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Scorpion Envenomation Treatment & Management

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  • 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.

Last Updated on Sunday, 07 October 2012 12:09

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Scorpion Sting Overview

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Scorpions are a member of the Arachnida class and are closely related to spiders, ticks, and mites. Scorpions have two pincers, 8 legs and an elongated body with a tail composed of segments; they range in length from about 9 to 21 cm. The last tail segment contains the stinger (also termed a telson) that transmits a toxin to the recipient of a sting. Most scorpions are harmless. Although about 2000 species exist, only about 25-40 species can deliver enough venom to cause serious or lethal damage to humans. One of the more venomous or potentially dangerous species, especially for infants, young children, and the elderly in the United States is Centruroides exilicauda or bark scorpion. Contact with scorpions is usually accidental. Scorpion stings are painful, and they can be fatal, particularly to children. Scorpions may sting more than once; the stinger, located at the end of the tail segment is usually not lost or left in the person's tissue after a sting. About 11 to 17 thousand people are stung each year in the US.

Scorpions come in a variety of colors - from tan to light brown to black. Each has a long tail segment that contains a stinger. Scorpions are found in highest numbers across the southern United States and in arid or desert regions in most other countries. However, they can be found occasionally in most US states and in temperate regions of both South America and Africa and some even reside in cold climates. Scorpions hunt at night and hide along rocks or trees during the days. Homes built in arid or desert regions commonly have scorpions in them.

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