7
- U of AZ has a new IND from FDA to use a Mexican equine F(ab)
2
antivenom for bark scorpion
stings
- adults stung by C. exilicauda should be observed for several hr; if significant toxicity appears,
admit
to
ICU
- majority can be safely treated at home (extremely rare for envenomations in adults to be severe
enough to require antivenin)
- symptomatic children should be admitted; if < 1 Y.O. or neurologic findings, observe in ICU
- no deaths reported since 1968, previously caused more than twice as many deaths in Arizona as all
other
venomous
animals
combined
C.
Non-neurotoxic Scorpions:
- the venoms of the less toxic U.S. scorpions are poorly characterized
1.
Clinical Manifestations:
- produce immediate, brief, intense burning or stinging sensation, mild soft tissue swelling and
possibly
mild
ecchymosis
- systemic manifestations are uncommon except in rare instance where victim proves to be allergic
to
the
venom
2.
Management:
a. Field Management:
-
ice
application
b. Hospital Management:
- check vital signs
-
no
labs
required
- local ice and mild analgesics
- tetanus status should be updated as necessary
- discharge if no signs of anaphylaxis
VI. Miscellaneous Arthropods:
A.
Centipedes:
- local reactions to sting (pain, swelling, erythema)
- standard wound care
B.
Caterpillars:
- children love to handle
- many can cause dermatitis
- most serious stinger = larva of Megalopyge opercularis (flannel moth), the "puss caterpillar"/"asp"
- southeastern U.S.
- intense pain (rhythmic), edema, pruritus, grid-like red rash, anxiety/restless, muscle cramps, fever,
lymphadenopathy,
delayed desquamation
- remove spines with tape; antihistamines; trial of IV calcium gluconate for pain control; narcotics;
wound
care;
tetanus
prophylaxis
VII. Suggested Reading:
·
Allen RC, Norris RL: Delayed Use of Antivenin in Black Widow Spider (Latrodectus mactans)
Envenomation. J Wild Med (3):187-192,1991.
·
Anderson PC: Necrotizing Spider Bites. Am Fam Phys 26(3):198-203, 1982.
·
Banner W: Bites and Stings in the Pediatric Patient. Curr Probl Pediatr 18(1):9-69, 1988.
·
Berger RS: Management of Brown Recluse Spider Bite. JAMA 251(7):889, 1984.
·
Berg RA, Tarantino MD: Envenomation by the Scorpion Centruroides exilicauda (C. sculpturatus): Severe and
Unusual Manifestations. Pediatr 87(6):930-933, 1991.
