A 30 years old man presented to ED after a scorpion sting to his rt leg while sleeping.He presented 30 mintues after the sting with severe local pain with no other symptoms .On examination,he is concious and alert ,complaining of local pain, His vitals are normal.Systematic examination is unremarkable. Local examination was also unremarkable apart mild erythema around the sting site
Below is the scorpion
Q1 How will you manage this patient?
Q2 What are the indications to give him antivenom?
Hottentotta Cont'
Thanks for your comments
Most Omani scorpions are in the dangerous family Buthidae recognized by their thin claws. The most common is Hottentotta jayakari which is in the photo
All Buthaidae scorpion stings produce an immediate very severe local pain due to their cholinergic toxins.
Most scorpion stings result in mild envenomation.
severe toxicity can due its cholinergic toxins and K+ channel blockers. Apart
from very severe pain, sweating and salivation,
Progressive envenomation can cause CNS toxicity e.g drowsiness, drooping eyelids, paralysis of neck muscles and general loss of muscle coordination,
and finally respiratory failure, which can result in death within hours.
o Symptomatic pancreatitis or upper GI bleeding has been reported.
o Toxin can cause ST segment or T wave abnormalities, dysrhythmias in ECG.
o Children are at higher risk of developing severe systemic manifestations than adults
Management :
o Reassure, obtain basic observations pulse, BP, respiration (ABCDEs). Endotracheal intubation and ventilation
may be required in severe envenomation cases.
o Clean the wound and administer tetanus prophylaxis, if indicated. Antibiotics only if signs of infection observed.
o Analgesics may be required to control the pain.
Severe pain can be treated with narcotics. Digital block can be
used in certain cases.
Scorpion antivenom is the treatment of choice for patients showing signs of systemic toxicity.
References:
1- National Guidelines on Poisoning Management 3rd edition
reassure, clean the wound , give tetanus prophylaxis.
analgesia, orally e.g NSAID, but if sever pain narcotics can be given as well as digital block.
observe for 2-4 hrs if improved and remain asymptomatic discharge home
antivenom indicated if patients showing signs of systemic toxicity.
From the photo i think it is southern devil scorpion species, isn’t lethal but usually makes sever local pain to the victim includes erythema and sore for a few day’s.
Q1: how will u manage this pt?
from the hx i think it’s grade 1 so i will manage the case in this way ;
A.B.C IV Access.
Labs ( CBC,Coagulation,U/E,LFT)
IV Analgesic + local anesthesia infiltration.
Keep the pt for observation for 6hr in ED dep, if he doesn’t develop any cranial nerve or somatic skeletal neuromuscular dysfunction, D/C on NSAID and if there is any new complain to come to ED.
Q2: what are the indication to give him anti-venom??
If the pt develop both cranial nerve and somatic skeletal neuromuscular dysfunction,should start anti-venom.
Give pain killer