IF ANTIVENOM IS UNAVAILABLE

1. Antivenom is the gold standard of care for symptomatic snake envenomations. Early treatment is the best strategy to prevent death, amputation, or other serious disability. Management of snake envenomations when antivenom is not available should be directed at getting the patient to the antivenom (or vice versa) as quickly as possible to prevent irreversible damage to organs and tissues.
2. Mission planning before deployment should include research and procurement of the appropriate regionally specific antivenom(s) recommended in this CPG for your area of operation. If currently deployed without antivenom, efforts to acquire the appropriate antivenom(s) recommended in this CPG for your area of operations should be initiated through proper channels as fake or low-quality antivenoms are frequently found in local pharmacies throughout Africa and elsewhere in the developing world.
3. For specific management until antivenom can be obtained, follow the checklist and skip the steps related to antivenom administration until it has been obtained.

Refer to Supportive Care measures for specific recommendations. Without antivenom, prognosis is poor. Expect high mortality, permanent disability, and supportive care for weeks or longer.

MILITARY WORKING DOGS / MULTIPURPOSE CANINES

All antivenoms can be administered to military working dogs (MWD) and multipurpose canines according to the treatment criteria and initial doses listed in this CPG; other management should be based on the Arachnid and Snake Envenomation, MWD CPG.

LATE PRESENTATIONS & TREATMENT DELAYS

There is no defined time limit to antivenom therapy for a symptomatic snakebite. Early antivenom within the first minutes or hours after a bite is the best means of preventing morbidity or mortality, but antivenom remains effective at resolving reversible issues like coagulopathy and preventing further irreversible tissue damage even in patients who present many hours or days after the snakebite.^{56,69,78,146,147}

OUTDATED INTERVENTIONS THAT SHOULD NOT BE PERFORMED

1. DO NOT cut, suck, electrocute, burn, or use chemicals on the envenomation site.

2. DO NOT apply constricting bandages, tourniquets, or other circulation-reducing intervention!