0071643192.pdf

ENVIRONMENTAL EMERGENCIES

The bark scorpion (Centruroides sculpturatus, in Arizona), however, can cause
systemic toxicity. Children <5 years old have a higher mortality rate than adults.

MECHANISM OFTOXICITY

■ Envenomation→↑Na+channel permeability →↑depolarization →
sympathetic, parasympathetic, and neuromuscular activation.

SYMPTOMS/EXAM

■ Sensitivity to touch at site
■ Numbness, tingling
■ Blurred vision or roving eye movements
■ Muscle spasms or weakness
■ Hyperthermia
■ Anxiety, nausea/vomiting
■ Respiratory distress with excessive secretions
■ May cause cardiopulmonary arrest

TREATMENT

■ Local wound care and tetanus prophylaxis
■ Symptomatic treatment with
■ Opioidsfor muscle pain
■ Benzodiazepinesfor neuromuscular symptoms
■ Atropine for excessive secretions
■ Scorpion antivenom
■ Available only in Arizona
■ Indicated in severe bark scorpion envenomation.

A 26-year-old man presents to the ED complaining of severe pain to his

right forearm 10 minutes after being stung by a lionfish while cleaning his

saltwater aquarium. His VS are normal. Physical exam shows a small

puncture wounds to the forearm with mild surrounding swelling. What can you

do to inactivate the venom?

Lionfish are venomous fish that cause envenomation through a specialized

sting apparatus. Symptoms will primarily consist of intense local pain. The

venom can be inactivated by immersing the wound in hot (45ºC) water for

90 minutes or until the pain subsides.

MARINE ANIMAL ENVENOMATIONS

Can be divided into three groups based on mechanism of venom delivery:

■ Stingers
■ Nematocysts
■ Bites

Stingers

Marine animals with specialized sting apparatus include (see Table 13.4):

■ Stingrays
■ Venomous fish (catfish, zebra fish, scorpion fish, stonefish)
■ Sea urchins
■ Cone shells

Serious bark scorpion

envenomations are more

common in children.

Bark scorpion envenomation

→roving eye movements,

muscle spasms, and excessive

secretions.

Atropine may be needed to

treat excessive secretions.