Venomous snakebite treatment is controversial. Venomous snakebites are known to occur in all but a few states. Approximately 10 to 15 individuals die from snakebites each year, with bites from diamondback rattlesnakes accounting for 95 percent of fatalities. The identification of the two endogenous classes of venomous snakes are discussed in detail to aid in determining the proper treatment for each class. Approximately 25 percent of all pit viper bites are "dry" and result in no envenomation. The best first aid is a set of car keys to get the victim to a facility where antivenin is obtainable. Incision and suction should be limited to very special situations; cryotherapy and use of tourniquets applied by laymen should be avoided. Proper medical management at a health care facility requires establishing whether envenomation has occurred and to what extent, followed by appropriate dosing of antivenin. The use of corticosteroids and antibiotics is controversial. Tetanus immunization should be updated, if necessary. Although research in developing a more purified antivenin is under way, the best treatment for snakebite is prevention.