SCORPIONS EndoGastroHep.com

By Dr / Essam M. Hafez Lecturer of clinical toxicology M.D, clinical toxicology Diploma , internal medicine Diploma, hospital administration Diploma, medical law EndoGastroHep.com

General Facts Scorpions are classified a venomous arthropods in the class Arachnida Today’s scorpions look generally the same as the fossilized remains that date back to 430 million years ago. Across the globe there are over 1400 different species, 75 of which are in the US Scorpions can range in size from ½ to 7 ¼ inches They can live from 3 to 25 years

DESCRIPTION Scorpions are eight legged venomous invertebrates belonging to the arachnid Related to spiders, mites, and ticks Long slender body with a five segmented tail that can be arched over the back The tail ends in a bulb like poison gland or stinger

Habitat While there are numerous scorpion species throughout desert climates, scorpions can be found in nearly any dry habitat including pine forests and grass lands. Scorpions are nocturnal, most encounters will occur while they are hiding during the day.

Diverse Habitats

Striped Bark Scorpion, Centruroides vittatus, gravid female from Texas Emperor Scorpion, Pandinus imperator, female eating cockroach, native to West Africa Striped Bark Scorpion, Centruroides vittatus, gravid female from Texas

Black Thick-Tailed Scorpion, Parabuthus transvaalicus, ahighly venomous species native to South Africa

Native Species Florida Bark Scorpion It is slender and brown with a broad flat body. Their sting is comparable to that of a wasp It is the largest of the 3 scorpions found in Florida EndoGastroHep.com

Native Species Hentz Striped Scorpion This is the smallest and most common scorpion found in Florida Life span of 3-5 years The sting is also like a wasp’s sting

SCORPION VENOM The venom is used for both prey capture , defense and possibly to subdue mates All scorpions do possess venom and can sting but their natural tendency is to hide and escape Scorpions can control the venom flow so some sting incidents are venom less or only mild envenomations Scorpion venoms are a complex mixture of neurotoxins that affect the victims’ nervous system. The venom of a bark scorpion may produce severe pain, rarely swelling, at the site of the sting

Mechanism of action It produces repetitive firing of the axons via creation a widened action potential through : (1)Maintenance of Na-channels open after depolarization. (2)Blocking the voltage-gated K channels

Clinical picture The clinical course of envenomation can be divided into 4 grades as in the following scale: Grade I: Local pain or paraesthesia at the site of sting. Grade II: Pain or paraesthesia away from the site of sting. Grade III: One or more of the following systemic effects: (3G +3C) (1)General manifestations: -Sweating and cold extremities. -Thirst, dehydration and fever up to 42° C.

(2)Neuropsychiatric manifestations: -Cranial nerve dysfunction: *Blurred vision and disturbed eye movements. *Dysphagia and excessive salivation. *Tinnitus and slurred speech. -Neurological dysfunction: *Involuntary movements and jerky motility. *Agitation, restlessness, and confusion. *Convulsions altered conscious level, or coma. *Malignant hyperthermia. (3)Cardiovascular manifestations: -Tachyarrhythmias & hypertension. -Heart failure, hypotension, and circulatory collapse. -Cardiomyopathy & toxic myocarditis. -ECG changes: Depressed S-T segment & inverted T-wave (injury pattern).

(4)Respiratory manifestations: -Tachypnea &respiratory distress. -Rhonchi &crepitations. -Pulmonary oedema: It may be cardiac or non-cardiac in origin. (5)GIT manifestations: severe vomiting, diarrhea, and may be haematemesis. (6)Genitourinary manifestations: -Priapism: It is a very common finding in scorpion sting, but its exact mechanism is unclear. -Uterine contractions which may induce abortion. EndoGastroHep.com

Grade IV: The patient has all of the above manifestations (local &systemic). Generally, the scorpion stings are dangerous in children (below 10 years) and in elderly (above 60 years -Clinically, the following manifestations have been found to carry a very poor outcome: 2SE PAM *Altered conscious level. *Seizures. *Shock or hypotension. *ECG changes. *Pulmonary edema. *Malignant hyperthermia.

Laboratory Radiological Investigations Laboratory Radiological

Considerations for Construction Since scorpions tend to hide during the day they can be found in: Wood piles Scrap piles Boots hats and gloves left out Any dry dark area

Prevention The best way to remove the threat is to remove the attraction: Piles of debris Food sources This is not always possible, so awareness and caution are important

treatment (I)First-aid measures: The same as in case of snake bite ( CIM) C: calming the patient I: immbilization of the bitten Part M: moving the patient to hospital

ABCs (II)Definitive Therapy: (At hospital) in the form of: -No manifestations: Close observation for 3-4 hr. is usually needed. (III)Life-threatening manifestations: Advanced life support measures should be undertaken rapidly, which include ABCs

(IV)Specific measures (Antivenom): -It should be considered for: (I)Overt cases (with clinical manifestations). (II)After stabilization of life-threatening conditions. -Dose: *Skin test (hypersensitivity) must be performed before the administration to avoid anaphylaxis. *Start with one ampoule I.M.*If there is no response within 0.5-1hr., the dose can be repeated up to 3 ampoules I.M. *In severe cases → 1-5 ampoules can be given by slow I.V. drip method

Thank You, Dr .Essam M. Hafez EndoGastroHep.com Thank You, Dr .Essam M. Hafez