The fi rst aid currently recommended is based around the mnemonic \u2018R.I.G.H.T\u2019. The
\ndetails provided earlier in Table no.6 is again furnished below for easy reading.
\nTable No. 6: Currently recommended First aid
\n\u2022 R = Reassure the patient.
\n\u2022 I = Immobilisation of the limb in the same way as a fractural limb helps to
\nprevent rapid absorption of the venom into the circulation. (Use bandages
\nor cloth to hold the splints, not to block the blood supply or apply
\npressure. Do not apply any compression in the form of tight ligatures,
\nthey don\u2019t work and can be dangerous!).
\n\u2022 G. H. = Get to Hospital Immediately. (Traditional remedies have NO PROVEN
\nbenefi t in treating scorpion sting).
\n\u2022 T = Tell the doctor all that happened from the time of scorpion sting along
\nwith symptoms that developed till reaching (or arrival) the hospital.
\nThis method will get the victim to the hospital quickly, without recourse to
\ntraditional medical approaches which can delay effective treatment.
\nTraditional methods
\nThe traditional methods such as application of counter irritants, herbal materials
\nor paste over the site of sting or tight tourniquet (it may intensify local effects of
\nvenom), or hot fomentation should be avoided as they may enhance the effects of
\nvenom. Also avoid cutting and suction (oral extraction of venom from the site), or
\ncutting and letting out the blood, or washing the wound with chemicals or alcohol or
\nother methods as they facilitate the absorption of toxin. In view of the consequences
\nnoticed, these traditional methods have to be discarded.
\nHowever, local application of ice bags (one of the traditional methods) to reduce
\nthe pain is acceptable for some time if not contraindicated. This method slows down
\nthe absorption of venom via vasoconstriction. This is the most effective one during the
\nfi rst 2 hours following the scorpion sting. One should not cause freezing injury, while
\nusing ice cubes \/ bag.
\nWhile dealing a case of scorpion sting consider mnemonic \u2018RASI\u2019.
\n\u2022 Remember principles
\n\u2022 Address the problems \u2013 clinical and social
\n\u2022 Seek help from others when required and
\n\u2022 Inform the patient and \/ or care givers on the status of illness, clinical course,
\nmanagement, outcome, welfare measures and follow up clearly with empathy.
\nPrinciples involved in the management of scorpion sting
\nThe principles envisaged to treat scorpion sting at all Health Centres \/ Hospitals
\nirrespective of the status (Government or Private) are given below (the same given
\nunder snake bite) under \u201c12 As\u201d.
\nTable No. 7: Principles involved in the management
\n1. Admit the victim immediately.
\n2. Ask effectively.
\n3. Assess quickly.
\n4. Act swiftly.
\n5. Administer medication meticulously.
\n6. Address to the wound properly.
\n7. Anticipate complications keenly.
\n8. Avoid errors carefully.
\n9. Ascertain the status repeatedly.
\n10. Amicable with patients and care givers and show empathy.
\n11. Advise on follow up accordingly.
\n12. Arrange for referral early.
\n1) Admit all victims of scorpion sting & keep the victims under observation for
\n24 to 48 hrs. (If scorpion is brought try to identify the colour and size of it).
\n2) a) Ask for the details of scorpion sting and never be carried away with the sting
\nmarks either for diagnosis or for assessment of severity.
\n\u2022 Time of sting
\n\u2022 Number of stings
\n\u2022 Nature of the incident
\n\u2022 Depth of the sting
\n\u2022 Site of envenomation-close to head & torso [results in quicker venom
\nabsorption & onset of symptoms in the former]
\nb] Ask for the time interval between the sting and arrival at the hospital.
\nc] Ask for the details of traditional medicines or household remedies used, as it
\nmay sometimes cause confusing symptoms or interfere with other drugs to be
\nadministered.
\nd] Ask for clinical symptoms and correlate with the progression of symptoms and
\nsigns due to scorpion sting [provided in page vide supra]
\n3] Assess the following quickly.
\na] Airway, Breathing and Circulation
\nb] Vitals HR, RR, BP and Pulse oximetry (if required)
\nc] Site of sting and the probable route of envenomation – (Intravenous have
\nimmediate effects, while subcutaneous and intramuscular routes take several
\nminutes to hours to cause effect)
\nd] Chest expansion
\ne] Clinically from head to foot as well as back
\nf] For associted co-morbid illness[es]
\ng] For consuming any medication[s]
\nh] Status of envenomation \u2013 mild, moderate and severe
\n[in view of neurotoxic, cardiotoxic, hemotoxic, myotoxic or a combination of them]
\n4] Act swiftly
\na] To support Airway, Breathing and Circulation
\nb] To start IV line [fl uid for children – refer Annexure II Table No.29]
\nc] To provide supportive measures depending upon the requirements
\nd] To connect ventilator if there is a need
\n5] Administer medication meticulously
\na] Tetanus Toxoid injection intramuscularly
\nb] Topical anaestetic agent to the site of sting to decrease paraesthesia.
\nc] Injection lignocaine 1% without adrenaline; 2ml as local infi ltration
\n(after test dose for lignocaine) (0.1 to 0.2mg\/kg body weight for children)
\nd] Oral rehydration solution to hydrate the patient if not contraindicted.
\ne] Tab. Paracetamol 10mg\/kg body weight to reduce pain
\nf] Tab. Prazosin [plain 1mg]
\nPharmacological aspects of Prazosin
\nPrazosin is an alpha blocker. It counteracts scorpion induced adrenergic
\ncardiovascular effects and reduces pulmonary edema through vasodilatory effect,
\nUsually it is started with small dose using plain tablet but not exceeding 5mg\/day.
\nFor children the dose preferred is 30 microgram \/ kg body weight. Though pediatric
\nrequirement has not been established, it is started with small dose. Prazosin can be
\ngiven irrespective of blood pressure, provided there is no hypovolemia
\nIt should be avoided, if the patient is hypersensitive to prazosin. Always exercise
\ncaution if patient has renal insuffi ciency and hypertension. Users must remember that
\nit interacts with beta blocker and causes hypotension. Also, verapamil may increase
\nserum levels of prazosin and increase patient\u2019s sensitivity to prazosin and cause
\npostural hypotension. Interestingly, prazosin decreases the anti hypertensive effect of
\nclonidine. Safety in pregnancy has not been established. Also, users are informed to
\nfollow standard measures while using prazosin (Refer Table No.21).
\nTable No. 21: Measures to be adopted while using Prazosin
\n\u2022 Prazosin should not be given as prophylactic dose when pain is the only
\nsymptom.
\n\u2022 Give Prazosin through nasogastric tube, if baby has vomiting.
\n\u2022 Keep the patient in lying posture for about 3 hours (even while examining
\nthe case) in order to prevent \u2018fi rst dose phenomenon\u2019 (hypotension) due to
\nPrazosin.
\n\u2022 Monitor pulse, BP, and respiration every 30 minutes for 3 hours.
\n\u2022 Reassess for warmth and return of pain at the site of sting.
\n\u2022 Continue monitoring of pulse, BP, and respiration every 60 minutes for next
\n6 hours.
\n\u2022 Recheck the same every 4 hours till improvement is visible.
\n\u2022 Repeat Tab. Prazosin in the same dose at the end of 3 hours according to
\nclinical response and later every 6 hours till extremities are warm, dry and
\nperipheral veins are visible easily.
\n* Alternative to Tab. Prazosin is Nifi dipine, Nitroprusside, Nitroglycerine, Isosorbide
\ndi-nitrate, Hydralazine or Angiotensin converting enzyme inhibitors (ACEIs).
\nHowever, users have to remember the constraints while prescribing such drugs.
\ng] Beta-blockers in small doses along with alpha blockers if needed and if not
\ncontraindicated.
\nh] Nitrates if patient has hypertension and myocardial ischemia
\ni] Ionotropics such as digitalis (has little effect), or dobutamine (refer snake bite
\nsection for details). Avoid Dopamine as it aggravates the myocardial damage.
\nj] Nor-epinephrine as IV drip to correct hypotension refractory to fl uid therapy.
\nk] Antimicrobials if infection is suspected
\nl] Inj. Atropine (required at times) to counter venom induced parasympathetic
\neffects.
\nm] Inj. Insulin has been shown to prevent multiorgan failure (especially cardiopulmonary)
\nin animal experiments.
\nn] Barbiturate and \/ or benzodiazepine as continuous infusion for severe \/
\nexcessive motor activity
\no] Steroids to decrease shock and edema is of unproven benefi t.
\np] Antivenom for scorpion sting is not used commonly in India (as species specifi c
\nantivenom is not available and usage has not demonstrated any benefi t)
\nq] Vaccine \u2013 not available (tried in experimental animals).
\nr] IV fl uids as per need [fl uid for children- refer Annexure II Table No.29].
\ns] Other supportive medications such as sodium nitroprusside (0.3 \u20130.5 mcg\/
\nkg\/min with upward titration), or nitroglycerine as per need (usually in
\npulmonary edema)
\nThough Inj. Morphine is used as a standard therapy for pulmonary edema, it should
\nbe avoided in scorpion sting since narcotics worsen dysrhythmias in children
\n6] Address to the wound properly
\nThe details of wound care are provided below. However, one should also remember
\nthe other surgical issues described vide Table 11 in the snake bite section.
\na] Wound following scorpion sting may show sting marks with or without local
\nmanifestations.
\nb] Sometimes venom may penetrate deep and hence deeper tissues may be
\ndamaged which may not be visible during initial examination (rare).
\nc] At the site of the sting a bleb or vesicle may develop and end in the form of non
\nspecifi c ulcer. (Non-specifi c ulcers are defi ned as ulcers due to infection of
\nwounds, physical or chemical agents or due to local irritation).
\nd] Consider the following while managing the wound \/ ulcer (uncommon in
\nscorpion sting).
\n\u2022 Minimize unnecessary blood loss.
\n\u2022 Initiate adequate cleaning with normal saline or tap water, and edema
\ncontrol.
\n\u2022 Remove debris and necrotic tissue, irrigate gently with water \/ normal
\nsaline.
\n\u2022 Expose viable tissues, excise eschar after controlling hemotoxic
\ncomplications.
\n\u2022 Use topical antibacterial agents.
\n\u2022 Apply dressings after complete debridement.
\n\u2022 Maintain proper wound environment and prevent ischemia.
\n\u2022 Keep the bacterial count as low as possible.
\n\u2022 Facilitate healing of acute wound by applying non adherent dressing to
\nensure adequate epithelialization and to prevent contamination of the
\nwound.
\n\u2022 Keep wounds clean and dry.
\n\u2022 Avoid soaking or scrubbing the wound.
\n\u2022 Teach & explain the care of wound to the patients and \/ or care givers.
\n\u2022 Educate on good personal hygiene and nutrition.
\n\u2022 Control diabetes if identifi ed.
\n7] Anticipate complications keenly.
\na] Examine the victims at regular intervals for alterations in symptoms and signs
\nb] Anticipate dysrhythmias during the fi rst 24 to 48 hours after sting
\nc] Start tapering prazosin after the clinical improvement begins to manifest
\nd] Observe for drug related systemic changes and drug toxicity, and treat them
\naccordingly.
\n8] Avoid errors carefully while assessing the case, investigating the victims,
\nadministering medications, following the case at hospital, undertaking any
\nprocedures for the patient, referring to other specialists or hospitals, communicating
\nwith patients \/ and care givers, planning for discharge, preparing reports, fi lling up
\nthe forms, reviewing the data and conducting the audit.
\n9] Ascertain the status repeatedly and provide supportive measures, as these cases
\nmay develop covert signs during hospital stay while on treatment.
\n10] Amicably interact with patient and care givers and show empathy to them in
\nview of the socio clinical aspects related to scorpion sting.
\n11] Advise on follow up accordingly in view of the systemic toxicity. Patients may
\nalso be motivated to attend to the nearest Health Centre \/ Hospital for follow up
\ncare. Follow-up checks are required for assessment of long term effects on different
\norgans \/ systems and for appropriate management wherever required \/ needed.
\n12. Arrange for referral early – One should also remember the criteria for referral and
\nprovide clear instructions while referring the case. The details on referral aspects
\nare provided in Table 24.<\/p>\n","protected":false},"excerpt":{"rendered":"
The fi rst aid currently recommended is based around the mnemonic \u2018R.I.G.H.T\u2019. The details provided earlier in Table no.6 is again furnished below for easy reading. Table No. 6: Currently recommended First aid \u2022 R = Reassure the patient. \u2022 I = Immobilisation of the limb in the same way as a fractural limb helps […]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":63,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-75","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages\/75","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/comments?post=75"}],"version-history":[{"count":0,"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages\/75\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages\/63"}],"wp:attachment":[{"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/media?parent=75"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}