Page 70 - 2023 SMOG Digital

Environmental

Scorpion Envenomation

Pearls:
• Anaphylactic reactions should be treated as soon as recognized.

• For clinically significant envenomation, management is sup portive and focused on the patient’s symptoms and graded 1-4.
• Patients graded 3&4 will require antivenom, evacuate to a MTF able to administer antivenom.
• Administer Benzodiazepines aggressively to ensure sympt om control.
• For significant neuromuscular spasm, oral secretions, sed ation, or other threats to the patent airway, perform endotracheal

intubation to prevent aspiration and ensure adequate ventilation.

• Pulmonary edema should be managed with noninvasive or invasive ventilation in combination with optimization of cardiac
output
• Direct acting vasopressors(epinephrine and norepinephrin e) are recommended to treat bradycardia and hypotension
• Elevate effected limb to reduce swelling.
• DO NOT apply constricting bandages or tourniquets as these may worsen local tissue injury and increase the risk of
permanent disability.

• DO NOT cut, suck, electrocute, burn, or use chemicals on the envenomation site.
Clinical Grade and Treatment of Scorpion Stings
Grade Effects Treatment
1 Local Effects Only Analgesia
Mild/Moderate autonomic excitation (i.e. tachycardia, hypertension) Benzodiazepines
2 Agitation and anxiety Benzodiazepines
Pain and paresthesias remote from the sting site Analgesia
Pulmonary edema Antivenom, noninvasive or mechanical ventilation
Hypotension and cardiogenic shock Antivenom, vasopressors (i.e., norepinephrine, epinephrine)
3 Neuromuscular excitation, somatic neuromuscular dysfunction or Antivenom, benzodiazepines
cranial nerve dysfunction (associated with Centruroides species)
Multiorgan failure, coma, seizures, end-organ damage secondary to Antivenom, vasopressors, sedation (benzodiazepine, propofol,
4 hypotension, somatic neuromuscular dysfunction and cranial nerve phenobarbital), mechanical ventilation
dysfunction (associated with Centruroides species)
Allergic Reaction/ Analgesia Benzodiazepines
Anaphylaxis Consider acetaminophen, NSAIDs,
and Opioids: Midazolam 2.5––5mg IV / IO q15-30min prn
or
Allergic Reaction Guideline Acetaminophen Diazepam
1g PO prn q6–8hr max 4g in 24 hour 5-10mg IV/IO; then 5–10mg in 3-4 hours, if necessary
Airway Compromise period
Airway Guideline Ketorolac Hypotension/Cardiogenic Shock:
Vasopressors
15mg IV q6hr
or 15-30mg IM q6hr,
Rapid Sequence Intubation max daily dose 120mg HYPOTENSION / SHOCK GUIDELINE
ENVIRONMENTAL
Establish Advanced Airway per
procedure in the following Fentanyl
sequence: 0.5–1.0mcg/kg IV/IO Norepinephrine
(Move to next procedure per 100mcg IN 2– –20mcg/min IV/IO, titrate to effect
individual competencies, May repeat q30min (See Norepinephrine Infusion Chart)
contraindications, and/or attempt or or
failures) PO 800mcg OTFC Epinephrine 1mg/10ml
–
• ENDOTRACHEAL INTUBATION 5–20mcg IV/IO Push; may repeat ONCE in 2–5 min.
• BIAD Increased Secretions / Salivation/ If patient remains hypotensive, proceed to
• CRICOTHYROIDOTOMY Lacrimation continuous infusion.
Atropine 2–10mcg/min; titrate to desired effect
Pulmonary Edema: 0.5mg q q3––5min, until atropinization (See Epinephrine 1mg/10ml Infusion Chart)
Use ARDS for
Ventilator Management achieved, not to exceed a total of 3mg
or 0.04mg/kg
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