Is the patient envenomed?
Is it likely that a clinically relevant injection of venom has taken place?
- time of the bite,
- local pain,
- nausea, vomiting.
- state of consciousness (restlessness, sleepiness, coma).
- blood pressure/pulse,
- breathing (respiratory rate).
- local swelling,
- local redness.
- hypersalivation, increased bronchial secretion,
- abdominal pain (acute pancreatitis),
- bradycardia/tachycardia/cardiac arrhythmia,
- arterial hypotension/hypertension,
- apical systolic murmur (mitral regurgitation), protodiastolic gallop,
- clinical signs of pulmonary oedema,
- clinical signs of shock,
- clinical signs of acute hypertensive encephalopathy,
- blurred vision, "wandering" eye movements,
- pharyngeal reflex,
- generalised muscle pain and cramps,
- muscle weakness,
- paralysis of the respiratory musculature (respiratory failure).
Record and measure:
- ECG (cardiac arrhythmias, "myocardial infarction-like pattern"),
- blood sugar.
Exclusion of a clinically relevant systemic reaction
Monitoring for signs and symptoms of systemic envenoming for 12–24 h.
Severe systemic symptoms of envenoming may first arise a long time after the sting (see Parabuthus spp.; Müller 1993, Smith et al. 1983).