Dr Himmatrao Bawaskar.
Bawaskar Hospital and Research center, Mahad, Dist-Raigad, Maharashtra, India. | Other therapies :
DIC, sub-dural hematoma and hemiplegia, hypoxic brain damage with generalized brain edema are known to occur and should be treated with fresh blood transfusion and decongestive treatment. If the victim becomes delirious or comatose, hyperbaric oxygen might help. Non-cardiac pulmonary or secretary pulmonary edema or adult respiratory distress syndrome is rare due to mesobuthus tamulus envenomation but may necessitate tracheal intubations and hyperventilation. captopril, lytic cocktail, insulin glucose -potassium drip, l-carnitine have been reported with limited benefits in the management of scorpion sting
Management of cardiac arrhythmias :
Initial bradycardia often accompanied with ventricular premature contraction at times ventricular bigeminy pattern with excessive profuse sweating, salivation and priapism is transient and self-limiting provided dehydration and electrolytes imbalance are corrected. Runs of ventricular premature contraction or R on T phenomenon and ventricular tachycardia respond to intravenous lidocaine. mexiletine is a drug of choice for ventricular premature contraction occurring with gallop because it does not alter the QTC interval, which is already increased due to scorpion envenoming. Intravenous amiodarone should be used with caution in presence of impending myocardial failure or pulmonary edema which may precipitate massive pulmonary edema, marked bradycardia and cardiac arrest, resuscitation trolley should be ready or it should be administered in intensive care unit.
Atropine, steroids, antihistamines, beta-blockers, calcium channel blockers, excessive diuretics, adrenaline and narcotics should be avoided. They do more harm than good in scorpion envenoming.
Prevention :
Scorpions are killed by organophosphorus pesticides. A false ceiling of plastic sheet should be put under the roof of Hutto prevent scorpion failing in bed from loose tiles of roof particularly in early June with heavy rain. Shoes, clothes should be checked before wearing. Shoes should be packed with paper so as to prevent the entry of scorpion during night. Hand gloves made of thick rubber (electrician gloves) should be worn while harvesting and handling fire woods, dry cow dung, lifting dry paddy and Jawar husk and sugar cane husk. Simple slippers do not protect. Children should not be allowed to go out side in early darkness without shoes. One should not put hand blindly in craves, doors or storage material during night hours or one should keep distance from mud house wall or one should not backrest to mud wall.
At the time of opening of school benches and rooms should be washed and cleaned.
In endemic areas where high fatality have been reported, the doctors should be aware of severe clinical manifestations or should be trained how to diagnosed and manage the severe scorpion sting.
| | | | Compliance with Ethical Standards | | Funding None | | | | Conflict of Interest None | | |
- Bawaskar HS Scorpion sting and literature review (monogram) Popular Prakashan mumbai. [PubMed]
- Bawaskar HS Diagnostic cardiac premonitory signs and symptoms of red scorpion sting Lancet 1982;II: 552-54. [CrossRef]
- Bawaskar HS and Bawaskar PH. Prazosin in the management of cardiovascular manifestations of scorpion sting Lancet 1986;II: 510-11. [CrossRef]
- Bawaskar HS and Bawaskar PH. Stings by scorpions (Buthotus tamulus) in Maharashtra state, India: a clinical study. Transaction of Roy.Soc.Trop.med.hyg. 1989,83:858-60.Bawaskar HS and Bawaskar PH.Management of the cardiovascular manifestations of poisoning by Indian red scorpion. British heart Journal 1992; 68:478-80. [CrossRef] [PubMed] [PMC free article]
- Bawaskar HS and Bawaskar PH. Prazosin therapy and scorpion envenomation. JAPI 2000;48:1175-80. [PubMed]
- Abroug F, Eiatrous S, Nouria S, et al. Serotherapy in scorpion envenomation : a randomized controlled trial. Lancet 1999;354:906-09. [CrossRef]
- Mahadevan S. Scorpion sting( personal practice). Indian pediatric 2000;37:504-13. [PubMed]
- Bawaskar HS and Bawaskar PH. Clinical profile of severe scorpion envenomation in children at rural setting. Indian pediatrics 2003;40:1072-75. [PubMed]
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| Cite this article as: | | Bawaskar H. SCORPION STING: CURRENT MANAGEMENT. Pediatr Oncall J. 2006;3: 3-8. |
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