Snakebites – Myths and Reality

On behalf of their work at the University of Virginia School of Medicine and the Blue Ridge Poison Center, Christopher Holstege, MD, and Rita Farah, MPH, PharmD, PhD discuss the myths and realities of snakebites as summer heats up in Virginia.

Summer is in full swing, and with it comes increased outdoor activities such as hiking and camping. As we increase the time we spend outdoors, it is important to understand a creature we may come into contact with in Virginia – the venomous snake. According to data associated with America’s Poison Centers, over 4,700 venomous snakebites occurred in the United States in 2022. During the same time period, 111 snakebites were reported to Virginia’s poison centers. In Virginia, three venomous snakes exist: the eastern copperhead (Agkistrodon contortrix), the timber rattlesnake (Crotalus horridus), and the northern cottonmouth (Agkistrodon piscivorus). The majority of snakebites reported in Virginia are due to the copperhead. 

There are numerous myths involving snakes. Snakes are neither typically aggressive nor eager to bite humans. The reality is that these snakes would rather preserve their venom for a rodent meal. Studies have shown that numerous snakebites occur in males who were intentionally handling the snake while intoxicated. However, numerous bites have also occurred in persons who did not mean to encounter a snake. When a bite occurs to humans, the snake injects venom for protection. When a snake bites its prey, the venom contains enzymes that help digest its food. Venom injected into human tissue will begin to digest it, resulting in swelling, pain, bruising, and bleeding at the injection site. Rarely, Virginia venomous snakes may cause problems with clotting factors leading to an increased risk of bleeding. Fortunately, the majority of Virginia’s venomous snakebite victims do well with minimal treatment, and associated deaths are rare. 

There are numerous myths pertaining to the immediate treatment of snakebites. For example, snakebite victims commonly try to suck out the venom or use a tourniquet, which may make the wound worse than if they had left it alone. If you are bitten by a venomous snake, a number of key points should be remembered:

• Get the victim away from the snake. Do not try to capture it for identification. Identification will not change management, and a number of people have been bitten twice because they tried to capture the snake.
• Stay calm. Remember, Virginia’s venomous snakes may cause pain and swelling but rarely cause permanent disability or death.
• Check the snakebite for puncture wounds. If one or two fang markings are visible or the wound turns swollen or bruised, the bite may have come from a venomous snake.
• Clean the wound with soap and water.
• Never apply a constriction band. Decreasing blood flow to an area by a constriction band will result in more tissue damage.
• Avoid the application of ice or heat.
• Never use electric shock devices. Studies show that these devices do nothing to inhibit the snake venom and actually cause more harm.
• Avoid performing incision and suction of the wound as portrayed in old Western movies. It is not uncommon for persons performing this to sever vessels, tendons, and nerves. 
• Watch for general symptoms (i.e., sharp pain, bruising, swelling around the bite, weakness, shortness of breath, vomiting, bleeding from sites distant to the bite).
• Get the victim to the hospital as soon as possible.

Snake envenomation victims who are treated in hospitals may need pain medications, splints, or antivenin in the most severe cases. For further information on Virginia’s venomous and poisonous animals, see the Cleopatra Project (https://med.virginia.edu/brpc/the-learning-center/the-cleopatra-project/). If you have a question pertaining to a potential snakebite, call your local poison control center at 1-800-222-1222.