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Scorpion
Aka: Scorpion, Centruroides sculpturatus, Arizona Bark Scorpion
- See Also
- Neurotoxin
- Mechanism
- Arizona Bark Scorpion (Centruroides sculpturatus) venom is a Neurotoxin
- Striped Bark Scorpion (Centruroides vittatus) is also a Neurotoxin, but less harmful than sculpturatus
- Other Scorpions cause only local reactions
- Envenomation is via the tip of the Scorpion tail
- Types
- Arizona Bark Scorpion (Centruroides sculpturatus)
- Yellow to brown Scorpions
- Subnuclear tooth at the base of the Stinger
- Much more potentially dangerous than the Striped Bark Scorpion
- Striped Bark Scorpion (Centruroides vittatus)
- Black stripes on thorax
- Symptoms
- Immediate burning pain at site of sting
- Local or regional hyperesthesia for varying period
- Signs
- Local reaction (Scorpion other than C. sculpturatus)
- Erythema
- Edema
- Ecchymosis
- Tap test (Suggests C. sculpturatus sting)
- Administer sharp tap at wound site
- Positive
- Patient experiences significant pain
- Abruptly withdraws wound site
- Centruroides sculpturatus reaction
- Muscle spasm
- Excessive Salivation
- Fever
- Tachycardia
- Nystagmus
- Blurred Vision
- Slurred speech
- Respiratory distress or Wheezing
- CNS hyperstimulation
- Seizures
- Exam
- Sting site evaluation
- Thorough Neurologic Exam including Cranial Nerve exam
- Grading: Envenomation
- Grade 1
- Pain and Paresthesias at localized site of sting
- Grade 2
- Pain and Paresthesias at remote site from bite (as well as meeting Grade 1 Criteria)
- Grade 3
- Meets criteria for Grade 2 sting AND
- ONE of the following neurologic criteria
- Cranial Nerve Involvement (e.g. Nystagmus, Dysarthria, Dysphagia, Drooling)
- Skeletal neuromuscular involvement (e.g. writhing, fasciculations, jerking, Tetany)
- Autonomic signs (Salivation, Vomiting, bronchospasm, diaphoresis, Tachycardia)
- Grade 4
- All findings of Grade 3 Envenomation are present
- Labs: Grade III and IV Envenomations
- Complete Blood Count
- Comprehensive Metabolic Panel
- Creatine Kinase
- Urinalysis
- Course: Centruroides sculpturatus
- Infants <1 years: Fatal reactions are not uncommon
- Child <5 years: Potentially life threatening reactions
- Adults: Variable reactions but rarely fatal
- Management
- Immediate medical attention for children
- Try to identify the Scorpion type that caused the bite
- Consult poison control
- Tetanus Vaccine as needed
- Arizona Bark Scorpion (Centruroides sculpturatus) Antivenom
- Indicated for Grade III or Grade 4 Envenomations
- Reduces length of severity of symptoms
- Antivenom is a risk for Anaphylaxis
- Observe closely
- ABC Management
- Respiratory depression
- Adequate ventilation
- CNS Hyperstimulation
- Seizures
- First aid measures
- Ice or cool compress to wound site
- Elevation of affected part
- Tourniquets are not recommended for the affected, stung limb
- Symptomatic therapy
- Antihistamines
- Corticosteroids
- Analgesics (Opioids are often needed)
- Avoid Morphine if antivenom planned (increases histamine release with risk of Anaphylaxis)
- References
- Cowling and Ferreri (2019) Crit Dec Emerg Med 33(2): 17-25