When the patient enters the hospital, blood should be drawn immediately for typing, matching and coagulation studies. Although envenomation by one of the snakes of North America may present severe signs and symptoms, death is rare except in children or following envenomation by a large snake. However, permanent damage of an involved extremity is frequent following a bite by certain of the North American venomous snakes; plastic or orthopedic surgical repair to restore function, or amputation, are not unusual consequences. Early and continuing close observation is needed to determine if certain therapeutic measures prevent or promote undesirable results. _Laboratory Tests_ No rigid set of rules regarding therapy can be justified; the responsible physician must use his best judgment in his choice of tests to be performed as a guide to procedures to be used. Clinical studies could include items such as repeated hematologic tests, hepatic and renal function studies, serial electrocardiograms, electroencephalograms, and other studies to therapy, depending on the composition of the venom involved and within the limits of personnel, time and equipment available. _Therapeutic Procedures_ A. Systemic 1. Immobilization. During transportation, admission procedures, and most of the early hospitalization period, immobilization of the affected part and absolute rest should be continued. A sedative or analgesic may be administered to relieve restlessness and anxiety; ice bags may be applied to alleviate severe pain. The extremity should be immobilized in the position of function, and active and passive exercises to prevent contracture started after the third day if consistent with the patient’s condition. 2. Blood Transfusion. Postmortem examinations have at times revealed extensive retroperitonial and intraperitonial hemorrhage, and hemorrhage into the viscera, including the liver and kidney. Progressive decrease in the total volume of circulating red blood cells has been attributed to the development of a massive hemolytic anemia or internal hemorrhage. Blood transfusions may be necessary and at times have been followed by marked improvement. Studies of the several factors involved in blood clotting may be useful as guides to treatment. The first and subsequent specimens of urine should be especially examined for the presence of red blood cells, hemoglobin, and protein. 3. Electrolyte Balance. Abnormality of fluid and electrolyte balance should be detected and corrected on a continuing basis.