What is the treatment approach for a patient, particularly a child, elderly, or someone with a pre-existing medical condition, who has been stung by a scorpion and is experiencing symptoms such as difficulty breathing, rapid heartbeat, or swelling of the face, lips, or tongue?

Treatment of Scorpion Stings

Immediate Emergency Response

Call emergency services immediately if the patient develops systemic symptoms including difficulty breathing, rapid heartbeat, muscle rigidity, dizziness, confusion, or swelling of the face, lips, or tongue. 1

High-Risk Populations Requiring Urgent Attention

• Children are at significantly higher risk for severe systemic envenomation and life-threatening complications including cardiovascular and respiratory compromise 1, 2
• Elderly patients and those with pre-existing cardiac or respiratory conditions warrant heightened vigilance for systemic toxicity 1
• Rapidly progressive facial, lip, or tongue swelling suggests angioedema requiring immediate emergency intervention 3

Antivenom Administration (Definitive Treatment)

Antivenom should be administered for severe systemic envenomation, particularly in pediatric patients who are at higher risk, with severe systemic symptoms including cardiovascular or respiratory compromise. 1

Anascorp (Scorpion Antivenom) Dosing Protocol

• Initial dose: 3 vials reconstituted with 5 mL sterile normal saline each, combined and diluted to 50 mL total volume, infused IV over 10 minutes 4
• Indications for antivenom include: loss of muscle control, roving or abnormal eye movements, slurred speech, respiratory distress, excessive salivation, frothing at the mouth, and vomiting 4
• Additional doses: Administer one vial at a time at 30-60 minute intervals if clinically important signs persist after initial dose 4
• Monitor patient closely during and up to 60 minutes following completion of infusion 4
• Early administration prevents many complications and improves outcomes 5

Antivenom Safety Considerations

• Severe hypersensitivity reactions including anaphylaxis may occur; maintain readiness with epinephrine, corticosteroids, and diphenhydramine during infusion 4
• Patients with known horse protein allergies are at particular risk 4
• Delayed allergic reactions (serum sickness) occur in approximately 0.5% of patients; monitor with follow-up visits for rash, fever, myalgia, or arthralgia 4
• Modern antivenoms are highly purified immunoglobulin fragments with excellent efficacy and safety profiles, making adverse reactions rare and usually mild 5

Supportive Care and Symptom Management

Initial First Aid Measures

• Thoroughly irrigate the wound with copious amounts of warm or room temperature water until no foreign matter remains 1, 3
• Apply ice with a clean barrier between ice and skin for local pain relief 1, 6, 3
• Remove rings and constricting objects immediately from the affected extremity as swelling may occur 6, 3
• Elevate the affected extremity to reduce swelling 3
• Apply antibiotic ointment and cover with clean occlusive dressing 6, 3

Pain Management

• Over-the-counter acetaminophen or NSAIDs are recommended for local pain control 1, 3
• Topical lidocaine 5% can be applied if skin is intact, showing significant pain reduction 1, 3
• Continue pain management with over-the-counter medications as needed for several days 1, 3

Intensive Care Monitoring

• Close surveillance in an intensive care unit with continuous cardiac monitoring enables early detection and treatment of life-threatening complications including cardiac failure, respiratory failure, convulsions, or hypertension 2, 7
• Hypertension is constant at the beginning of systemic envenomation and may have severe cardiac and respiratory impact 5
• Myocarditis and acute pulmonary edema are major causes of mortality, particularly in children 8, 7

Critical Pitfalls to Avoid

• Do NOT apply suction to the sting site—this is ineffective and potentially harmful 1, 6, 3
• Do NOT apply tourniquets or pressure immobilization bandages—these may worsen tissue injury 6, 3
• Do NOT assume antibiotics are needed for swelling around the sting site—swelling is typically caused by mediator release, not infection 1, 6, 3
• Do NOT delay hospital presentation—mortality is significantly higher in patients who arrive more than 4 hours after the sting 2, 8, 7

When Antibiotics ARE Indicated

Antibiotics are only warranted if signs of secondary bacterial infection develop:

• Progressive erythema extending beyond the initial sting site 1
• Purulent discharge 1
• Systemic signs of infection such as fever or elevated white blood cell count 1
• First-line therapy: Trimethoprim-sulfamethoxazole or doxycycline to cover MRSA 3
• Alternative: Clindamycin if local resistance patterns permit 3

Follow-Up Care

• Most patients with local symptoms only recover completely within 24-48 hours 1, 3
• Follow-up within 24 hours by phone or office visit is advised 3
• Monitor for signs of secondary infection requiring prompt medical attention 1
• Watch for delayed serum sickness symptoms in the weeks following antivenom administration 4

Time-Critical Considerations

The time from sting to hospital arrival is a critical determinant of outcome. Patients presenting after 4 hours have significantly worse prognosis, and the beneficial effect of antivenom and prazosin becomes questionable in severe cases with delayed presentation 2, 7. This underscores the absolute necessity of immediate emergency transport for any patient with systemic symptoms.