Patrick Reany
30 March 2024
Introduction: A pit viper is a snake that injects its venom through two fangs. The US snakes in particular that are of interest to this article are the rattlesnake, the copperhead, and cottonmouths (water moccasin).
Disclaimer: The information given here is for general educational use and should not be taken as necessarily current medical treatment for snake bites, pit viper bites in particular. Accepted medical procedure for pit viper first aid has changed a lot over the years and may continue to change. For proper first aid for pit viper bites, do your own studying to best prepare before you get bit, because snake bite treatment is not one-size fits all, as you will see. Much, but not all, of the advise given here is taken from videos I have seen by Dr. Sean Bush, who is a US ER physician and snakebite expert.
Fact: The terms 'antivenom' and 'antivenin' are both used, the latter being the older variant.
There are a number of commonly held practices recommended among health care workers, but there are some controversial ones too.
1) Who should transport, the paramedics, a friend or family member, or yourself? On average, probably the parmedics should transport, as they can start treatment and call the ER for you. On the other hand, if you are two blocks from the ER, maybe you should self-transport so long as you feel up to it, but call ahead. One problem is that not all ERs stock antivenom, but time is critical to avoid local and/or systemic damage to your body after a snake bite.
2) Antivenom is expensive, so its use might be minimized when indicated. Also, people can sometimes have very serious adverse allergic reactions to antivenom.
Fact: CroFab is the older antivenom treatment medication; Anavip is a newer alternative medicine.
The following YouTube video is where I got much of the information in this article:
Mgmt_NA_Pit_Viper_Envenomation-4:[Featuring Dr. Sean Bush (ER physician and snakebite expert), Sept 2012]
1) You may get bitten but not see the snake that bit you, as pit vipers are very fast in biting and may quickly move away before you can identify it.
2) The appearance of two small puncture wounds separated by one to two inches is a pretty good indicator of being bitten by a pit viper.
3) People report the initial sensation of being bitten as of an electric shock or a strong bee or wasp sting.
1) Get to medical care ASAP. Call 911.
2) Remove jewlry and tight-fitting clothing because swelling around these items can be a huge issue itself.
3) Mark with a pen the leading edge of the swelling and include the time. Repeat if swelling continues rapidly. This will help the ER physician to diagnose the severity of the patient's response to the venom.
4) Parametic personnel has supportive procedures to follow during transport, which includes starting an introvenus line.
5) Remain calm.
6) Pit viper antivenom is nonspecific, so you do not need to capture the snake for identification. The same medicine is used for all pit vipers in the US.
7) Monitor for any abnormal medical symptoms in the patient.
8) Try to not move the bitten extremity very much, so as to slowdown the transport of the venom away from the injection site.
1) Do not apply tourniquet or make cuts of the puncture wounds or employ suction devices. Do not apply ice. If the bite has punctured an artery (very rare), resulting in severe bleeding, try to control it first with direct pressure. If that does not control it enough, call 911 for additional instructions on what to do. But you should be in contact with 911, anyway, if possible.
2) Do not transport the snake. If you can take a picture of it safely, do so. The antivenom for all pit viper bites is the same. And, although knowledge of the particular snake may be of use to a snakebite expert, your ER doctor is unlikely to be one. So leave the snake alone: You have more urgent things to attend to.
If you know which hospital you are going to, call ahead to let them know you are coming so that they can prepare the antivenom for you. If parametics are transporting you, they will do that for you.
What if the snakebite victim is a pregnant female? The latest information I have on this question is that there is no reliable data on the treatment of pregnant women, as they are so rarely bitten in the first place. But be sure to tell the doctor if you are pregnant and it doesn't yet show.
The symptoms of a snakebite can reappear even after one is released from the hospital, and that has to be dealt with. As for pain medications, Ibuprofen and aspirin are not recommended for up to two weeks (Dr. Sean Bush).
Yes. If the victim is not very young, nor very old, and has no serious concurrent medical issues and gets proper medical treatment soon enough, he or she will probably make a full recovery, though they may have some local tissue damage to live with.
What about swelling? Tissue swelling is very common for pit viper bites. But so long as the bite patient has adaquate medical treatment early enough after the bite, the patient should have a full recovery from that too.
Yes. First, I haven't described what the doctors and nurses attending the patient should be doing, as I have made this essay from the viewpoint of the responsibility of the patient. However, one thing the patient might keep in mind is the possible need to get a tetanus vaccination or booster at the hospital, as any puncture through the skin may cause tetanus.
Second, if the ER you end up getting to first is not capable of perfoming adequate care for you, you my need to be transported to another facility to get it. One reason to call 911 quickly is to be sure your first ER stop is at one that has the antivenom on hand and ready to go when you arrive there.
Third, there is a lot of information that I did not include in this essay, so please investigate further any aspect of pit-viper treatment as you see fit to educate yourself. In fact, there is quite a lot of post-release care for snakebites with lots of do's and don't's.