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.