Emedinews:Insights on Medicolegal issues: What is the treatment of poisonous bites and stings?

• Antivenom should only be given in a hospital or medical center where resuscitation can be given, because the patient may develop an allergic reaction. Antivenin should be used, if there are signs of severe systemic envenoming. It should not be used when there are no signs of systemic envenoming. To decide whether venom has been injected, and how serious the poisoning is, look for these signs:
• Swelling and local tissue injury at the site of the bite
• Blood that does not clot, causing bleeding from gums, nose, wounds and injection sites
• Shock caused by circulatory failure
• Neurotoxic paralysis (ptosis, ophthalmoplegia, dysarthria, peripheral muscle weakness, respiratory distress)
• Generalized muscle pain and local tissue damage
• Kidney failure, red or black urine
• Tender swollen lymph nodes near the bite site

• To test clotting time of whole blood: Place 2–3 ml of whole venous blood in a clean, dry, glass test–tube and leave undisturbed for 20 minutes at room temperature. Normal blood should have clotted by this time. Tip the tube to see if the blood is still liquid.
• If the wound becomes infected, treat as for any other local infection. Use antibiotics if needed.
• If there is local tissue injury, do not cover the wound, instead leave it open.