Pain and paresthesias near envenomation site.
"Tap" test: severe local tenderness when affected area is lightly tapped
"Tap" test: severe local tenderness when affected area is lightly tapped
Uncommon but can be severe, particularly in children
Cranial nerve palsies and somatic motor dysfunction can develop:
Abnormal roving eye movements, blurred vision, pharyngeal muscle incoordination
Tongue fasciculations and uncoordinated motor agitation (flailing or jerking extremities)
Hypersalivation, noncardiac pulmonary edema
can → respiratory distress/failure
Tachycardia, other dysautonomias, and severe agitation can also be present
Without antivenom, symptoms typically last 24-48 hrs
Abnormal roving eye movements, blurred vision, pharyngeal muscle incoordination
Tongue fasciculations and uncoordinated motor agitation (flailing or jerking extremities)
can → respiratory distress/failure
Grade 1 - Local pain and/or paresthesias at site of envenomation
Grade 2 - Pain and/or paresthesias remote from the site of the sting, in addition to local findings
Grade 3 - Either cranial nerve/autonomic dysfunction or somatic skeletal neuromuscular dysfunction
Cranial nerve dysfunction - Blurred vision, roving eye movements, hypersalivation, tongue fasciculations, dysphagia, dysphonia, problems with upper airway
Somatic skeletal neuromuscular dysfunction - Restlessness, severe involuntary shaking or jerking of the extremities that may be mistaken for a seizure
Grade 4 - Combined cranial nerve/autonomic dysfunction and somatic skeletal neuromuscular dysfunction
Cranial nerve dysfunction - Blurred vision, roving eye movements, hypersalivation, tongue fasciculations, dysphagia, dysphonia, problems with upper airway
Somatic skeletal neuromuscular dysfunction - Restlessness, severe involuntary shaking or jerking of the extremities that may be mistaken for a seizure
Scorpion envenomation
Hymenoptera stings 
Stonefish envenomation
Mammalian bites
Fire coral envenomation
Closed fist infection 
Lionfish envenomation
Dog bite