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Key elements in examination are:

  • Bite site, looking for local effects, multiple bites, persistent bleeding (coagulopathy), plus swab for venom detection if in Australia or New Guinea (cut away first aid over bite area, leaving the rest of the bandage in place).
  • Draining lymph nodes, looking for tenderness or swelling, suggesting venom movement.
  • Neurological function (neurotoxic paralysis), specifically looking for ptosis, lateral gaze diplopia, fixed dilated pupils, poor tongue extrusion, dysarthria, dysphagia, drooling, limb weakness, reduced DTRs, respiratory weakness.
  • Muscle movement pain, tenderness (myolysis).
  • Easy bruising, active bleeding from gums, venepuncture or drip sites (coagulopathy).
  • Urine, looking for reduced output, myoglobinuria or haematuria.