Note: If anaphylaxis is evident, the causative agent is of secondary concern, and the patient should be treated for anaphylaxis without waiting to determine the cause.
The following key is intended only as a guide to aid in the identification of the agent of envenomation where venom intoxication has already been diagnosed. It should be remembered that the suggestion arrived at by using this key should remain consistent with the patient’s history and the clinician’s own opinion.
| 1. |
| a. | No evidence of bite site: possibly a tick in a skin fold. |
| b. | Bite site consists of scratches, irregular punture marks (often paired), sometimes several bites: snake. |
| c. | Regular puncture marks (often paired, sometimes very close together): possibly snake, spider or centipede. Go to 2. |
| d. | Tiny, pinprick sting mark, with or withour swelling and erythema: scorpion, ant, bee or wasp. Go to 3. |
| e. | As (d), but numerous such: ant, bee or wasp. |
| 2. |
| a. | Significant pain at the bite site, with or without nausea and vomiting, no coagulopathy, no myalgia: spider. |
| b. | Neurological impairment, sweating at bite site, no coagulopathy, no myalgia, with or without nausea and vomiting: spider. |
| c. | No nausea and vomiting, neurological impairment with or without coagulopathy or myalgia, no sweating at bite site: snake. |
| d. | No nausea and vomiting, coagulopathy with or without neurological impairment or myalgia, no sweating at bite site: snake. |
| 3. |
| a. | Nausea and vomiting: scorpion. This is not seen in cases of ant, bee or wasp sting where the number of stings is one or few. |
| b. | No nausea and vomiting: ant, bee or wasp. |
