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Scorpion sting

Mechanism of action, clinical features and management of poisoning

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Scorpion sting

  1. 1. SCORPION STING SUBMITTED BY, Group-1 MBBS PIMS
  2. 2. OBJECTIVES • Introduction • Distribution • Venom property • Clinical manifestation • Laboratory evaluation • Management of envenomation
  3. 3. INTRODUCTION • Scorpion –phylum arthropod have a lobster like body shape with seven sets of paired appendages Chelicerae Pedi alps (claws) 4 sets of legs Pectines (a pair of comb like structures on the ventral surface)
  4. 4. SCORPION • Segmented tail curves upward dorsally ending in a terminal bulbous segment called telson (venom glands and stinger) • Envenomation occurs through stinging ,not biting
  5. 5. SCORPION • Characteristic physical property-fluorescence when illuminated by UV light/wood’s lamp • This property used in  collecting scorpions for breeding  venom harvesting and  providing pest control
  6. 6. SCORPION
  7. 7. DISTRIBUTION • Found in all continent except Antartica • Live in desert areas, semiarid grassland, tropics • About 1400 scorpion species are found • Of which 30 species cause potentially fatal stings • Dangerous species:  Centruroides sculpturatus Parabuthus species
  8. 8. Centruroides sculturatus
  9. 9. Parabuthus species
  10. 10. Indian red scorpion
  11. 11. Indian black scorpion
  12. 12. VENOM PROPERTIES • Venoms are complex mixtures containing mucopolysaccharides,hyaluronidase,phospholi pase,acetylcholinesterase,serotonin,histamine ,protease inhibitors, histamine releasers and neurotoxins • Scorpion alpha toxins are important venom in human envenomations
  13. 13. Alpha toxin • Neuronal membrane-inhibits the inactivation of sodium channels which prolongs depolarization • Causes membrane hyperexcitability and leads to uncontrolled firing of axons • Hence release of neurotransmitter at synapse and the neuromuscular junction is enhanced • Leads to excessive neuromuscular activity(Centruroides and parabuthus species) • Autonomic dysfunction(Androcotonus and tityus species)
  14. 14. TAP TEST: Little swelling, prominent pain, paresthesia and hyperesthesia can be accentuated by tapping on the affected area
  15. 15. CLINICAL MANIFESTATION • SYMPTOMS PROGRESS TO MAXIMAL SEVERITY WITHIN 5 HOURS. • SYMPTOMS ARE GRADED BASED ON SEVERITY • THERE ARE 4 GRADES
  16. 16. GRADE CLINICAL FINDINGS TREATMENT 1. Localized pain or paresthesias at site •Pain management (eg,ibuprofen) •Local wound care •Tetanus prophylaxis 2. Local and remote pain or paresthesias •As above, regional anesthesia for severe local pain and IV opioids (eg; fentanyl) for severe remote pain 3. Cranial nerve dysfunction: OR Somatic skeletal neuromuscular dysfunction: with Autonomic dysfunction •Antivenom , if available* •Supportive care : Frequent suctioning of oral secretions •Endotracheal intubation if airway compromise or pulmonary edema with hypoxemia •Monitor for and treat myocardial ischemia, heart failure, and rhabdomyolysis. •Treat pain with intravenous opioids (eg, fentanylΔ) •If antivenom is not available, treat muscle activity and anxiety with short-acting benzodiazepines (eg, midazolam) •Provide local wound care as above
  17. 17. Cranial nerve dysfunction: Dysphagia, drooling of saliva, abnormal eye movement, blurred vision, slurred speech, tongue fasciculation or Somatic skeletal neuromuscular dysfunction: Restlessness, fasciculations, shaking and jerking of the extremities, opisthotonus, embrosthotonus with Autonomic dysfunction: Centruroides-salivation, vomiting, diaphoresis, tachycardia Parabuthus-salivation, diaphoresis and urinary retention
  18. 18. COMPLICATIONS a. Hyperthermia b. Respiratory failure - (most common cause of death) c. Pulmonary edema d. Metabolic acidosis e. Rhabdomyolysis f. Arrythmia
  19. 19. MANAGEMENT
  20. 20. LABORATORY EVALUATION • Grade1 to 2envenomation: Lab studies are not needed • Grade3 to 4envenomation: Serum electrolytes, liver enzymes(AST &ALT),blood urea nitrogen, serum creatinine, serum creatine kinase, urinalysis.
  21. 21. •Identification of the offending scorpion helps to determine the course of treatment. •Stings of non-lethal species atmost require icepacks, analgesics and antihistamines. Because they undergo only local discomfort. •Supportive care and anti venom usage. •Keeping the patients calm and applying pressure dressings and icepacks to the sting site.
  22. 22. • Proper IV infusuion , medication and other sedatives or narcotics is necessary for persons with neuromuscular symptoms because of the risk of respiratory arrest. • Hypertension and pulmonary edema respond to NIFEDIPINE, NITROPRUSSIDE, HYDRALAZINE or PRAZOSIN.
  23. 23. Pain management • Oral IBUPROFEN other NSAIDs • Oral OPIOIDS medications • Short-acting intravenous opioids .eg - FENTANYL •Continuous IV infusion of MIDAZOLAM controls agitation, flailing and involuntary muscle movements
  24. 24. Wound management • Cleansing of the sting site • Tetanus prophylaxis as needed • These patients should be observed for 4 hours to ensure no further progression of symptoms.
  25. 25. ANTIVENOM •An FDA approved C.Sculpturatus antivenom in horse serum is now available. •IV administration of antivenom rapidly reverses cranial nerve dysfunctions and muscular symptoms. •Although antivenom should be reserved for only the most severe envenomations. • Initiate therapy as soon as possible after scorpion sting.
  26. 26. •Initial: 3 vials (containing ≤57 mg total protein and ≥450 LD50 [mouse] neutralizing units); may administer additional vials in 1-vial increments every 30 to 60 minutes as needed. • Typical dosage range: 1 to 5 vials •Mechanism of Action Contains venom-specific F(ab’)2 fragments of IgG which bind and neutralize venom toxins; thereby helping to remove the toxin from the target tissue and eliminate it from the body.
  27. 27. Administration: • IV - Administer over 10 minutes. • Monitor for return of symptoms of envenomation and repeat as needed. • Medications (eg, epinephrine, corticosteroids, diphenhydramine) and equipment for resuscitation should be readily available in case of hypersensitivity reactions. • Avoid IM since the time to peak blood concentration may be prolonged with this route of administration
  28. 28. Adverse Reactions •Central nervous system: Fatigue, headache, lethargy •Dermatologic: Pruritus, skin rashes •Gastrointestinal: Diarrhea, nausea, vomiting •Miscellaneous: Fever
  29. 29. • Neuromuscular & skeletal: Myalgia • Respiratory: Cough, rhinorrhea • Rare but important or life-threatening: Aspiration, ataxia, chest tightness, hypersensitivity, hypoxia, ocular edema, palpitations, pneumonia, respiratory distress, serum sickness (delayed) • There is no contraindication.
  30. 30. THANK YOU

    Sé el primero en comentar

  • AishwaryaAishwarya24

    Sep. 27, 2020

Mechanism of action, clinical features and management of poisoning

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