Page 328 - Learnwell EVS
P. 328
10. Medical and minor surgical procedures
Scorpion stings and envenomation
– I n m o st cases, th e sting causes lo cal effects includ ing: p ain, o ed em a, ery th em a.
M anagem ent includ es strict rest, w o und cleansing, analgesics P O , and tetanus
p ro p hy laxis (see Tetanus, p age 1 7 0 ) . I n p atients with significant p ain, infiltrate the
area aro und the sting with lo cal anaesthetic (1% lidocaine). O bserve fo r 1 2 ho urs.
– G eneral signs ap p ear in the event o f severe enveno m atio n: hy p ertensio n, excessive
salivatio n and sweating, hy p ertherm ia, vo m iting, d iarrho ea, m uscle p ain, resp irato ry
d ifficulties, seiz ures; rarely , sho ck .
– A etio lo gical treatm ent:
T h e use o f sco rp io n antiveno m sera is co ntro versial ( m o st o f th em are no t very
effective; they m ay be p o o rly to lerated d ue to insufficient p urificatio n).
I n p ractice, in co untries where sco rp io n enveno m atio ns are severe (N o rth A frica, the
M id d le E ast, C entral A m erica and A m az o nia), check lo cal availability o f antiveno m
sera and fo llo w natio nal reco m m end atio ns.
T he criteria fo r ad m inistratio n are the severity o f the enveno m atio n, the age o f the
p atient (m o re severe in child ren) and the tim e elap sed since the sting. T his sho uld no t
exceed 2 to 3 h o urs. I f th e tim e elap sed is m o re th an 2 o r 3 h o urs, th e benefit o f
antiveno m serum is p o o r in co m p ariso n with the risk o f anap hy laxis (in co ntrast to
enveno m atio n by snak es).
– S y m p to m atic treatm ent:
• I n th e event o f vo m iting , d iarrh o ea o r excessive sw eating : p reventio n o f
d ehy d ratio n (o ral rehy d ratio n salts), esp ecially in child ren.
• In the event o f m uscle p ain: 10% calcium gluconate slo w I V (child ren: 5 m l/ injectio n,
ad ults: 1 0 m l/ injectio n, ad m inistered o ver 1 0 to 2 0 m inutes).
• In the event o f seiz ures: d iaz ep am m ay be used with cautio n; the risk o f resp irato ry
d ep ressio n is increased in enveno m ated p atients (see Seizures, p age 2 3 ).
Spider bites and envenomation
– T reatm ent is usually lim ited to w o und cleansing, strict rest, analgesics P O and
tetanus p ro p hy laxis (see Tetanus, p age 1 7 0 ). 10
– S evere enveno m atio ns are rare. T here are two m ain clinical sy nd ro m es:
• N euro to xic sy nd ro m e ( black w id o w sp id er) : severe m uscle p ain, tach y card ia,
hy p ertensio n, nausea, vo m iting, head ache, excessive sweating. T he signs d evelo p
fo r 2 4 ho urs and then reso lve sp o ntaneo usly o ver a few d ay s.
• N ecro tic sy nd ro m e ( recluse sp id er) : lo cal tissue lesio ns, p o ssible necro sis and
ulceratio n; m ild general signs (fever, chills, m alaise and vo m iting) which usually
reso lve o ver a few d ay s. I f p resent, haem o ly sis m ay so m etim es be life threatening.
A s well as the general m easures listed abo ve, treatm ent includ es ad m inistratio n o f
10% calcium gluconate by slo w I V in th e event o f m uscle sp asm s ( ch ild ren:
5 m l/ injectio n, ad ults: 1 0 m l/ injectio n, ad m inistered o ver 1 0 to 2 0 m inutes).
I ncisio n and d ebrid em ent o f necro tic tissue are no t reco m m end ed (no t useful; m ay
im p air healing).
285
Scorpion stings and envenomation
– I n m o st cases, th e sting causes lo cal effects includ ing: p ain, o ed em a, ery th em a.
M anagem ent includ es strict rest, w o und cleansing, analgesics P O , and tetanus
p ro p hy laxis (see Tetanus, p age 1 7 0 ) . I n p atients with significant p ain, infiltrate the
area aro und the sting with lo cal anaesthetic (1% lidocaine). O bserve fo r 1 2 ho urs.
– G eneral signs ap p ear in the event o f severe enveno m atio n: hy p ertensio n, excessive
salivatio n and sweating, hy p ertherm ia, vo m iting, d iarrho ea, m uscle p ain, resp irato ry
d ifficulties, seiz ures; rarely , sho ck .
– A etio lo gical treatm ent:
T h e use o f sco rp io n antiveno m sera is co ntro versial ( m o st o f th em are no t very
effective; they m ay be p o o rly to lerated d ue to insufficient p urificatio n).
I n p ractice, in co untries where sco rp io n enveno m atio ns are severe (N o rth A frica, the
M id d le E ast, C entral A m erica and A m az o nia), check lo cal availability o f antiveno m
sera and fo llo w natio nal reco m m end atio ns.
T he criteria fo r ad m inistratio n are the severity o f the enveno m atio n, the age o f the
p atient (m o re severe in child ren) and the tim e elap sed since the sting. T his sho uld no t
exceed 2 to 3 h o urs. I f th e tim e elap sed is m o re th an 2 o r 3 h o urs, th e benefit o f
antiveno m serum is p o o r in co m p ariso n with the risk o f anap hy laxis (in co ntrast to
enveno m atio n by snak es).
– S y m p to m atic treatm ent:
• I n th e event o f vo m iting , d iarrh o ea o r excessive sw eating : p reventio n o f
d ehy d ratio n (o ral rehy d ratio n salts), esp ecially in child ren.
• In the event o f m uscle p ain: 10% calcium gluconate slo w I V (child ren: 5 m l/ injectio n,
ad ults: 1 0 m l/ injectio n, ad m inistered o ver 1 0 to 2 0 m inutes).
• In the event o f seiz ures: d iaz ep am m ay be used with cautio n; the risk o f resp irato ry
d ep ressio n is increased in enveno m ated p atients (see Seizures, p age 2 3 ).
Spider bites and envenomation
– T reatm ent is usually lim ited to w o und cleansing, strict rest, analgesics P O and
tetanus p ro p hy laxis (see Tetanus, p age 1 7 0 ). 10
– S evere enveno m atio ns are rare. T here are two m ain clinical sy nd ro m es:
• N euro to xic sy nd ro m e ( black w id o w sp id er) : severe m uscle p ain, tach y card ia,
hy p ertensio n, nausea, vo m iting, head ache, excessive sweating. T he signs d evelo p
fo r 2 4 ho urs and then reso lve sp o ntaneo usly o ver a few d ay s.
• N ecro tic sy nd ro m e ( recluse sp id er) : lo cal tissue lesio ns, p o ssible necro sis and
ulceratio n; m ild general signs (fever, chills, m alaise and vo m iting) which usually
reso lve o ver a few d ay s. I f p resent, haem o ly sis m ay so m etim es be life threatening.
A s well as the general m easures listed abo ve, treatm ent includ es ad m inistratio n o f
10% calcium gluconate by slo w I V in th e event o f m uscle sp asm s ( ch ild ren:
5 m l/ injectio n, ad ults: 1 0 m l/ injectio n, ad m inistered o ver 1 0 to 2 0 m inutes).
I ncisio n and d ebrid em ent o f necro tic tissue are no t reco m m end ed (no t useful; m ay
im p air healing).
285
