FOCUSED ASSESSMENT & EXAMINATION

Perform a physical examination and history focused on identifying signs and symptoms of neurotoxic, hemotoxic, cytotoxic, and systemic instability envenomation syndromes. General approach is to identify syndrome à determine severityà administer initial LOW, MEDIUM, or HIGH DOSE antivenom based on syndrome AND current severityà reassess and retreat as needed based on response of key STOP/GO criteria for additional doses.

1. Mark the bite site. Circle the site of the bite wound and write the specific time that it occurred with a permanent marker on the patient. Don’t rely on fang marks—bites may look like punctures, scratches, or nothing at all.

2. Check for cytotoxic signs (tissue damage). Look for pain, swelling, or tissue destruction. Mark the edge of pain (dashed line) and swelling (solid line) with a marker and note the time.