What is the management approach for a scorpion bite?

Management of Scorpion Bites

For scorpion stings, immediate medical attention should be sought if systemic symptoms develop such as difficulty breathing, muscle rigidity, dizziness, or confusion, while local symptoms can be managed with pain control measures and wound care. 1

Initial Assessment and First Aid

• Call emergency services immediately if the person develops systemic symptoms such as difficulty breathing, muscle rigidity, dizziness, or confusion 1
• Medical care should be sought if pain extends beyond the sting site, becomes severe, is not controlled by over-the-counter pain medications, or if an open wound develops 1
• Most scorpion stings in North America cause only local symptoms, but severe local and systemic symptoms can occur, especially with bark scorpion (Centruroides) stings 1
• Children are at higher risk for severe envenomation, with studies showing that 29.4% of pediatric cases develop severe systemic signs and a 3.9% mortality rate 2

Pain Management

• Apply ice to the sting site for local pain relief 1
• Use over-the-counter acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate local pain 1
• Apply topical lidocaine (5%) if the skin is intact, which has shown significant pain reduction in clinical studies 1
• Thoroughly irrigate the wound with copious amounts of water to clean the area 3

Severe Envenomation Management

• Patients with severe toxicity require administration of specific antivenom and close surveillance in an intensive care unit 2
• Continuous cardiac monitoring is essential to enable early intervention for life-threatening complications such as cardiac and respiratory failure, convulsions, or hypertension 2
• For scorpion stings from Mesobuthus tamulus, a combination of antivenom and prazosin is more effective than prazosin alone for faster resolution of symptoms 4
• Antivenom against Centruroides species has been shown to reverse the clinical syndrome faster than supportive care alone in children 4

Special Considerations

• Delayed presentation to medical care is associated with more severe toxicity - patients with severe symptoms typically arrive at hospitals after a significantly longer time lapse 2
• Scorpion envenomation can rarely lead to serious complications including myocarditis, cardiogenic shock, and acute pulmonary edema 5
• Neurological complications may occur due to toxic effects of the venom affecting the central nervous system, neuromuscular transmission, cardiovascular system, or coagulation cascade 6

Common Pitfalls to Avoid

• Do not apply suction to the sting site (this recommendation is based on evidence for snakebites but is generally applicable to other venomous bites/stings) 3
• Do not assume antibiotics are needed for swelling around the sting site, as swelling is typically caused by mediator release, not infection 1
• Do not delay medical care when systemic symptoms are present, as this can lead to worse outcomes 2
• Do not underestimate the severity of envenomation in children, who are at higher risk for severe reactions 2

Follow-up Care

• Most patients with local symptoms only will recover completely within 24-48 hours 1
• Continue pain management with over-the-counter medications as needed for several days 1
• Seek prompt medical attention for any signs of secondary infection at the sting site 1
• Monitor for delayed reactions, particularly in children and the elderly 2