How Should Native Crotalid Envenomation Be Managed in the Emergency Department?

Statement reviewed and approved by AAEM Board of Directors. (9/14/2020)
Updated 4/26/2021 and 8/16/2021.


  1. Address airway, breathing, circulation, then assess for local, hematologic, and/or systemic toxicity indicative of envenomation.
  2. Assess and determine the antivenom dosage needed.
  3. Prophylactic antibiotics and surgical intervention are unnecessary and should be avoided.

Executive Summary

  1. How should patients with potential snake envenomation be assessed?
    After life-threatening airway, breathing, or circulatory conditions are identified and corrected, snakebite victims should be assessed for local, hematologic, and systemic toxicity. Clinicians should examine the affected extremity for swelling, tenderness, and hemorrhagic blebs every 15 – 30 minutes for a minimum of eight hours and until progression has halted [1].
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