• Primary assessment of airway, breathing, and circulation takes precedence.
• Few studies have evaluated the utility of most first aid.
• The utility of negative pressure extraction devices has not been evaluated for scorpion stings.
• Perform endotracheal intubation and vascular access as needed.

Emergency Department Care

Supportive care in all cases and antivenom in severe cases are used for the treatment of scorpion envenomation.

• Grades of Centruroides envenomation
  • Grade I - Local pain and/or paresthesias at the site of envenomation
  • Grade II - Pain and/or paresthesias remote from the site of the sting, in addition to local findings
  • Grade III - 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 IV - Combined cranial nerve/autonomic dysfunction and somatic nerve dysfunction
• Androctonus australis Hector Hospitalization Score
  • Priapism: +3
  • Vomiting: +2
  • SBP >160: +2
  • Corticosteroid PTA: +2
  • Temperature >38ºC: +1
  • Heart rate >100 bpm: +1

Total ≥2 = Hospitalization

• Although grading and scoring systems have been developed, they are limited due to species specificity and low-degree symptoms that would lead to hospitalization or therapy.