BACKGROUND
Snakebite, recently declared a neglected tropical disease and global health priority by the World Health Organization (WHO), results in an estimated 2.5 million envenomations, 138,000 deaths and over 500,000 cases of permanent disability worldwide every year.1–10 Snake, spider, and scorpion envenomations are a common environmental and occupational hazard for military forces worldwide.11–46 The consequences of an envenomation range from mild local effects to permanent disability or death, and the outcome is largely determined by the time to antivenom treatment and the level of training of the medical providers involved.
Once an envenomation has occurred, the provider and patient are racing against the clock to neutralize active venom components before extensive damage has occurred. Necrosis caused by cytotoxic venoms cannot be reversed, but it can be prevented by early antivenom administration or arrested before further damage can occur in cases of late antivenom treatment.1,7,47,48 Hemotoxic venoms can induce coagulopathies within an hour of the envenomation which is quickly followed by a standard progression of worsening local and systemic external and internal bleeding. Neurotoxic venoms can act rapidly and be fatal. Africa is one of the few places in the world with snakes like the black mamba that are capable of killing a human within one hour due to direct effects of the venom, and most patients with mamba envenomation who are not rapidly treated with antivenom will die within 2 - 6 hours from respiratory arrest.1,49 When a neurotoxic bite occurs, rapid antivenom administration prior to the onset of respiratory muscle weakness can arrest the progression of descending paralysis before serious systemic manifestations develop.1,50,51 Every hour wasted between bite and antivenom administration is strongly associated with sharp increases in mortality and the development of chronic or permanent sequelae including amputation, disfigurement, PTSD, blindness, kidney injury, infections, and partial or complete loss of function of the bitten limb.4,7,8,52–58
This CPG will cover the continuum of snakebite care for snake envenomations in all combatant commands.