VAPAGuide - Flowcharts

Emergency & clinical flowcharts

Signs and symptoms¹		Emergency medical treatment	Region	Possible cause	Antivenom²

Transient cholinergic effects: vomiting, profuse sweating, hypersalivation, increased bronchial secretion, priapism, bradycardia, arterial hypotension (see Diagnosis & Treatment: Hospital) Longer-lasting adrenergic effects: tachycardia, arterial hypotension, pulmonary oedema, (cardiogenic + ?non-cardiogenic component), hyperglycaemia, hypertensive encephalopathy, myocardial failure, shock; acute pancreatitis (see Diagnosis & Treatment: Hospital)	Neuromuscular dysfunction: cranial nerves: "wandering" eye movements, dysphagia, dysarthria, pharyngeal reflex absent; skeletal musculature: involuntary movements, restlessness, reduced grip and pinch strength (see Diagnosis & Treatment: Hospital)	Caution: avoid the use of atropine whenever possible (see Diagnosis & Treatment: Hospital) Vasodilators: hydralazine, nifedipine (see Diagnosis & Treatment: Hospital), α-blockers (prazosin) (see Diagnosis & Treatment: Hospital), ACE inhibitors (see Diagnosis & Treatment: Hospital); caution with fluid replacement (see Diagnosis & Treatment: Hospital); caution with diuretics (see Diagnosis & Treatment: Hospital) Maintain the airways, endotracheal intubation, artificial respiration Contraindicated or to be avoided: pethidine, morphine, barbiturates, atropine, calcium, anti-inflammatory drugs, including corticosteroids, digitalis	India	Hottentotta thamulus	MAVIN Antivenom index
			North Africa, Middle East	Androctonus sp. Leiurus quinquestriatus Buthus sp.
			Brazil, Trinidad	Tityus sp.
			Mexico, southern USA	Centruroides sp.
			Southern Africa	Parabuthus sp.

Local pain, redness, oedema (see Diagnosis & Treatment: Hospital)		Infiltration with local anaesthetic (xylocaine 1%, max. 0.5 ml, without the addition of a vasoconstrictor); regional nerve block anaesthesia	Numerous regions throughout the world	All scorpions

See also the Clinical flowchart as a guide to the dynamics of envenoming.

Assessment of the importance of antivenom in the treatment of scorpion stings is very controversial (see Diagnosis & Treatment: General practitioner / health post). If clinical information regarding the efficacy of an antivenom is available, it is presented in the relevant Biomedical database entry. See "Essentials of the management of envenoming and poisoning: 9. How is the appropriate antivenom chosen? When is it administered?".