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Dr. H. S. Bawaskar
(A) Non poisonous sting
Signs and symptoms
Severe excruciating, burning pain at sting site, radiating along adjacent dermatomes. No other systemic involvement.

Treatment Following drugs should be avoided because of their detrimental effects in these victims Tourniquet and local incision should avoided.

(B) Poisonous sting (Bite)

Signs and Symptoms Management Prazosin therapy
Prazosin 250 microgram to child and 500 microgram to adult administered as early as possible, 2nd dose repeated within 4 hours according to response if temperature of skin, extremities, pulse volume, blood pressure (reduction in raised blood pressure and improvement if hypotension on admission), subjective feeling and reduction in paraesthesias. Later on repeated six hourly till extremities became dry warm usually took 10 to 24 hour. During this therapy victim must experience severe excruciating burning pain at sting site which was mild or absent initially confirming improved tissue perfusion caused by alpha blockade property of prazosin. Once prazosin is administered blood pressure, pulse rate should be manually monitored every 30 minute for hours, then every hour for next six hour and every 4 hourly till extremities became warm.

First dose phenomenon
Rarely severe hypertension due to profound vasodilaton can occur after initial dose usually within 30 to 90 minute after first dose. To avoid this initial dose administered is very low, victims are not allowed to sit or stand and vigorous replacement of hypovolemia by ORS.

Slow calcium channel blocker because of negative inotropic action can precipitate pulmonary edema and should not be used in impending myocardial failure with hypertension. It has no additional benefit over prazosin in severe hypertension due to scorpion sting.
While discharging the patient