Is the patient envenomed?
Is it likely that a clinically relevant injection of venom has taken place?
- time of the sting,
- local pain,
- muscle pain, in particular back pain.
- state of consciousness.
- blood pressure/pulse,
- breathing (respiratory rate).
- the sting itself ("prints", which may enable differentiation of the cause Fig. 4.11).
- extent of the sting (important for the distinction between "minor stings" and "major stings" in Chironex fleckeri and Chiropsalmus quadrigatus envenoming).
- Eyes: conjunctivitis, corneal lesions.
- Clinical signs of regional vascular insufficiency distal to a sting on the extremities.
- Clinical signs of mononeuritis multiplex distal to a sting on the extremities.
- Respiratory insufficiency/respiratory failure.
- Clinical signs of shock (cardiogenic shock, anaphylactic shock).
With one exception, systemic signs of envenoming following cnidarian stings occur more or less immediately after the sting. Carukia barnesi causes the so-called "Irukandji syndrome", which manifests itself after a delay of a number of hours after an initially harmless local reaction.