- 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.