Treatment for Scorpion Stings
For most scorpion stings in North America, treatment consists of local wound care with irrigation, ice application, and over-the-counter pain medications, with immediate emergency services activation only if systemic symptoms develop. 1
Initial Assessment and Triage
Call emergency services immediately if any of these systemic symptoms appear: 1
- Difficulty breathing
- Muscle rigidity
- Dizziness or confusion
- Cardiovascular symptoms (though rare in adults, can include severe hypertension, arrhythmias, or cardiac failure) 2, 3, 4
Seek medical care (non-emergent) if: 1
- Pain extends beyond the sting site
- Pain becomes severe or is not controlled by over-the-counter medications
- An open wound develops
- Signs of infection appear (progressive erythema, purulent discharge, fever)
Most scorpion stings in North America cause only local symptoms, but bark scorpion (Centruroides) stings can produce severe local and systemic manifestations. 1 The key distinction is that up to 95% of scorpion stings result in only local signs, but when systemic envenomation occurs, it can be life-threatening, particularly in children. 3
Immediate First Aid Management
Wound care: 1
- Thoroughly irrigate the wound with copious amounts of water to clean the area
- Apply antibiotic ointment and cover with a clean occlusive dressing
Pain management: 1
- Apply ice to the sting site with a clean barrier between ice and skin for local pain relief
- Administer over-the-counter acetaminophen or NSAIDs
- Apply topical lidocaine 5% if the skin is intact (has shown significant pain reduction in clinical studies)
Remove rings and constricting objects from the affected extremity immediately, as swelling may occur. 5
Critical Pitfalls to Avoid
Do NOT: 1
- Apply suction to the sting site (ineffective and potentially harmful)
- Apply tourniquets or pressure immobilization bandages
- Assume antibiotics are needed for swelling around the sting site—swelling in the first 24-48 hours is caused by mediator release, not infection
Antibiotic Considerations
Universal prophylaxis with antibiotics is NOT recommended. 1 Antibiotics should only be considered if true signs of secondary bacterial infection develop: 1
- Progressive erythema extending beyond the initial sting site
- Purulent discharge
- Systemic signs of infection (fever, elevated white blood cell count)
The American Academy of Allergy, Asthma, and Immunology specifically notes that swelling is typically caused by mediator release, not infection. 1
Advanced Care for Severe Envenomation
For patients with severe systemic toxicity, management requires intensive care unit monitoring with: 2, 3
- Continuous cardiac monitoring (ECG changes including AV blocks, bundle branch blocks, and arrhythmias can occur)
- Vital signs surveillance
- Specific antivenom administration when indicated (particularly for Centruroides species in USA/Mexico, where there is acceptable evidence for Fab'2 antivenom use) 3
The pathophysiology involves massive catecholamine release causing vasoconstriction, increased systemic arterial pressure, and potentially reversible Takotsubo-like cardiomyopathy. 3 Time to hospital presentation is critical—patients with severe toxicity historically arrived significantly later than those with mild symptoms. 2
Expected Recovery Timeline
Most patients with local symptoms only will recover completely within 24-48 hours. 1 Continued pain management with over-the-counter medications may be needed for several days. 1 Any signs of secondary infection at the sting site require prompt medical attention. 1