Clinical Assessment: Patient History
1. Circumstances under which the envenomation took place
| Locality: Is the animal found in the locality where the bite or sting was received? | Example: A coastal taipan in Northern Queensland. |
| Environment: Does the animal occur in the type of habitat where the bite or sting was received? | Example: Blue-ringed octopus occurring in seaweed on the beach. |
| Activity: Is the animal likely to have been encountered while pursuing the activity during which the bite or sting occurred? Note: the animal may bite or sting the patient after the activity ceases. | A redback spider encountered while moving planks from a woodpile may crawl onto the clothing but only bite when the person later leans back in a chair. |
The above information helps determine how likely the diagnosis of envenomation is:
- Definite: The animal was seen to bite or sting.
- Probable: A bite or sting was felt and the animal was seen nearby at the time and had the opportunity to bite or sting.
- Possible: Circumstances allowed for a bite or sting but the animal not seen nearby at the time.
2. First aid
- What first aid was applied?
- How long has first aid been in place?
3. Tetanus status
4. Past history
- Previous bites or stings
- Previous use of antivenom
- History of allergy to horse serum
5. Symptoms and signs consistent with envenomation may include:
- EARLY (within 30 minutes)
headache, nausea and vomiting, abdominal pain, coagulopathy. - LATE (within several hours)
cranial nerve palsies (ptosis, external ophthalmoplegia, dysarthria, dysphonia, dysphagia), limb and truncal weakness, respiratory failure, haemorrhage - VERY LATE(delayed presentation, wrong or inadequate treatment)
prolonged paralysis, renal failure, uncontrollable haemorrhage