Venomous snakebite: past, present, and future treatment options.

BACKGROUND Venomous snakebites continue to cause great morbidity, and treatment options are confusing the attending physician. In the United States approximately 45,000 snakebites occur each year, of which some 8000 are by 20 species of venomous snakes. METHODS Information on venomous snakes and snakebite treatment was gathered from the libraries of the Wilderness Medical Society and the Rocky Mountain Center for Wilderness Medicine in Boise, Idaho (co-supported by the Boise State University and the Family Practice Residency of Idaho), as well as from current literature files of physicians practicing wilderness medicine. RESULTS AND CONCLUSIONS Three genera of venomous snakes account for the majority of poisonous snake envenomations in this country. Most hospitalized victims are bitten either by rattlesnakes or copperheads or by unidentified snakes. Most of these bites occur during the summer months and are found on the extremities. Field treatment focuses on the application of a vacuum extractor and transportation to the nearest medical facility. Although constriction band use can be helpful, tourniquets, incision and suction, and ice therapy are contraindicated. Electric shock therapy is of no use and could cause serious injury. Hospital management focuses on rapid clinical evaluation and laboratory tests to establish the degree of envenomation, looking for clotting abnormalities. If envenomation has occurred and is reactive, polyvalent antivenin should be administered according to the degree of envenomation. Errors in diagnosis and treatment result in increased morbidity and put attending physicians at risk for litigation. Prevention remains the most successful approach to snakebite management.