Treatment of Scorpion Stings
For most scorpion stings in North America, treat with over-the-counter pain medications (acetaminophen or NSAIDs), ice application, and topical lidocaine 5% if skin is intact, while monitoring for systemic symptoms that require immediate emergency care. 1
Immediate Assessment
Determine if the patient has systemic symptoms requiring emergency services:
- Call emergency services immediately if the patient develops difficulty breathing, muscle rigidity, dizziness, or confusion 1
- Most North American scorpion stings cause only local symptoms, but bark scorpion (Centruroides) stings can produce severe systemic effects 1
- Time from sting to presentation matters—delayed presentation (>4 hours) is associated with higher complication rates 2
First Aid and Initial Management
Clean the wound thoroughly:
- Irrigate with copious amounts of water to remove any foreign matter 1
Apply local pain relief measures:
- Ice application to the sting site with a clean barrier between ice and skin 1
- Topical lidocaine 5% can be applied if skin is intact, which provides significant pain reduction 1
- Over-the-counter acetaminophen or NSAIDs for pain control 1
Critical pitfalls to avoid:
- Do not apply suction to the sting site—this is ineffective and potentially harmful 1
- Do not apply tourniquets or pressure immobilization bandages 3
When to Seek Medical Care
Seek immediate medical attention if:
- Pain extends beyond the sting site or becomes severe 1
- Pain is not controlled by over-the-counter medications 1
- An open wound develops 1
- Systemic symptoms appear (respiratory distress, muscle rigidity, altered mental status, cardiovascular instability) 1
Antibiotic Considerations
Do not routinely prescribe antibiotics:
- Universal antibiotic prophylaxis is not recommended for scorpion stings 1
- Swelling around the sting site is typically caused by mediator release, not infection 1
Only consider antibiotics if true infection develops:
- Progressive erythema extending beyond the initial sting site 1
- Purulent discharge 1
- Systemic signs of infection (fever, elevated white blood cell count) 1
Corticosteroid Use
Oral corticosteroids lack definitive proof of efficacy through controlled studies for scorpion stings and are not specifically recommended 1
Follow-up Expectations
- Most patients with local symptoms only recover completely within 24-48 hours 1
- Continue over-the-counter pain medications as needed for several days 1
- Monitor for signs of secondary infection requiring prompt medical attention 1
Special Considerations for Severe Envenomation
For patients presenting with systemic symptoms (primarily relevant in pediatric cases or with highly venomous species):
- Specific antivenom is indicated for systemic manifestations, particularly in children 4, 2
- Intensive care monitoring with continuous cardiac surveillance is essential for severe cases 5
- Protocol-guided therapy with prazosin and dobutamine has shown significant mortality reduction in severe pediatric cases with acute pulmonary edema and myocarditis 2