Venomous Snake Bite Management
Venomous Snake Bites in the U.S.: What Outdoor People Need to Know
Bottom line: most bites aren’t fatal if you act fast and get the right care. Here’s the no-nonsense, wilderness-ready guide from PrepEM Wild’s ER docs.
The scope (and which snakes matter)
In the U.S., ~7,000–8,000 venomous snakebites occur each year with ~5 deaths—usually when care is delayed. The four medically relevant groups here are rattlesnakes, copperheads, cottonmouths (water moccasins)—all pit vipers—and coral snakes. 
Venom types & what they do to your body
• Pit vipers (rattlesnakes, copperheads, cottonmouths): venom often causes progressive swelling, severe pain, tissue damage, and blood/clotting problems that can lead to bleeding and shock. 
• Coral snakes (Micrurus): primarily neurotoxic—risking muscle weakness, trouble breathing, and respiratory failure if untreated. (Bites are rare but serious.) 
Antivenom saves limbs and lives
For pit viper bites (the vast majority):
Two FDA-approved options exist—CROFAB® (ovine Fab) and ANAVIP® (equine F(ab’)₂)—both indicated for North American pit viper envenomation in adults and children. Early treatment stops venom progression and corrects coagulopathy. 
• CROFAB® is indicated for all North American pit vipers (rattlesnakes, copperheads, cottonmouths), with dosing aimed first at control (stopping progression of swelling/systemic effects) and then maintenance. 
• ANAVIP® is also indicated for North American pit vipers and, due to F(ab’)₂ fragments’ longer half-life, may reduce late coagulopathy “recurrence” in some patients—clinical practice varies by region and toxicologist. 
For coral snake bites:
North American Coral Snake Antivenin (equine) remains available in limited supply; the FDA has extended expiration on certain lots while supply chain solutions are maintained. Hospitals that stock it are regional; know your local tertiary centers if you recreate in coral snake country. 
What not to do (myths that make things worse)
1. No tourniquets. They can worsen tissue damage and don’t stop venom spread
2. Do not cut, suck, apply ice, or use electric shock. These increase complications without benefit
3. Do not drink alcohol or take NSAIDs “for pain” right after a bite.
4. Instead: immobilize the limb, remove rings/watches, keep it at heart level, and get to a hospital. 
What to do in the field (the PrepEM Wild checklist)
1. Back away from the snake; note appearance only if safe (photo if effortless).
2. Stop moving fast. Venom spreads with muscle pumping. Splint the limb in a functional position.
3. No tight bands/pressure wraps for pit vipers. (Pressure immobilization is reserved for some neurotoxic elapids outside North America and is not recommended for our pit vipers.) 
4. Mark swelling edges and check every 15–20 min if you’re with the patient.
5. Rapid transport to a hospital that can deliver antivenom; call Poison Control (1-800-222-1222) en route—clinicians use them, and you should too. 
How ER teams decide on antivenom
Antivenom is given when there are progressive local effects, abnormal labs/coagulation, or systemic signs (vomiting, low blood pressure, neuro symptoms). Dosing is individualized to achieve control (stop progression and correct labs) and then maintain it for the next 12–24 hours, with careful reassessment. 
If you skip treatment (or it’s delayed), expect complications
• Tissue necrosis and permanent loss of function from unchecked local venom effects.
• Coagulopathy/DIC with serious bleeding (internal or at the bite).
• Rhabdomyolysis → kidney injury/failure in severe cases.
• Respiratory failure (especially with coral snakes) and shock. Prompt antivenom sharply reduces these risks. 
Side effects & safety of antivenom
Modern U.S. antivenoms are purified antibody fragments:
• CROFAB® (sheep-derived Fab) and ANAVIP® (horse-derived F(ab’)₂) have a low but real risk of hypersensitivity (immediate allergic reactions) and serum sickness (delayed immune reaction days to weeks later). Teams monitor closely and treat reactions (e.g., antihistamines, steroids, epinephrine if needed). The benefits of antivenom far outweigh these risks when envenomation is progressing. 
Region-by-region snake quick hits
• Copperhead (Agkistrodon contortrix): common in the East/South; often “moderate” envenomation but can still cause significant pain/swelling and coagulopathy—don’t dismiss them. Antivenom indicated when progression/systemic findings are present. 
• Cottonmouth (Agkistrodon piscivorus): aquatic habitats in the Southeast; high local tissue injury risk. Early antivenom helps limit damage. 
• Rattlesnakes (Crotalus/Sistrurus): West, Southwest, Appalachians, and pockets nationwide; higher rates of severe coagulopathy and systemic toxicity. Treat early. 
• Coral snake (Micrurus fulvius/tenere): Southeast (especially FL, TX). Neuro signs may be delayed—get to a center with coral antivenom and observe closely. 
Rumors we hear all the time—debunked
• “It didn’t hurt much, so I’m fine.” False. Coagulopathy can evolve silently for hours. Get checked. 
• “I should suck out the venom.” No—causes wounds and doesn’t remove meaningful venom. 
• “Tight tourniquet saves the limb.” No—increases ischemic injury and doesn’t stop venom spread. 
• “Hospitals don’t have antivenom anymore.” False. Pit viper antivenoms (CROFAB®/ANAVIP®) are widely stocked; coral antivenom exists but is regionally limited—know your referral centers. 
Prep list for snake country
• Carry a pressure-relief splint, broad marker, and charged phone for location sharing.
• Know your receiving hospital (and backup) that stocks pit viper antivenom; in coral-snake states, know which centers carry coral antivenom. 
• Keep a calm, methodical plan—panic accelerates venom spread.
Takeaway
Early evaluation + the right antivenom = fewer complications, fewer surgeries, better outcomes. Most U.S. bites are survivable when you avoid field myths, immobilize, and get expert care quickly. 
From PrepEM Wild—board-certified EM physicians helping you become the asset, not the liability. “Stay Prepared. Stay Wild.”
Snake Bite FAQ (Expert Answers from PrepEM Wild)
Q: What is the best first aid for a venomous snake bite in the U.S.?
A: Stay calm, immobilize the limb, remove tight jewelry, keep the bite at heart level, and get to the hospital quickly. Do not use ice, suction, or tourniquets.
Q: Which antivenoms are used for rattlesnake, copperhead, and cottonmouth bites?
A: CROFAB® and ANAVIP® are the FDA-approved antivenoms for all North American pit viper bites. They stop swelling, bleeding issues, and systemic venom effects.
Q: How do doctors decide if antivenom is needed?
A: Antivenom is given when there is worsening swelling, abnormal blood work, or systemic symptoms like low blood pressure or vomiting.
Q: What happens if a snake bite isn’t treated?
A: Untreated venom can cause permanent tissue loss, severe bleeding, kidney failure, and—in rare cases—death. Early antivenom reduces these risks dramatically.
Q: What are the side effects of CROFAB® or ANAVIP®?
A: Both are generally safe, but allergic reactions and delayed serum sickness can occur. Medical teams monitor and treat these quickly if they happen.
Q: Is coral snake antivenom still available?
A: Yes, but it is in limited supply and stocked at select hospitals. In coral snake regions (Florida, Texas, Southeast), know which centers carry it.
