SlideShare una empresa de Scribd logo
1 de 31
Descargar para leer sin conexión
SCORPION STING
SUBMITTED BY,
Group-1
MBBS
PIMS
OBJECTIVES
• Introduction
• Distribution
• Venom property
• Clinical manifestation
• Laboratory evaluation
• Management of envenomation
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)
Scorpion sting
SCORPION
• Segmented tail curves upward dorsally ending
in a terminal bulbous segment called telson
(venom glands and stinger)
• Envenomation occurs through stinging ,not
biting
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
SCORPION
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
Centruroides sculturatus
Parabuthus species
Indian red scorpion
Indian black scorpion
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
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)
TAP TEST:
Little swelling, prominent pain, paresthesia
and hyperesthesia can be accentuated by
tapping on the affected area
CLINICAL MANIFESTATION
• SYMPTOMS PROGRESS TO MAXIMAL
SEVERITY WITHIN 5 HOURS.
• SYMPTOMS ARE GRADED BASED ON
SEVERITY
• THERE ARE 4 GRADES
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
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
COMPLICATIONS
a. Hyperthermia
b. Respiratory failure - (most common cause of death)
c. Pulmonary edema
d. Metabolic acidosis
e. Rhabdomyolysis
f. Arrythmia
MANAGEMENT
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.
•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.
• 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.
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
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.
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.
•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.
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
Adverse Reactions
•Central nervous system: Fatigue, headache,
lethargy
•Dermatologic: Pruritus, skin rashes
•Gastrointestinal: Diarrhea, nausea, vomiting
•Miscellaneous: Fever
• 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.
THANK YOU

Más contenido relacionado

La actualidad más candente

Snake Bite and Scorpion Stings,(Kurdistan)
Snake Bite and Scorpion Stings,(Kurdistan)Snake Bite and Scorpion Stings,(Kurdistan)
Snake Bite and Scorpion Stings,(Kurdistan)Znar Mzuri
 
Snake bite management in India
Snake bite management in India Snake bite management in India
Snake bite management in India Prasenjit Gogoi
 
Snake bite and its management
Snake bite and its managementSnake bite and its management
Snake bite and its managementDr.Muhammad Omer
 
Treatment protocol of snake bite
Treatment protocol of snake biteTreatment protocol of snake bite
Treatment protocol of snake bitePratik Kumar
 
Scorpion envenomation copy
Scorpion envenomation  copyScorpion envenomation  copy
Scorpion envenomation copyHanan Fathy
 
Emergency treatment of anaphylaxis
Emergency treatment of anaphylaxisEmergency treatment of anaphylaxis
Emergency treatment of anaphylaxisAhmad Thanin
 
Scorpion sting
Scorpion stingScorpion sting
Scorpion stingikramdr01
 
Aluminium phosphide poisoning - Dr. Chandan
Aluminium phosphide poisoning - Dr. ChandanAluminium phosphide poisoning - Dr. Chandan
Aluminium phosphide poisoning - Dr. Chandanapollobgslibrary
 
Bites and Stings emergency medicine
Bites and Stings emergency medicineBites and Stings emergency medicine
Bites and Stings emergency medicineLijo Joy
 
Organophosphate poisoning and its management (Clinical Toxicology)
Organophosphate poisoning and its management (Clinical Toxicology)Organophosphate poisoning and its management (Clinical Toxicology)
Organophosphate poisoning and its management (Clinical Toxicology)Soujanya Pharm.D
 
Corrosive poisoning by Dr.Ashwin Menon
Corrosive poisoning by Dr.Ashwin MenonCorrosive poisoning by Dr.Ashwin Menon
Corrosive poisoning by Dr.Ashwin MenonDr.Ashwin Menon
 
SNAKE BITE MANAGEMENT
SNAKE BITE MANAGEMENTSNAKE BITE MANAGEMENT
SNAKE BITE MANAGEMENTabhija babuji
 
Managing Spider Bites in the ED
Managing Spider Bites in the EDManaging Spider Bites in the ED
Managing Spider Bites in the EDKane Guthrie
 
Medical emergency on scorpion sting new 4
Medical emergency on scorpion sting new 4Medical emergency on scorpion sting new 4
Medical emergency on scorpion sting new 4Indhu Reddy
 

La actualidad más candente (20)

Bee Sting
Bee StingBee Sting
Bee Sting
 
Snake Bite and Scorpion Stings,(Kurdistan)
Snake Bite and Scorpion Stings,(Kurdistan)Snake Bite and Scorpion Stings,(Kurdistan)
Snake Bite and Scorpion Stings,(Kurdistan)
 
Snake bite management in India
Snake bite management in India Snake bite management in India
Snake bite management in India
 
Snake bite and its management
Snake bite and its managementSnake bite and its management
Snake bite and its management
 
Snake bite
Snake biteSnake bite
Snake bite
 
Treatment protocol of snake bite
Treatment protocol of snake biteTreatment protocol of snake bite
Treatment protocol of snake bite
 
Scorpion envenomation copy
Scorpion envenomation  copyScorpion envenomation  copy
Scorpion envenomation copy
 
Emergency treatment of anaphylaxis
Emergency treatment of anaphylaxisEmergency treatment of anaphylaxis
Emergency treatment of anaphylaxis
 
Scorpion sting
Scorpion stingScorpion sting
Scorpion sting
 
Aluminium phosphide poisoning - Dr. Chandan
Aluminium phosphide poisoning - Dr. ChandanAluminium phosphide poisoning - Dr. Chandan
Aluminium phosphide poisoning - Dr. Chandan
 
Insect bites and stings
Insect bites and stingsInsect bites and stings
Insect bites and stings
 
Bites and Stings emergency medicine
Bites and Stings emergency medicineBites and Stings emergency medicine
Bites and Stings emergency medicine
 
Organophosphate poisoning and its management (Clinical Toxicology)
Organophosphate poisoning and its management (Clinical Toxicology)Organophosphate poisoning and its management (Clinical Toxicology)
Organophosphate poisoning and its management (Clinical Toxicology)
 
Corrosive poisoning by Dr.Ashwin Menon
Corrosive poisoning by Dr.Ashwin MenonCorrosive poisoning by Dr.Ashwin Menon
Corrosive poisoning by Dr.Ashwin Menon
 
Bee sting MANAGEMENT
Bee sting MANAGEMENT Bee sting MANAGEMENT
Bee sting MANAGEMENT
 
SNAKE BITE MANAGEMENT
SNAKE BITE MANAGEMENTSNAKE BITE MANAGEMENT
SNAKE BITE MANAGEMENT
 
Snake Bites- Dr Sabah
Snake Bites- Dr SabahSnake Bites- Dr Sabah
Snake Bites- Dr Sabah
 
Managing Spider Bites in the ED
Managing Spider Bites in the EDManaging Spider Bites in the ED
Managing Spider Bites in the ED
 
Medical emergency on scorpion sting new 4
Medical emergency on scorpion sting new 4Medical emergency on scorpion sting new 4
Medical emergency on scorpion sting new 4
 
Snake Bites
Snake Bites Snake Bites
Snake Bites
 

Similar a Scorpion sting

SNAKE BITE AND ENVENOMATION.pptx
SNAKE BITE AND ENVENOMATION.pptxSNAKE BITE AND ENVENOMATION.pptx
SNAKE BITE AND ENVENOMATION.pptxkennynana
 
Snake Bite Management.pptx
Snake Bite Management.pptxSnake Bite Management.pptx
Snake Bite Management.pptxsamirich1
 
Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 1...
Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 1...Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 1...
Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 1...rajendra deshpande
 
GB syndrome_015823.pptx
GB syndrome_015823.pptxGB syndrome_015823.pptx
GB syndrome_015823.pptxShubhrimaKhan
 
Peripheral nerve injury
Peripheral nerve injuryPeripheral nerve injury
Peripheral nerve injuryHazel Panabe
 
Snake bite and its management by first aid and antivenom
Snake bite and its management by first aid and antivenomSnake bite and its management by first aid and antivenom
Snake bite and its management by first aid and antivenomShwetaKhadka
 
Leprosy & its pt management
Leprosy & its pt management Leprosy & its pt management
Leprosy & its pt management SwetaUpadhyay5
 
Introduction to Anesthesia
Introduction to AnesthesiaIntroduction to Anesthesia
Introduction to AnesthesiaBABAR SURI
 
Clinical features & Management of ARTHROPODS STING AND BITES.pptx
Clinical features & Management of ARTHROPODS STING AND BITES.pptxClinical features & Management of ARTHROPODS STING AND BITES.pptx
Clinical features & Management of ARTHROPODS STING AND BITES.pptxvuyyuribhaargavi
 
VIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENT
VIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENTVIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENT
VIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENTfareedresidency
 
VIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENT
VIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENTVIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENT
VIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENTfareedresidency
 
Autonomic nervous system-I
Autonomic nervous system-IAutonomic nervous system-I
Autonomic nervous system-IKarun Kumar
 

Similar a Scorpion sting (20)

SNAKE BITE AND ENVENOMATION.pptx
SNAKE BITE AND ENVENOMATION.pptxSNAKE BITE AND ENVENOMATION.pptx
SNAKE BITE AND ENVENOMATION.pptx
 
Snake Bite Management.pptx
Snake Bite Management.pptxSnake Bite Management.pptx
Snake Bite Management.pptx
 
Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 1...
Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 1...Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 1...
Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 1...
 
GB syndrome_015823.pptx
GB syndrome_015823.pptxGB syndrome_015823.pptx
GB syndrome_015823.pptx
 
Snake bite 1
Snake bite 1Snake bite 1
Snake bite 1
 
Scorpions
ScorpionsScorpions
Scorpions
 
Peripheral nerve injury
Peripheral nerve injuryPeripheral nerve injury
Peripheral nerve injury
 
Rabies.pptx
Rabies.pptxRabies.pptx
Rabies.pptx
 
snake bite management
snake bite managementsnake bite management
snake bite management
 
Snake bite and its management by first aid and antivenom
Snake bite and its management by first aid and antivenomSnake bite and its management by first aid and antivenom
Snake bite and its management by first aid and antivenom
 
Leprosy & its pt management
Leprosy & its pt management Leprosy & its pt management
Leprosy & its pt management
 
Anaesthesia and its types. aga umar tariq
Anaesthesia and its types. aga umar tariqAnaesthesia and its types. aga umar tariq
Anaesthesia and its types. aga umar tariq
 
Snake bite.pptx
Snake bite.pptxSnake bite.pptx
Snake bite.pptx
 
SNAKE BITE.pptx
SNAKE BITE.pptxSNAKE BITE.pptx
SNAKE BITE.pptx
 
Introduction to Anesthesia
Introduction to AnesthesiaIntroduction to Anesthesia
Introduction to Anesthesia
 
Clinical features & Management of ARTHROPODS STING AND BITES.pptx
Clinical features & Management of ARTHROPODS STING AND BITES.pptxClinical features & Management of ARTHROPODS STING AND BITES.pptx
Clinical features & Management of ARTHROPODS STING AND BITES.pptx
 
VIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENT
VIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENTVIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENT
VIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENT
 
VIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENT
VIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENTVIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENT
VIPER SNAKE BITE SEMINAR AND ANTIVENOM TREATMENT
 
Autonomic nervous system-I
Autonomic nervous system-IAutonomic nervous system-I
Autonomic nervous system-I
 
Rabies
RabiesRabies
Rabies
 

Último

EYE CANCER.pptx prepared by Neha kewat digital learning
EYE CANCER.pptx prepared by  Neha kewat digital learningEYE CANCER.pptx prepared by  Neha kewat digital learning
EYE CANCER.pptx prepared by Neha kewat digital learningNehaKewat
 
Assisted Living Care Residency - PapayaCare
Assisted Living Care Residency - PapayaCareAssisted Living Care Residency - PapayaCare
Assisted Living Care Residency - PapayaCareratilalthakkar704
 
Empathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadEmpathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadAlex Clapson
 
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11crzljavier
 
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdfCompliatric Where Compliance Happens
 
Artificial Intelligence in Healthcare: Challenges, Risks, Benefits
Artificial Intelligence in Healthcare: Challenges, Risks, BenefitsArtificial Intelligence in Healthcare: Challenges, Risks, Benefits
Artificial Intelligence in Healthcare: Challenges, Risks, BenefitsIris Thiele Isip-Tan
 
Introduction to Evaluation and Skin Benefits
Introduction to Evaluation and Skin BenefitsIntroduction to Evaluation and Skin Benefits
Introduction to Evaluation and Skin Benefitssahilgabhane29
 
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdfAnatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdfhezamzaki1
 
Three Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborThree Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborHealth Catalyst
 
Understanding Warts and Moles: Differences, Types, and Common Locations
Understanding Warts and Moles: Differences, Types, and Common LocationsUnderstanding Warts and Moles: Differences, Types, and Common Locations
Understanding Warts and Moles: Differences, Types, and Common LocationsNeha Sharma
 
person with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptxperson with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptxMUKESH PADMANABHAN
 
Artificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementArtificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementIris Thiele Isip-Tan
 
LARYNGEAL CANCER.pptx Prepared by Neha Kewat
LARYNGEAL CANCER.pptx  Prepared by Neha KewatLARYNGEAL CANCER.pptx  Prepared by Neha Kewat
LARYNGEAL CANCER.pptx Prepared by Neha KewatNehaKewat
 
Identifying Signs of Mental Health Presentation (1).pptx
Identifying Signs of Mental Health Presentation (1).pptxIdentifying Signs of Mental Health Presentation (1).pptx
Identifying Signs of Mental Health Presentation (1).pptxsandhulove46637
 
Diseases of the Respiratory System (J00-J99),.pptx
Diseases of the Respiratory System (J00-J99),.pptxDiseases of the Respiratory System (J00-J99),.pptx
Diseases of the Respiratory System (J00-J99),.pptxEMADABATHINI PRABHU TEJA
 
Pharmacovigilance audits inspections.pptx
Pharmacovigilance audits inspections.pptxPharmacovigilance audits inspections.pptx
Pharmacovigilance audits inspections.pptxCliniminds India
 
Eating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports PsychologyEating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports Psychologyshantisphysio
 

Último (20)

EYE CANCER.pptx prepared by Neha kewat digital learning
EYE CANCER.pptx prepared by  Neha kewat digital learningEYE CANCER.pptx prepared by  Neha kewat digital learning
EYE CANCER.pptx prepared by Neha kewat digital learning
 
Assisted Living Care Residency - PapayaCare
Assisted Living Care Residency - PapayaCareAssisted Living Care Residency - PapayaCare
Assisted Living Care Residency - PapayaCare
 
Painting Rats White Angers Them to No End
Painting Rats White Angers Them to No EndPainting Rats White Angers Them to No End
Painting Rats White Angers Them to No End
 
Empathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadEmpathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion instead
 
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11
 
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
 
Artificial Intelligence in Healthcare: Challenges, Risks, Benefits
Artificial Intelligence in Healthcare: Challenges, Risks, BenefitsArtificial Intelligence in Healthcare: Challenges, Risks, Benefits
Artificial Intelligence in Healthcare: Challenges, Risks, Benefits
 
Introduction to Evaluation and Skin Benefits
Introduction to Evaluation and Skin BenefitsIntroduction to Evaluation and Skin Benefits
Introduction to Evaluation and Skin Benefits
 
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdfAnatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
 
Three Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborThree Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and Labor
 
Understanding Warts and Moles: Differences, Types, and Common Locations
Understanding Warts and Moles: Differences, Types, and Common LocationsUnderstanding Warts and Moles: Differences, Types, and Common Locations
Understanding Warts and Moles: Differences, Types, and Common Locations
 
person with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptxperson with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptx
 
Artificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementArtificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes Management
 
LARYNGEAL CANCER.pptx Prepared by Neha Kewat
LARYNGEAL CANCER.pptx  Prepared by Neha KewatLARYNGEAL CANCER.pptx  Prepared by Neha Kewat
LARYNGEAL CANCER.pptx Prepared by Neha Kewat
 
The Power of Active listening - Tool in effective communication.pdf
The Power of Active listening - Tool in effective communication.pdfThe Power of Active listening - Tool in effective communication.pdf
The Power of Active listening - Tool in effective communication.pdf
 
Identifying Signs of Mental Health Presentation (1).pptx
Identifying Signs of Mental Health Presentation (1).pptxIdentifying Signs of Mental Health Presentation (1).pptx
Identifying Signs of Mental Health Presentation (1).pptx
 
SCOPE OF CRITICAL CARE ORGANIZATION
SCOPE OF CRITICAL CARE ORGANIZATIONSCOPE OF CRITICAL CARE ORGANIZATION
SCOPE OF CRITICAL CARE ORGANIZATION
 
Diseases of the Respiratory System (J00-J99),.pptx
Diseases of the Respiratory System (J00-J99),.pptxDiseases of the Respiratory System (J00-J99),.pptx
Diseases of the Respiratory System (J00-J99),.pptx
 
Pharmacovigilance audits inspections.pptx
Pharmacovigilance audits inspections.pptxPharmacovigilance audits inspections.pptx
Pharmacovigilance audits inspections.pptx
 
Eating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports PsychologyEating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports Psychology
 

Scorpion sting

  • 2. OBJECTIVES • Introduction • Distribution • Venom property • Clinical manifestation • Laboratory evaluation • Management of envenomation
  • 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)
  • 5. SCORPION • Segmented tail curves upward dorsally ending in a terminal bulbous segment called telson (venom glands and stinger) • Envenomation occurs through stinging ,not biting
  • 6. 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
  • 8. 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
  • 13. 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
  • 14. 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)
  • 15. TAP TEST: Little swelling, prominent pain, paresthesia and hyperesthesia can be accentuated by tapping on the affected area
  • 16. CLINICAL MANIFESTATION • SYMPTOMS PROGRESS TO MAXIMAL SEVERITY WITHIN 5 HOURS. • SYMPTOMS ARE GRADED BASED ON SEVERITY • THERE ARE 4 GRADES
  • 17. 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
  • 18. 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
  • 19. COMPLICATIONS a. Hyperthermia b. Respiratory failure - (most common cause of death) c. Pulmonary edema d. Metabolic acidosis e. Rhabdomyolysis f. Arrythmia
  • 21. 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.
  • 22. •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.
  • 23. • 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.
  • 24. 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
  • 25. 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.
  • 26. 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.
  • 27. •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.
  • 28. 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
  • 29. Adverse Reactions •Central nervous system: Fatigue, headache, lethargy •Dermatologic: Pruritus, skin rashes •Gastrointestinal: Diarrhea, nausea, vomiting •Miscellaneous: Fever
  • 30. • 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.