When should snakebite victims be admitted to the hospital?

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

Patients should be admitted to the hospital or an observation unit if there is any evidence of envenomation, whether or not antivenom has been administered. The decision to admit to a general medical ward versus the ICU depends on the severity of the envenomation, the availability of resources, and specific hospital protocols. The authors recommend that the initial dose of antivenom should be administered in a monitored setting (eg, emergency department, ICU).

Most snake envenomations do not require prolonged hospitalization. Unless the patient requires a prolonged course of antivenom, develops end-organ damage, or requires parenteral narcotics, most snakebite victims can be discharged within 24-36 hours. During the hospitalization, it is advisable to have a physical therapist consult on patients with lower extremity bites to assist them with crutches training. Consultation with an occupational therapist and/or a hand specialist may be indicated for bites to the hand.

Patients may be discharged home once the following criteria are satisfied:

  • The antivenom course has been completed
  • Pain can be controlled with oral medication
  • Vital signs have stabilized
  • The patient can tolerate a regular diet
  • Any hematologic laboratory abnormalities have normalized
  • All of the appropriate consultations have been completed

Patients with a crotalid envenomation should be instructed to keep the affected extremity elevated as much as possible. The authors also recommend no weight-bearing for at least 1 week and until it is no longer painful. Snakebite victims should follow up 3-4 days post discharge with a snakebite expert, if possible, or their primary care provider for reassessment and, if indicated, repeat bloodwork. Patients should be instructed to avoid NSAIDs if there is any risk of hematologic toxicity. Surgery should also be avoided for the first 2 weeks post envenomation.


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