Venomous Snakebite — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Is antivenom needed?
   After field management, is there local progression or systemic envenomation (antivenom needed)? (Venoms are cytotoxic/hematotoxic (vipers/pit vipers — local necrosis, coagulopathy [VICC], thrombocytopenia, AKI, shock) or neurotoxic (cobras/kraits/sea snakes — mild local, progressive paralysis, respiratory failure). Field care: stay calm, immobilize the limb at heart level, remove rings/constrictors, transport quickly (antivenom timing is the key prognostic factor). Avoid arterial tourniquets, incision, suction, ice, NSAIDs. Pressure immobilization bandage only for neurotoxic snakes, not cytotoxic snakes (worsens necrosis).)
   • Local progression or systemic envenomation → Systemic envenomation → antivenom
   • Fang marks only, no envenomation signs → No envenomation signs · observe
2. [End] No envenomation signs · observe
   Fang marks only, no local progression or systemic envenomation ('dry bite' possible): observe at least several hours to 24 h (some species have delayed onset); check coagulation/platelets/CK/renal function and recheck serially, mark the swelling border with the time; tetanus prophylaxis, analgesia (avoid NSAIDs). Manage as systemic envenomation the moment swelling progresses/coagulopathy/neurological symptoms appear.
3. [End] Systemic envenomation → antivenom
   Local progression or systemic envenomation (coagulopathy/bleeding, neuromuscular paralysis, circulatory collapse, respiratory difficulty): give the appropriate antivenom as soon as possible (by species/region; neurotoxic and hematotoxic products differ), titrating further doses by response; be ready to manage anaphylaxis/anaphylactoid reactions (epinephrine, etc.). Support: neurotoxic paralysis → airway/mechanical ventilation; shock → fluids/vasopressors; manage AKI; active bleeding + coagulopathy → FFP after antivenom. Tetanus prophylaxis. Monitor ≥24 h after dosing, watch for delayed/recurrent coagulopathy.

Source guidelines & references

• WHO guidelines on management of snakebite envenoming; AFP review of venomous snakebite management

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways