What are primary elements of prehospital care in snakebites?

Updated: Apr 09, 2021
  • Author: Spencer Greene, MD, MS, FACEP, FACMT, FAAEM; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

The most important prehospital interventions are establishing a patent airway, ensuring adequate oxygenation and ventilation, and maintaining euvolemia.

Analgesia should be provided. Opioids are preferred. Nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended because of their potential hematologic effects, which could compound with venom-induced coagulopathies.

Proper positioning of the affected extremity in the prehospital setting is controversial. Previously, experts recommended keeping the extremity below heart level to minimize the spread of the venom. However, this could exacerbate local swelling, which is almost always present in crotalid envenomation. Elevating the extremity above heart level can reduce the swelling, and patients often report significant pain relief with elevation. Some people fear that elevation can accelerate systemic absorption of the venom, but there is no evidence demonstrating this occurs. In areas where bites are unlikely to cause significant systemic toxicity, elevation is recommended. If systemic illness is a major concern, it is reasonable to keep the affected extremity at heart level. Once the patient arrives in the hospital, however, elevation is recommended for all pit viper envenomations. [42] Coral snake envenomations do not result in tissue damage. Place the affected extremity in whatever position the patient finds most comfortable.

Unstable patients should generally be taken to the closest hospital. Stable patients should be brought to the closest appropriate hospital, that is, one that carries antivenom and has one or more staff physicians with expertise in managing snake envenomations.


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