These facilities maintain a list of consulting physicians as well as the Antivenin Index, which is published and periodically updated by the American Zoo and Aquarium Association and the American Association of Poison Control Centers. This index catalogs the location and number of vials of antivenoms available for all native venomous snakes and most exotic species. Antitetanus therapy should be given when indicated. Signs of hypovolemic shock require isotonic fluid replacement. Blood products should not be administered until an adequate dose of neutralizing antivenom has been given.
Corticosteroids are of no value during the acute stages and are contraindicated.
Endotracheal intubation or tracheostomy may be needed, particularly if trismus, laryngeal spasm, or excessive salivation is present. Mild sedation with an IV benzodiazepine is indicated for severe envenomation when respiratory failure is not a problem. A narcotic may be needed for pain. An extremity should never be iced. Surgical debridement of blebs, bloody vesicles, or superficial necrosis, if present, should be carried out between days 3 and 10 and may need to be done in stages.