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The most significant morbidity and mortality from scorpion stings is from the Buthidae family, characterized by a triangular central sternal plate. This family includes the venomous Androctonus genus in northern Africa, Leiurus in the Middle East, Tityus in South America, and Centruroides in North America.
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Centruroides are found primarily in the southwestern United States and northern Mexico and are characterized by a variable subaculear tooth beneath the stinger. They may be striped and are yellow to brown in color. These scorpions tend to hide in crevices, woodpiles, bedding, clothing, and shoes. Envenomation produces a mild local reaction of pain, swelling, burning, and ecchymosis.
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Centruroides exilicauda (the bark scorpion) envenomation can lead to progressive symptoms and, very rarely, death. The venom of C exilicauda initially produces local paresthesias and pain (grade 1), which may be accentuated by tapping the involved area. More severe envenomations may produce remote paresthesias (grade II) and either somatic or autonomic nervous system dysfunction (grade III). Systemic symptoms may include tachycardia, nausea, wandering eye movements, blurred vision, difficulty breathing, trouble swallowing, restlessness, and involuntary shaking. Both somatic and autonomic dysfunction may be present (grade IV). Systemic reactions tend to be more severe in younger patients and may result in death, usually from respiratory arrest.
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Management and Disposition
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Treatment depends on the severity of envenomation. Grade I or II envenomations are treated with supportive care (ice, oral analgesia) and tetanus prophylaxis. Envenomations that progress to ...