2025 – PAGE 215 – EMERGENCY MEDICINE & TOXICOLOGY

SCORPION STING

A sting from a scorpion can cause pain, tingling and numbness at the sting site. Scorpions are active at night and all scorpions can sting, but not all stings inject venom. The stinger has venom that causes pain. The bark scorpion, found in the southwest United States, can cause serious symptoms within the first 2-3 hours after the sting. They manifest as muscle twitching or rapid eye movements, followed by pain, tingling, and numbness spreading to all extremities. Treat with wound care and pain medication (acetaminophen or ibuprofen). Pain and shock waves of tingling usually resolve by 24 hours and numbness and tingling around the sting can last for 2-3 days.

BURN TREATMENT

• Antibiotics are NOT mandatory in the treatment of burns. Consider a tetanus booster.
• SUPERFICIAL: Red, painful skin. Treat with soap, cool water, and analgesics.
• PARTIAL THICKNESS: Look for blisters and erythematous skin that blanches with pressure. These burns are also PAINFUL. Once the blisters rupture (do not actively rupture them), treat with debridement, topical antibiotics, and a nonadherent dressing.
• FULL THICKNESS: Look for white, dry, leathery skin that is PAINLESS. These burns require immediate referral to a burn center and will likely require surgical excision.
• DRESSINGS: If asked about dressings, use cool, wet dressings on small burns for better comfort. Use dry, non-adhesive dressings on larger burns to avoid hypothermia.
• BURN CENTER CARE: Refer for full thickness burns and any burns on more than 10% of the body (by surface area), and any burns in sensitive areas (face, mouth, perineum, hands, and feet). For burns on more than 15% of the body, the Parkland formulafor acute fluid management says to add an EXTRA (4 ml/kg)*(% body burned) to maintenance fluids, giving half over the first 8 hours from the time of the burn.
• ELECTRICAL BURNS can cause deep tissue and muscle injury that is not obvious to the eye. Electrical burns are frequently in the perioral area (electrical cord bite). Provide anticipatory guidance prior to the child becoming mobile (around or prior to the 6-month visit).
• PEARLS: Almost 20% of pediatric burns are from abuse. Classic patterns include well-demarcated burns and stocking- or glove-patterned burns. Sparing of the folds and splash pattern burns are NOT necessarily from abuse (they may be unintentional).
• MNEMONIC: Use the “rule of 9s” to help estimate the body surface area affected. An arm is approximately 9% of a child’s BSA. A leg is approximately 18% of a child’s BSA. A palm is approximately 1% of a child’s BSA. The BSA percentage of the head changes significantly with age. The head is approximately 19% of a newborn’s BSA and only 9% of a teenager’s. For more specific calculation, ERs use a Lund & Browder chart(low-yield fact):

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NEAR DROWNING

A near drowning usually requires INPATIENT monitoring because they can result in ARDS after an asymptomatic period. This can lead to DEATH from hypoxic ischemic brain injury and cerebral edema.

PEARLS:

• GOOD PROGNOSIS IF: Patient had good pulses on EMS arrival or required < 10 minutes of CPR. If the patient was in the water for less than 60 seconds, had NO loss of consciousness, and did not require CPR, then the patient does NOT need to be hospitalized.
• POOR PROGNOSIS IF: Cold on EMS arrival (< 90° F), CPR needed for > 25 min, > 10 minutes underwater, apnea, coma, or pH < 7.1. Rewarm these patients to > 90° F and consider intubation to provide PEEP for possible ARDS.