Evaluation and Treatment of Scorpion Stings
Initial Evaluation
Immediately assess for systemic symptoms including difficulty breathing, muscle rigidity, dizziness, or confusion—if present, call emergency services without delay. 1
Key Clinical Assessment Points
- Local symptoms only: Most North American scorpion stings cause only pain and swelling at the sting site 1
- High-risk stings: Bark scorpion (Centruroides) stings can produce severe local and systemic manifestations 1
- Time-sensitive evaluation: Children with severe toxicity historically presented to hospitals after longer delays than those with mild symptoms, making early assessment critical 2
- Pediatric vulnerability: Children under 6 years are at highest risk for lethal complications 3
Systemic Symptoms Requiring Emergency Care
Seek immediate medical attention if any of the following develop 1:
- Difficulty breathing
- Muscle rigidity
- Dizziness or confusion
- Cardiovascular instability
- Seizures
Immediate First Aid Management
Wound Care
- Thoroughly irrigate the sting site with copious amounts of clean water to reduce venom load 1
- Remove rings and constricting objects from the affected extremity before swelling develops 4
- Apply a clean occlusive dressing after irrigation 5
Pain Management Algorithm
For local pain control, use this stepwise approach:
- Apply ice to the sting site with a clean barrier between ice and skin to prevent tissue damage 1, 4
- Administer over-the-counter acetaminophen or NSAIDs for systemic pain relief 1
- Apply topical 5% lidocaine if skin is intact—clinical studies show significant pain reduction 1
- For severe refractory pain: Regional nerve blocks with local anesthetics provide immediate relief in cases where pain is intractable 6
Critical Pitfalls to Avoid
Do not apply suction to the sting site—this is ineffective and potentially harmful 1, 4
Additional contraindicated interventions 4:
- No tourniquets or pressure immobilization bandages (may worsen tissue injury)
- No cutting of the wound
- No attempts to suck out venom
When to Seek Medical Care
Obtain medical evaluation if any of the following occur 1:
- Pain extends beyond the sting site
- Pain becomes severe or uncontrolled by over-the-counter medications
- An open wound develops
- Signs of infection appear (progressive erythema, purulent discharge, fever, elevated WBC) 1
- Any systemic symptoms develop
Antibiotic Management
Antibiotics are NOT routinely indicated for scorpion stings. 1
- Swelling around the sting site is caused by mediator release, not infection 1
- Universal antibiotic prophylaxis is not recommended 1
Antibiotics should only be considered when clear signs of secondary infection develop 1:
- Progressive erythema extending beyond initial sting site
- Purulent discharge
- Systemic infection signs (fever, elevated WBC)
Hospital-Based Management for Severe Cases
For patients with systemic envenomation requiring hospitalization 2:
- Intensive care monitoring with continuous cardiac surveillance
- Specific antivenom administration for systemic manifestations, particularly in children 2, 6
- Prazosin has been used successfully for significant sympathetic nervous system symptoms 3
- Early intervention for life-threatening complications including cardiac failure, respiratory failure, convulsions, or hypertension 2