What do you do when a patient arrives with a venomous snakebite? Which bites are truly dangerous, when should antivenom be used, and what are the biggest myths that continue to circulate about snakebite management? On this episode of So What?, host Dr. Howie Mell sits down with one of the nation's leading experts on snake envenomation, Dr. Spencer Greene, for a practical, evidence-based discussion on the diagnosis and management of snakebites. From identifying clinically significant envenomations to avoiding outdated treatments that can do more harm than good, they break down what emergency clinicians need to know when every minute counts. The conversation explores initial assessment, laboratory evaluation, indications for antivenom, management of pit viper bites, patient disposition, and common misconceptions surrounding tourniquets, incision and suction, and other persistent folklore. Dr. Greene also shares clinical pearls from years of treating snakebite victims and discusses how emergency physicians can approach these uncommon but high-stakes cases with confidence. Whether you practice in an area where venomous snakes are common or simply want to be prepared for the unexpected, this episode delivers practical takeaways that can immediately impact patient care.

In this episode:

• Initial evaluation of suspected snake envenomation
• Pit viper versus nonvenomous bites
• When antivenom is indicated—and when it isn't
• Laboratory testing and ongoing monitoring
• Common myths and management pitfalls
• Disposition, observation, and follow-up recommendations
• Practical pearls for emergency clinicians

Mentioned in this episode:

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