There are approximately 300 species of snakes native to the United States, and roughly 10% of them are venomous. Between 5,000 – 10,000 people are bitten by these venomous snakes annually, typically between April and October. Death is extremely rare and occurs in fewer than 1% of cases. Many bites, however, cause significant pain and disability.

There are 2 types of venomous snakes native to the U.S. Pit vipers include rattlesnakes, copperheads, and cottonmouths, a.k.a. water moccasins. Pit vipers account for more than 95% of all venomous bites reported to U.S. Poison Centers. Coral snakes account for fewer than 5% of bites.

Not all bites from venomous snakes result in envenomation (when venom is injected into a person’s body). A “dry bite” means that no venom was introduced and may occur up to 25% of the time following pit viper bites and up to 60% of the time following a bite from a coral snake.

Symptoms

If there is an envenomation, pain is almost always present. Pit viper bites are also characterized by significant swelling and bruising, though it may take several hours for these to peak. Other signs of a pit viper bite may include:

  • Bloody wound discharge
  • Fang marks in the skin
  • Enlarged lymph nodes in the area
  • Nausea or vomiting
  • Excessive sweating
  • Weakness, dizziness, or fainting
  • Difficulty swallowing
  • Numbness and tingling, especially in the mouth 
  • Generalized bleeding or hemorrhage
  • Shock

Coral snake bites cause pain but do not produce significant tissue damage or bruising. Signs of a coral snake envenomation may include:

  • Nausea or vomiting
  • Excessive sweating
  • Weakness, dizziness, or fainting
  • Difficulty swallowing
  • Numbness and tingling, especially in the mouth 
  • Difficulty breathing
  • Double vision

Treatment

There are a lot of myths regarding the management of snake bites, and it is important to avoid interventions that were once believed to be helpful but have since been proved to be ineffective and possibly dangerous.

If you are caring for a child who has been bitten by a rattlesnake, copperhead, or cottonmouth, you should do all of the following:

  • Get yourself and the patient to a safe place away from the snake
  • Call 911 and have the patient transported to an emergency department. It is helpful to have already identified a facility where there are experts in envenomation management.
  • Remove jewelry and constrictive clothing on the affected extremity
  • Have the child lie down and help keep him or her calm
  • Do not allow the patient to eat or drink
  • Keep the patient warm, but do not apply heat to the bite itself
  • Monitor the child’s heart rate and breathing
  • Gently wash the area – but do not delay transport to do this
  • Elevate the affected extremity above heart level. Though the opposite was previously recommended, it is now known that local damage is a much greater concern than systemic illness, especially following bites from pit vipers in Southeast Texas. Elevating the extremity minimizes the amount of swelling and tissue damage and decreases the likelihood of permanent disability.
  • Avoid applying ice to the bite – this increases the amount of local tissue damage
  • Avoid commercially-made suction devices since these do not remove venom and actually increase tissue damage
  • Avoid cutting into the bite and applying suction; this does not remove venom and actually worsens the wound and increases the likelihood of infection
  • Do not apply a tourniquet or a constriction band

Treatment for a coral snake is the same except, in this situation, the affected extremity should be kept below heart level.

It is helpful if you can identify the type of snake, but it is never necessary to put yourself at risk trying to capture or photograph the snake. Ultimately the physician can determine clinically if there is an envenomation and whether it is due to a pit viper or coral snake.

Once the patient has arrived at the hospital, he or she will receive any needed supportive care and analgesia. An expert should be consulted to determine the need for antivenom, which can directly neutralize the snake venom. Antivenom is most effective if started within the first 6 hours after the envenomation but still provides a benefits if started at 24 or even 48 hours after the bite. Antibiotics should not be administered unless there is evidence of an infection, which is uncommon. Surgical intervention is almost never necessary.

The best treatment of snake bites is prevention. Children are at risk for snake bites because they frequently play outdoors and often reach or step into areas blindly. Lower extremity bites are common because children often run barefoot during snake bite season. Ways to reduce the likelihood of a snake bite in children include:

  • Teach your child to leave snakes alone. Often people are bitten because they try to kill a snake or get too close to it.
  • Make sure your child stays out of tall grass unless he or she wears thick leather boots. Try to ensure that your child remains on hiking paths as much as possible.
  • Do not allow your child to place his or her hands and feet in areas he or she cannot see. Picking up rocks or firewood should be avoided.
  • Reinforce caution and alertness when your child is climbing rocks.

Reviewed by:

Spencer Greene, MD, MS, FACEP

Department:

Emergency Center