Human Snakebite Management
Please review the following guidelines for in-hospital management for all North American pit vipers. Pit vipers in the United States include all rattlesnakes, copperheads, and cottonmouths (also known as water moccasins). You do not need to identify the species of snake in order to treat in the USA as both CroFab and Anavip are both FDA approved for all North American pit viper envenomations. While antivenom is most effective in the first six hours, it can still benefit if there are ongoing venom effects.
Pit viper envenomation is GENERALLY characterized by local tissue injury and, less commonly, hematologic abnormalities and systemic toxicity such as low blood pressure, vomiting, airway swelling. Some pit vipers, such as certain populations of Mojave rattlesnakes, cause neurological toxicity.
Guidelines and algorithms
NSS in-hospital management
CroFab treatment algorithm
Download the the pdf format here.
View all CroFab’s resources including an interactive algorithm and full treatment algorithm research article at https://crofab.com/envenomation-education/treatment-algorithm.html?gad_source=1
Anavip treatment algorithm
Download the the pdf format here.
View all Anavip’s resources including the treatment algorithm, package insert, and product information at https://anavip-us.com/downloads/
The most important steps to be taken in-hospital:
Keep the affected extremity elevated.
Make sure they check the following laboratory tests: CBC, BMP, PT/INR, Fibrinogen, CK.
Ask them what their indications for antivenom are, and make sure they are consistent with what we have mentioned here:
Significant or progressive local tissue damage; e.g., tenderness and swelling that crosses one major joint, hemorrhagic bleb
Hematologic toxicity; e.g., PT >15s, fibrinogen <150mg/dL, platelets <150K/µL
Systemic toxicity; e.g., hypotension, airway swelling, neurological toxicity
If you do not feel you're getting appropriate care, advocate for yourself. Request they involve an expert. If necessary, request transfer to a more appropriate facility.
Do not agree to prophylactic antibiotics or prophylactic surgical intervention.
You do not need to identify the snake in order to receive antivenom. CroFab and Anavip are both FDA approved to treat all North American pit vipers. Pit vipers include rattlesnakes, copperheads, and cottonmouths (aka water moccasins).
Click for the BMC Emergency Medicine Unified Treatment Algorithm for the Management of Crotaline Snakebites in the United Statesand flowchart for your physician to review.