The key objective of this guideline is to enable even the doctors working in Primary
Care Institutions as well as private practitioners to treat scorpion sting with confi dence.
Evidences suggest that doctors are not willing to make use of the medications and
devices, even when available, due to lack the confi dence and guidelines. The present
handbook provides guidelines to meet their needs, and outlines how they should proceedwithin their context and setting. The principles envisaged to treat scorpion sting at
all Health Centres / Hospitals irrespective of the status (Government or Private) are
given in Table no: 7 (vide supra under treatment) The initial evaluation and systemic
manifestations following scorpion envenomation (described in Table 18, 19 and 20,
and Figure 1 and 2), and treatment aspects are provided in detail vide supra. However,
a format for quick assessment is provided in Table 22 and 23 (refer Annexure VIII
and X).
Table No. 22: Initial evaluation of scorpion sting without
Systemic Envenomation
ASSESS
Vital signs
• Pulse
• BP
• Respiration
SYMPTOMS AND
SIGNS
Local effects (Table 18)
• Sting marks and site
• Swelling and local
pain
• Pain, erythema &
wheal
• Induration, macule/
papule
• Progress to purpuric
plaque
• Local necrosis
• Lymphangitis
• Ascending
hyperesthesia
• Positive “Tap test”
• Conscious level
• Any other systemic
effects
CLASSIFY
Vital signs (Adult)*
• Pulse rate: 60-100/
min
• BP 110 / 70 to 140/95
• Respiratory rate <20/
min
SYMPTOMS AND
SIGNS
• Local pain and/ or
swelling
• Sting mark present
• No other symptoms
and signs
If the patient has
above fi ndings at the
time of assessment,
classify as No systemic
envenomation
TREATMENT
Tab.Paracetamol
Inj.Tetanus Toxoid IM
Routine antimicrobials are
not necessary
Monitor Pulse, Respiration
& BP every ½ hourly for 3
hours and every 4 hourly for
remaining 48 hours.
If normal send the
patient home
If the patient develops one or
other systemic manifestations
as described in Table 18, 19
and 20, and Figure 1 and 2,
proceed to treat as given in
Table 23.
*Vital signs for children (see age specifi c chart) are provided in Annexure III
(Table No.30 to 33). If the patient has any systemic manifestations as described in
Table 19 and 20, and Figure 1 & 2, proceed to manage as described in Table 23. The
details of local envenomation is provided in Table 18.
Table No. 23: Evaluation of scorpion sting with Systemic Envenomation
ASSESS
Vital signs
• Pulse
• BP
• Respiration
SYMPTOMS
AND SIGNS
In addition to
those described in
Table 22, look for
those mentioned
in Table 19 and 20
as well as fi gure
1 and 2 for one
or other systemic
manifestations as
described in Table
19 and 20, and
Figure 1 and 2.
CLASSIFY
Vital signs (Adult)*
Pulse rate >120 per
minute, feeble (a
response to hypotension)
Respiratory rate > 20/min
Hypotension < 90/60
SYMPTOMS AND
SIGNS
Swelling and local pain
If systemic fi ndings
are there at the time of
examination, classify as
systemic envenomation
TREATMENT
• Oxygen administration if
required
• Follow various principles
described vide supra
• Start IV Normal Saline with
wide bore needle as life line
• Treat the patient with Tab.
Prazosin (Plain)
• Continue to monitor the vital
signs at fi ve minutes interval
for fi rst 30 minutes and then
at 15 minutes interval for two
hours.
• For further details while using
Prazosin follow the details
provided in Table No.21.
• Stabilise the patient and
refer to the higher institution
keeping the patient in lying
posture.
Fluid requirements per day should be kept in mind while managing the case.
For children readers are requested to see the fl uid requirement chart provided in
Annexure II.
* Vital signs for children (see age specifi c chart) provided in Annexure III.