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IM21.1-9 | Envenomation — Assignment

CLINICAL SCENARIO

This assignment asks you to write a structured clinical case report for a patient with envenomation — either snakebite (any species from the big four) or scorpion envenomation. You may draw on a case you observed during your clinical posting or construct a representative fictional case based on your SDL learning. Your report should demonstrate that you can identify the envenomation syndrome, conduct and document a systematic clinical evaluation, make a justified treatment decision (including antivenom or prazosin), plan monitoring, and critically review the pre-hospital care received. A community first-aid education section is also required.

Instructions

Write a structured case report in the sections below. Use precise clinical language. Name specific drugs, doses, and monitoring parameters — avoid vague statements such as 'give antivenom' or 'monitor the patient'. Demonstrate mechanistic understanding where asked. Do not copy SDL text verbatim. Word limit: 1,100–1,500 words.

Length: 1,100–1,500 words across all sections

What to Submit

Section 1: Species Identification and Syndrome Recognition

Guidance: Describe the circumstances of the envenomation: when and where it occurred, the patient's account of the snake or scorpion, and the morphological features of the animal if seen. Based on these features and the clinical presentation, identify the most likely species or type. Name the envenomation syndrome (e.g., haematotoxic with VICC, neurotoxic, autonomic storm) and explain the key pathophysiological mechanism responsible for the main clinical features. Approximately 200 words.

Section 2: Clinical Evaluation

Guidance: Document a structured clinical evaluation. For snakebite: address all 7 history domains (time and circumstances, species features, local wound evolution, haematotoxic symptoms, neurotoxic symptoms, pre-hospital interventions, background history). For scorpion: address time, circumstances, local and systemic symptoms evolution, and autonomic features. Describe your systematic examination including ABCDE approach plus snakebite-specific examination (local wound grading, ptosis check, neurological signs, bleeding assessment). Detail the investigations you would select and state your interpretation of each, including the 20WBCT technique and result. Approximately 350 words.

Section 3: Treatment Plan and Decision-Making

Guidance: State whether antivenom (ASV) or prazosin is indicated, with explicit justification based on the indication criteria. If ASV: state the number of vials, dilution, route, and infusion rate. State what adverse reaction to watch for and your immediate management. If prazosin: state the dose, frequency, indication grade, and the drug that is absolutely contraindicated and why. Include your supportive care plan addressing the specific complications of this envenomation type. Approximately 250 words.

Section 4: Monitoring Plan and Response Assessment

Guidance: Describe your structured monitoring plan: specify which tests to repeat and at what time intervals (e.g., serial 20WBCT at 6h and 12h; neurological assessment every 30 minutes; urine output hourly). State what constitutes adequate response and what would prompt a repeat dose of ASV or escalation of scorpion management. Identify at least two complications specific to this envenomation type, the earliest observable sign of each, and the specific management. Approximately 200 words.

Section 5: First Aid Review and Community Education

Guidance: Review the first aid measures applied to this patient before arrival at hospital. For each measure, state whether it was correct or harmful and explain why. Then draft a brief, accurate community first-aid message (as if explaining to a village health worker or community member) for the type of envenomation in your case. Include what to DO and what NOT to DO, with a clear reason for each prohibited action. Approximately 200 words.

Section 6: Reflection

Guidance: Reflect on one key clinical decision-making challenge in this case — for example, the threshold for giving ASV in a patient with only local signs, distinguishing anaphylaxis from toxic bee envenomation, or recognising Grade II scorpion envenomation before it progresses. Explain how your SDL learning influenced your reasoning at that decision point and what you would do differently in a future similar case. Approximately 150 words.

Grading Rubric — Envenomation Case Report Rubric

Criterion	Points	Full-marks descriptor
Species/Envenomation Type Identification and Syndrome Recognition (Section 1): Accurately identifies the envenomating species or type (snakebite species/scorpion) using clinical and contextual features; correctly names the envenomation syndrome and its key pathophysiological mechanism.	15 pts	Species/type identified with precise clinical reasoning (morphological features + syndrome + pathophysiology linked); correct syndrome named with mechanism explained (e.g., VICC via Russell's viper PLA2/SVMP degrading fibrinogen, or autonomic storm via sodium channel toxin in scorpion).
Clinical Evaluation: History, Examination, and Investigations (Section 2): Presents a structured 7-domain snakebite history (or equivalent for scorpion); documents relevant physical examination findings including ABCDE assessment, local wound examination, neurological examination, and haemostatic assessment; selects and interprets appropriate investigations including 20WBCT.	20 pts	All 7 history domains documented; ABCDE + snakebite-specific examination recorded (ptosis check, 20WBCT technique correctly described, local wound graded); investigations selected and interpreted with reference to syndrome-specific expected findings.
Management Plan and Antivenom Decision-Making (Section 3): Correctly determines whether ASV or scorpion-specific treatment is indicated; if ASV indicated, states the correct dose, route, dilution, and infusion rate; names the adverse reaction to monitor for and its immediate management; for scorpion — states prazosin indication, dose, and contraindicated drug.	25 pts	Antivenom/specific treatment decision fully justified with reference to indication criteria; dose/route/rate/dilution correctly stated; adverse reaction management detailed (adrenaline IM FIRST for anaphylaxis); prazosin dose and beta-blocker contraindication stated if scorpion case; supportive care plan addressed.
Monitoring, Complications, and Response Assessment (Section 4): Describes a structured monitoring plan including serial 20WBCT schedule (if haematotoxic), neurological monitoring (if neurotoxic), urine output monitoring, and the criteria for repeat ASV dosing; identifies at least two potential complications and their early recognition.	20 pts	Serial monitoring plan detailed (20WBCT at 6h + 12h; neurological checks every 30 min for neurotoxic; urine output hourly); repeat ASV criteria stated; two complications identified with early signs and specific management.
First Aid Critique and Community Education (Section 5): Reviews the first-aid measures applied before arrival and identifies correct versus harmful interventions; constructs an accurate evidence-based community first-aid message for snakebite or scorpion sting.	15 pts	Pre-hospital interventions reviewed with explicit classification (correct/harmful) and reason for each; community message accurate, complete (what TO do + what NOT to do), and appropriately worded for lay audiences.
Reflection and Clinical Reasoning (Section 6): Identifies one key clinical decision-making challenge encountered (real or simulated) in this case and reflects on how the envenomation SDLs changed their approach to the clinical problem.	5 pts	Reflection is specific, personal, and demonstrates genuine learning — identifies a precise decision point (e.g., when NOT to give ASV, distinguishing anaphylaxis from toxic envenomation) and explains how prior SDL learning influenced clinical reasoning.

PEER REVIEW

Review your peer's case report using the rubric provided. For each section, assign a score and write one specific comment explaining your rating — do not copy rubric descriptors verbatim. Pay particular attention to: (1) In Section 3, check whether the ASV indication criteria are correctly applied — local swelling alone should NOT trigger ASV; (2) In Section 3, verify that the adverse reaction management names adrenaline IM as FIRST-LINE, not steroids or antihistamines; (3) In Section 3 for scorpion cases, confirm that propranolol is explicitly named as contraindicated with a reason. Complete your review within 72 hours.