This CPG provides comprehensive guidance on how to manage snakebites in all geographic Combatant Commands (CCMD), with clear steps for providers of all levels to follow in the field, and the clinic.

“How do I examine and treat snake envenomation patients?”

Perform a rapid snakebite exam to determine if the patient is currently symptomatic (NEURO vs HEMO/CYTO syndromes) or asymptomatic for snake envenomation, then follow the appropriate STAT treatment algorithms below:

Symptomatic treatment algorithms:

1. NEURO dominant syndrome = refer to Symptomatic NEURO Algorithm
2. HEMO and/or CYTO dominant syndrome = refer to Symptomatic HEMO/CYTO Algorithm

NOTE: For specific Antivenom doses, refer to Appendix H, Table 1: Antivenom Dosing by Product

Asymptomatic (suspected dry bite or non-venomous snake):

1. Refer to Asymptomatic Algorithm
2. Once a symptomatic patient begins to improve and control is achieved after the correct dose of antivenom, follow the Control Algorithm for assessment pathway and disposition guidance.

Within the CPG text, review Universal Approach, Initial Priorities, and Focused Assessment for a more detailed guide to identifying the syndrome, determining severity, managing ABCs, and trending.

“How do I know when I have given the right dose of antivenom?”

Keep giving antivenom until key S/Sx stop getting worse (initial control) - pain will begin to improve; edema will stop progressing; all active bleeding will stop; vision, speaking, swallowing, and breathing will begin to improve; and systemic instability will stabilize. For a detailed list of clinical endpoints indicating that initial control has been achieved, see Figure 4 - Identifying Initial Control by Syndrome. Once initial control has been achieved, follow the Control Algorithm.

“How do I find which antivenom(s) and doses I need for deployment?”

1. To select the appropriate regional antivenoms, refer to the regional antivenom selection flowcharts.
2. To find the High and Low Doses recommended for each product, refer to Appendix H: Antivenom Dosing by Product or find the short form regional entries in the regional section for each CCMD.

Detailed product pages containing additional information (coverage, formulation, preparation, administration, etc) can be found in the regional sections (Appendix B – G). Both the NEURO Algorithm and HEMO/CYTO Algorithm contain blank boxes and are designed to print and fill in the details for the products you need.

“What do I do to prevent or treat reactions to antivenom?”

See Pretreatment to Prevent Reactions, Treatment of Adverse Reactions, Antivenom Reactions Algorithm.

“If my patient arrives with a tourniquet or constricting band, how should I remove it?”

Tourniquets and constricting bands may worsen snakebite outcomes and must be removed according to the Tourniquet Algorithm. 

“What if I do not have antivenom (yet), or used it all?”

Reference Special Circumstances for full explanation. They have a very high morbidity and high mortality rate, and may require Supportive Care for weeks to months, if they survive.