Bite wounds - Snake bites
Concise emergency guidance on assessment and initial management of snake bites in the UK, emphasising recognition of systemic envenoming, indications for antivenom, practical logistics, and common pitfalls. Intended for ED clinicians and candidates preparing for postgraduate exams.
Key points up front
- The adder (Vipera berus) is the only venomous native UK snake and causes virtually all indigenous snake‑bite presentations.
- Non‑native (pet or exotic) species may cause very different clinical syndromes and often require specialist toxicology input and different antivenoms; always contact NPIS/TOXBASE for species‑specific advice.
- Early resuscitation and rapid escalation are priorities.
- Antivenom can be lifesaving for clinically significant envenoming but carries a risk of early hypersensitivity/anaphylactoid reactions; be prepared to manage anaphylaxis.
- Local antivenom availability varies between trusts; contact local pharmacy and NPIS/TOXBASE immediately when antivenom is being considered.
Epidemiology and legal note
- The UK has three indigenous snake species; only the adder is venomous.
- Avoid advice that encourages killing or handling protected wildlife; follow GOV.UK Natural England guidance.
- Bites from non‑native or overseas snakes require specialist toxicology input and often antivenom that is not stocked locally.
Pathophysiology
- Adder venom is principally cytotoxic and haemotoxic.