Major bleeding

Treat major bleeding secondary to snake envenoming as for any other cause of major bleeding from coagulopathy. Once antivenom has been administered, consider:

• clotting factor replacement—fresh frozen plasma is the treatment of choice in patients with active major bleeding but, if possible, avoid its use within 6 hours of the bite
• surgical intervention
• supportive care.

Discuss major bleeding cases with a clinical toxicologist and consider the need for admission to an intensive care unit.