Scorpion envenomation: Difference between revisions
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== Background == | == Background == | ||
[[File:Bbasgen-bark-scorpion.jpg|thumb|Arizona Bark Scorpion, (''Centruroides sculpturatus'')]] | |||
#Most scorpion stings in North America result only in local pain. | #Most scorpion stings in North America result only in local pain. | ||
#Arizona Bark Scorpion, ''Centruroides sculpturatus'', found in AZ, NM, TX, and CA, can cause systemic toxicity. | #Arizona Bark Scorpion, ''Centruroides sculpturatus'', found in AZ, NM, TX, and CA, can cause systemic toxicity. | ||
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==Clinical Features== | ==Clinical Features== | ||
===Local reaction=== | ===Local reaction=== | ||
*Immediate and severe pain | |||
** "Tap" test: severe local tenderness when affected area is lightly tapped | |||
===Systemic reaction=== | ===Systemic reaction=== | ||
*Uncommon but can be severe, particularly in children | |||
*Cranial nerve and somatic motor dysfunction can develop: | |||
**Abnormal roving eye movements (pathognomonic) , blurred vision, pharyngeal muscle incoordination | |||
**Can occasionally lead to respiratory compromise (excessive secretion) | |||
*Tachycardia and severe agitation can also be present | |||
===Grades of ''Centruroides'' envenomation=== | ===Grades of ''Centruroides'' envenomation=== | ||
*Grade 1 - Local pain and/or paresthesias at site of envenomation | |||
*Grade 2 - Pain and/or paresthesias remote from the site of the sting, in addition to local findings | |||
*Grade 3 - Either cranial nerve/autonomic dysfunction or somatic skeletal neuromuscular dysfunction | |||
**Cranial nerve dysfunction - Blurred vision, roving eye movements, hypersalivation, tongue fasciculations, dysphagia, dysphonia, problems with upper airway | |||
**Somatic skeletal neuromuscular dysfunction - Restlessness, severe involuntary shaking or jerking of the extremities that may be mistaken for a seizure | |||
*Grade 4 - Combined cranial nerve/autonomic dysfunction and somatic nerve dysfunction | |||
*Without antivenom, symptoms typically last 24-48 hrs | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 00:49, 12 March 2015
Background
- Most scorpion stings in North America result only in local pain.
- Arizona Bark Scorpion, Centruroides sculpturatus, found in AZ, NM, TX, and CA, can cause systemic toxicity.
Clinical Features
Local reaction
- Immediate and severe pain
- "Tap" test: severe local tenderness when affected area is lightly tapped
Systemic reaction
- Uncommon but can be severe, particularly in children
- Cranial nerve and somatic motor dysfunction can develop:
- Abnormal roving eye movements (pathognomonic) , blurred vision, pharyngeal muscle incoordination
- Can occasionally lead to respiratory compromise (excessive secretion)
- Tachycardia and severe agitation can also be present
Grades of Centruroides envenomation
- Grade 1 - Local pain and/or paresthesias at site of envenomation
- Grade 2 - Pain and/or paresthesias remote from the site of the sting, in addition to local findings
- Grade 3 - Either cranial nerve/autonomic dysfunction or somatic skeletal neuromuscular dysfunction
- Cranial nerve dysfunction - Blurred vision, roving eye movements, hypersalivation, tongue fasciculations, dysphagia, dysphonia, problems with upper airway
- Somatic skeletal neuromuscular dysfunction - Restlessness, severe involuntary shaking or jerking of the extremities that may be mistaken for a seizure
- Grade 4 - Combined cranial nerve/autonomic dysfunction and somatic nerve dysfunction
- Without antivenom, symptoms typically last 24-48 hrs
Differential Diagnosis
Envenomations, bites and stings
- Hymenoptera stings (bees, wasps, ants)
- Mammalian bites
- Closed fist infection (Fight bite)
- Dog bite
- Marine toxins and envenomations
- Toxins (ciguatera, neurotoxic shellfish poisoning, paralytic shellfish poisoning, scombroid, tetrodotoxin
- Stingers (stingray injury)
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish, cone shells, lionfish, sea urchins)
- Nematocysts (coral reef, fire coral, box jellyfish, sea wasp, portuguese man-of-war, sea anemones)
- Phylum porifera (sponges)
- Bites (alligator/crocodile, octopus, shark)
- Scorpion envenomation
- Reptile envenomation
- Spider bites
Treatment
- Apply ice to area of sting
- Atropine
- May be given for hypersalivation and respiratory distress caused
- Contraindicated for foreign scorpion stings because may exacerbate adrenergic effects
- May be given for hypersalivation and respiratory distress caused
- Antivenom
- Resolves clinical syndrome within 4hr
See Also
Source
- Tintinalli
- Medscape: Scorpion Envenomation Treatment & Management. http://emedicine.medscape.com/article/168230-treatment.