The diagnosis and identification of the animal causing the bite/sting may be obvious, particularly if the offending animal is presented with the patient, but it more often is less clear. The patient may present with marks that may or may not be due to a bite/sting by organism unknown. If they have symptoms, signs or laboratory test results indicative of envenoming then this will clarify the situation, but sometimes all of these are non specific and may point to a variety of possible aetiologies, of which envenoming is just one. Most worrying is the patient who presents with no history of a bite/sting, in whom the constellation of symptoms, signs and laboratory test results may not immediately suggest envenoming. In such cases it is essential to do the right tests to confirm or exclude envenoming.
To elaborate on all possible scenarios would exceed the scope of this publication. Some specific pointers for particular venomous animals are noted in the clinical sections for each antivenom, later in this book. A few important case situations are given in the general information for snakes, then basic details on various animal groups including clinical features of envenoming.
Major envenoming is a condition treated only rarely by most doctors, who therefore will have little opportunity to develop or maintain current knowledge or skills appropriate for these cases. Never delay or be hesitant in seeking expert advice in management of envenoming. Such advice from doctors trained in the management of envenoming is available through CSL (03 9389 1911) and also through the National Poisons Centre Network (131 126) - ask to speak to the Duty Medical Toxicologist.