Snake bites

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Snake bites occur when a snake bites the skin. They are medical emergencies if the snake is poisonous.

Considerations

Snake bites can be deadly if not treated quickly. Children are at higher risk for death or serious complications due to snake bites because of their smaller body size.
The right antivenom can save a person's life. Getting to an emergency room as quickly as possible is very important. If properly treated, many snake bites will not have serious effects.

Causes

Poisonous snake bites include bites by any of the following:

• Cobra
• Copperhead
• Coral snake
• Cottonmouth (water moccasin)
• Rattlesnake
• Various snakes found at zoos

All snakes will bite when threatened or surprised, but most will usually avoid people if possible and only bite as a last resort.
Snakes found in and near water are often mistaken as being poisonous. Most species of snake are harmless and many bites are not life-threatening, but unless you are absolutely sure that you know the species, treat it seriously.

Symptoms

Symptoms depend on the type of snake, but may include:

• Bleeding from wound
• Blurred vision
• Burning of the skin
• Convulsions
• Diarrhea
• Dizziness
• Excessive sweating
• Fainting
• Fang marks in the skin
• Fever
• Increased thirst
• Loss of muscle coordination
• Nausea and vomiting
• Numbness and tingling
• Rapid pulse
• Tissue death
• Severe pain
• Skin discoloration
• Swelling at the site of the bite
• Weakness

Rattlesnake bites are painful when they occur. Symptoms usually begin right away and may include:

• Bleeding
• Breathing difficulty
• Blurred vision
• Eyelid drooping
• Low blood pressure
• Nausea and vomiting
• Numbness
• Pain at site of bite
• Paralysis
• Rapid pulse
• Skin color changes
• Swelling
• Tingling
• Tissue damage
• Thirst
• Tiredness
• Weakness
• Weak pulse

Cottonmouth and copperhead bites are painful right when they occur. Symptoms, which usually begin right away, may include:

• Bleeding
• Breathing difficulty
• Low blood pressure
• Nausea and vomiting
• Numbness and tingling
• Pain at site of bite
• Shock
• Skin color changes
• Swelling
• Thirst
• Tiredness
• Tissue damage
• Weakness
• Weak pulse

Coral snake bites may be painless at first. Major symptoms may not develop for hours. Do NOT make the mistake of thinking you will be fine if the bite area looks good and you are not in a lot of pain. Untreated coral snake bites can be deadly. Symptoms may include:

• Blurred vision
• Breathing difficulty
• Convulsions
• Drowsiness
• Eyelid drooping
• Headache
• Low blood pressure
• Mouth watering (excessive salivation)
• Nausea and vomiting
• Numbness
• Pain and swelling at site of bite
• Paralysis
• Shock
• Slurred speech
• Swallowing difficulty
• Swelling of tongue and throat
• Weakness
• Skin color changes
• Skin tissue damage
• Stomach or abdominal pain
• Weak pulse

First Aid

1. Keep the person calm, reassuring them that bites can be effectively treated in an emergency room. Restrict movement, and keep the affected area below heart level to reduce the flow of venom.
2. If you have a pump suction device (such as that made by Sawyer), follow the manufacturer's directions.
3. Remove any rings or constricting items because the affected area may swell. Create a loose splint to help restrict movement of the area.
4. If the area of the bite begins to swell and change color, the snake was probably poisonous.
5. Monitor the person's vital signs -- temperature, pulse, rate of breathing, and blood pressure -- if possible. If there are signs of shock (such as paleness), lay the person flat, raise the feet about a foot, and cover the person with a blanket.
6. Get medical help right away.
7. Bring in the dead snake only if this can be done safely. Do not waste time hunting for the snake, and do not risk another bite if it is not easy to kill the snake. Be careful of the head when transporting it -- a snake can actually bite for several hours after it's dead (from a reflex).

DO NOT

• Do NOT allow the person to become over-exerted. If necessary, carry the person to safety.
• Do NOT apply a tourniquet.
• Do NOT apply cold compresses to a snake bite.
• Do NOT cut into a snake bite with a knife or razor.
• Do NOT try to suck out the venom by mouth.
• Do NOT give the person stimulants or pain medications unless a doctor tells you to do so.
• Do NOT give the person anything by mouth.
• Do NOT raise the site of the bite above the level of the person

Prevention

• Avoid areas where snakes may be hiding, such as under rocks and logs.
• Even though most snakes are not poisonous, avoid picking up or playing with any snake unless you have been properly trained.
• If you hike often, consider buying a snake bite kit (available from hiking supply stores). Do not use older snake bite kits, such as those containing razor blades and suction bulbs.
• Don't provoke a snake. That is when many serious snake bites occur.
• Tap ahead of you with a walking stick before entering an area where you can't see your feet. Snakes will try to avoid you if given enough warning.
• When hiking in an area known to have snakes, wear long pants and boots if possible.

Alternative Names

Bites - snakes

References

Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM. Reptile bites. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 195.
Otten EJ. Venomous animal injuries. In: Marx JA, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 59.

Update Date: 1/8/2012

Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.