Once a snakebite occurs, it is a race against time to prevent severe local tissue damage and deadly systemic symptoms. Some types of necrosis caused by cytotoxic venoms cannot be reversed but can be prevented by early antivenom administration (or arrested before further damage can occur in cases of late antivenom treatment).1,7,47-49 Hemotoxic venoms can induce bleeding and clotting abnormalities within minutes, which progresses over hours or days into widespread external and internal bleeding. Neurotoxic venoms can act rapidly and be fatal. When a neurotoxic snake bite occurs, rapid antivenom administration prior to the onset of respiratory failure can arrest the progression of descending paralysis before serious systemic manifestations develop.1,50,51 In many cases paralysis will reverse rapidly. When paralysis cannot be reversed before mechanical ventilation is needed (e.g. late-presenting krait envenomations), antivenom still plays a key role: clearance of unbound circulating venom, which permits recovery of damaged nerve terminals and reduces time to extubation to an average of 2 – 5 days versus weeks of ventilation in untreated patients. 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 provides comprehensive guidance on how to manage snakebites in all geographic CCMDs, with clear steps for providers of all levels to follow in the field and the clinic.