Emergency Flowchart

Signs and symptoms¹

Emergency medi-cal treatment²

Specific treatment

Neurological
Acroparaesthesias.
Cranial nerve deficts.
Paralysis, including paralysis of the respiratory musculature → Respiratory failure

Neurological + temperature dysaethesias 
Numbness, tingling, itching (palms of the hands, soles of the feet, lips, oral mucosa). 
Temperature dysaesthesias: Painful tingling or burning sensation to cold objects, air, fluids.
Vertigo, loss of consciousness, cerebellar syndrome, balance disturbance, hallucinations, depression, memory loss, concentration problems, behavioural disturbance, visual disturbance, multi-tasking problems, giddiness.

Mannitol

Endotracheal
intubation,
artificial ventilation;
etc.

Neurological with a focus on CNS
Coma, cerebral seizures (in the acute phase and spontaneous recurrent seizures weeks to months after ingestion), mutism, involuntary chewing and grimacing, emotional instability (uncontrolled screaming and aggression), headache, short-term memory loss, increased bronchial secretion

Cardiovascular
Bradycardia, arrhythmia, arterial hypotension

Treatment of cardiovacular problem

Gastrointestinal
Vomiting, diarrhoea → Dehydration (!), abdominal pain.

Rehydration

Trivalent ABE antitoxin

Refer to
toxicology manuals

Urticaria, redness, angio-oedema, itching

Respiratory
Dyspnoea

Cardiovascular
Arrhythmias, arterial hypotension

Gastrointestinal
vomiting, diarrhoea → dehydration, abdominal pain

H1 blockers and H2 blockers

For full advise on mild, moderate and severe scombroid fish poisoning see section 'Clinical management' in 'Clinical entries: Scombroid fish poisoning'.