How do you treat a copperhead snake bite? Duke and WakeMed doctors walk us through

Kimberly Cataudella
·7 min read
184

Copperhead snake bites are the most common venomous bite in our area. In fact, North Carolina leads the nation as the state with the most snake bites.

Internationally recognized snake bite experts and medical physicians work at Triangle hospitals, treating about four venomous bites per week in the warm-weather months.

The News & Observer spoke with snake bite experts at Duke Health, WakeMed and UNC Health to learn what snakebite treatment looks like in 2023.

Here’s what happens if you get bitten by a copperhead (or other venomous snake):

How are copperhead snake bites treated?

• Above all, show up for care: If you get bitten by a venomous snake (or you’re unsure if the snake that bit you is venomous), seek care.

If you have concerning symptoms, go straight to an emergency department. This can include:

  • Difficulty breathing

  • Chest pain

  • Dizziness

  • Significant swelling

“Any patient with worsening pain, swelling or any other concerning symptoms should be evaluated in person,” said Dr. Ben German, WakeMed emergency physician and medical professional with the international Asclepius Snakebite Foundation.

If you do not have these concerning symptoms, you can call NC Poison Control (1-800-222-1222) first. This is a free 24/7 hotline for people in North and South Carolina who want to speak with a medical expert before heading to the emergency room.

NC Poison Control works with Triangle hospitals to determine care, and WakeMed physicians often consult the Poison Center for envenomations.

• Avoid urgent care centers: It’s best to go to an emergency department and not an urgent care or clinic. These treatment facilities often don’t carry antivenom, said Dr. Charles Gerardo, emergency medical specialist with Duke Health who specializes in snake bites.

UNC Health, Duke Health and WakeMed all carry antivenom treatments and administer it when needed.

• Stay for observation: Envenomations (meaning bites that inject venom into the patient) need at least 24 hours of monitoring.

“The worst comes between the 24 and 48 hour mark, when you see how bad it’s going to be,” German said.

Patients with venomous bites typically stay for 36 hours. It can be one or two overnights in the hospital, depending on the time you come in for care, Gerardo said.

Even dry bites require observation. This is mainly to ensure the bite is absolutely not an envenomation, but at a minimum, it’s to ensure the area will not be infected.

Do you need antivenom if bitten by a copperhead?

Not always. Only about 25% of patients require antivenom as part of their treatment, said Dr. Ryan Lamb of UNC Health Rex, through a spokesperson.

Here’s when antivenom is not necessary:

• For dry bites: These types of bites are either by non-venomous snakes or by venomous snakes that did not inject any venom into the victim. They do not need antivenom, as there is no venom to neutralize.

If you received a dry bite from a snake, you typically need eight to 12 hours of hospital observation. Medical professionals will ensure you’re not at risk of infection, but more importantly, they will monitor you for enough time to be certain you were not envenomated.

“My favorite type of snakebite is a dry bite. Just last week, a lady was gardening and wearing heavy rubber gloves when she got bit by a copperhead. The fangs penetrated the glove, but she had no venom injected,” German said.

“She came in because she knew it was a copperhead bite, which we are glad she did, so we watched her to make sure. We were certain there was absolutely no envenomation, so she got to go home quickly.”

• For “clinically insignificant” bites: Even if you received an envenomation, it’s not guaranteed you will need antivenom. Many times, emergency department professionals determine the bite is not severe enough to administer antivenom.

Last year, an 11-year-old boy in Raleigh was bitten by a copperhead and experienced significant swelling. But his doctor determined antivenom was not needed, as the swelling remained in a concentrated area on his body and did not spread.

“They didn’t have to give him any antivenom, which they said they don’t give unless they have to,” his mother, Kelly Kivett, told The N&O last year. “Some people respond really negatively or have an allergic reaction to antivenom, and they monitored my son’s bite for a while, eventually concluding he didn’t need it.”

Just over a week later, all of his swelling and bruising completely healed, Kivett said.

How much does antivenom cost?

The market price of antivenom does not reflect how much a patient will be billed and how much a patient pays, said Kuldip Patel, Duke Health’s senior associate chief pharmacy officer, through a spokesperson.

Most insurance carriers (including Blue Cross Blue Shield, NC’s largest carrier) cover antivenom. It is typically considered emergency care. Plus, over 75% of snake bite patients have some sort of insurance coverage, Gerardo said.

The market price of antivenom ranges from $11,000 to $14,000 per vial at UNC Health and WakeMed in 2023, according to spokespeople. For a typical initial dose of four to six vials, this can range between $40,000 and $84,000. Duke Health declined to share figures.

Here are a few real life examples:

• In 2020, a teenager was bitten by a copperhead in Hillsborough. He needed 12 vials of antivenom, which cost about $200,000, The N&O reported at the time. His father’s insurance brought the out-of-pocket cost to $175.

• Last year, a Raleigh woman received a copperhead bite on her finger. Her copay for her Emergency Room visit came out to $1,250 with her insurance.

At Hilton Head Island Hospital, the black line on her hand was used to measure swelling over time from the copperhead snakebite on Carolyn Bivens Cote’s left index finger.
At Hilton Head Island Hospital, the black line on her hand was used to measure swelling over time from the copperhead snakebite on Carolyn Bivens Cote’s left index finger.

What is antivenom?

Antivenom is administered intravenously (through an IV). A typical treatment for a copperhead envenomation consists of four to six vials, but some bites require more.

The medicine consists of antibodies which bind and inactivate the venom proteins. The inactivated venom can no longer cause damage to the body. This typically reduces pain and stops the tissue damage from worsening, German said.

The earliest antivenoms were developed in the late 1800’s. Today, the process of designing and producing antivenom is more advanced and refined, but the idea of using antibodies to neutralize venom remains.

“Research is underway to develop other ways to treat envenomations. ... Some of these drugs can be given orally, which could hopefully lead to easier means to treat snake envenomations,” German said.

“Someone can keep it with them, like Advil in your pocket. It can be a bridge to definitive care in countries where snake bites lead to a significant amount of deaths each year.”

The N&O reported on Duke Health testing a possible antivenom pill last year.

Do you need to go to the hospital if bitten by a snake, copperhead?

Not always. While you may not always need to visit the ER, it is crucial to seek care.

This can include calling NC Poison Control (1-800-222-1222).

Their medical professionals offer treatment help by phone 24/7. Their advice may be to visit an emergency department immediately, or they can help monitor the situation by phone (and by sending photos via text) in real time, medical director Dr. Michael Beuhler told The N&O last year.

Do home remedies work for snake, copperhead bites?

No. Many home remedies can do significantly more damage.

This includes tourniquets, cutting, suction devices and even ice.

“For non-venomous snakebite, cleaning the wound, updating tetanus vaccination as needed and standard wound care is usually enough,” Gerardo said.

What to do if bitten by a snake, including a copperhead

IF YOU HAVE BEEN BITTEN BY A SNAKE, YOU SHOULD:

  • Sit down and stay calm.

  • Gently wash the bite area with warm, soapy water.

  • Remove any jewelry or tight clothing near the bite site.

  • Keep the bitten area still, if possible, and raise it to heart level.

  • Call the NC Poison Control: 1-800-222-1222.

Note: If a snakebite victim is having chest pain, difficulty breathing, face swelling or has lost consciousness, call 911 immediately.

IF BITTEN BY A SNAKE, YOU SHOULD NOT:

  • Cut the bitten area to try to drain the venom. This can worsen the injury.

  • Ice the area. Icing causes additional tissue damage.

  • Apply a tourniquet or any tight bandage. It’s actually better for the venom to flow through the body than for it to stay in one area.

  • Suck on the bite or use a suction device to try to remove the venom.

  • Attempt to catch or kill the snake.

(Source: NC Poison Control)