

Here's a NOLS "mythcrushers" video that gives a good overview of snakebite treatment:

Other helpful NOLS snakebite links:

Case Study #6 rattlesnake bite. From the WMI course cirriculum.

WMI Blog on rattlesnake bite. Man sucks venom from his dog’s nose!

Tod Schimelpfenig, EMT-I
Curriculum Director, Wilderness Medicine Institute of NOLS
Fellow of the Academy of Wilderness Medicine

Snake photo by Gates Richards.

Posted on at 8:20 PM

Tagged: NOLS, WMI, backcountry, first aid, rattlesnake, snakebite, wilderness medical institute and wilderness medicine

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As a person who has had experience with this topic, I'll say the advice in this video is pretty sound. I was bitten by a common Rattlesnake in WA. I made sure to remain calm, as to not speed up blood flow, I used a tourniquet, and got to the ER as soon as possible. The tourniquet did slow the spread of the venom but almost cost me my finger. Some helpful advice I was given by the AZ Poison Control, and the treating physicians:

Do not elevate the limb - as this will cause a gravity flow effect
Do not keep the limp low - as this will increase swelling, and pool the venom
You want to keep the limb at heart level
Wrap the bite area, with an ace bandage, as though treating a sprain. Firm, but not restricting
With a rattlesnake bite - Open your mouth, and tilt your head back. If your tung involuntarily "dances" or twitches, this is a sure sign of envenomation (Rattlesnake)

These accidents are not to be taken lightly, and NOT cheap!

Stay safe, and don't touch!

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