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Poisonous animals
 
Cnidarians (Jellyfish, Corals and Anemones)
 
Venomous fish
 
Scorpions
 
Spiders
 
Hymenopterans (Bees, Wasps and Ants)
 
Sea snakes
 
Terrestrial snakes
 
Miscellaneous animals
 
 
 
 
 
 
 
 

Is the patient envenomed?

 

Is it likely that a clinically relevant injection of venom has taken place?

D  Diagnostics

Inquire re:

  • time of the sting,
  • local pain,
  • muscle pain, in particular back pain.

Assess:

  • state of consciousness.

Measure:

  • blood pressure/pulse,
  • breathing (respiratory rate).

Observe/investigate:

  • 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).
C  Comments

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.