Inquire re:

• time of the bite,
• local pain,
• nausea, vomiting.

Assess:

• state of consciousness (restlessness, sleepiness, coma).

Measure:

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

Investigate/observe:

• local swelling,
• local redness.

Systemic reactions:

• sweating,
• hypersalivation, increased bronchial secretion,
• priapism,
• 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,
• dysphagia,
• dysarthria,
• 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.