Experiences of Emergency Physicians on Scorpion Stings

Year 2024, Volume: 6 Issue: 2, 27 - 32, 31.08.2024

Eylem Ersan , Melih Yüksel

https://doi.org/10.51262/ejtox.1528694

Abstract

INTRODUCTION and PURPOSE: This study aims to evaluate the level of knowledge and approaches of emergency physicians about scorpion stings.
MATERIALS and METHODS: In the study, aquestionnaire including 16 questions was administered to emergency physicians about their titles, length of service in the emergency department, geographical region and institutional information, experiences with scorpion stings, treatment approaches, and hospitalization information of the patients.
RESULTS: A total of 282 physicians participated in the study. In emergency medicine physicians (EMPs), regularly checking the availability of scorpion antivenom (p=0.01), taking precautions for complications before antivenom administration (p=0.03), and preferring intravenous (IV) route for scorpion antivenom administration were found to be significantly higher compared to other title groups. Needing consultation before scorpion antivenom (p=0.01) and recommending antibiotic prophylaxis to sting patients (p=0.02) were significantly lower in EMPs compared to other title groups. 31.7% (n=26) of general practitioners administered antivenom "half to the wound edge/half intramuscularly", which is significantly higher compared to other groups (p=0.01). Hospitalization problems in sting cases were most frequently experienced in university hospitals (p= 0.01).
DISCUSSION and CONCLUSION: Our study indicated errors in managing scorpion sting patients and antivenom use. The necessity of reorganization of vocational and undergraduate training should be evaluated.

Keywords

scorpion stings, antivenom, emergency medicine

References

• Abroug F.,Ouanes-Besbes L., Tilouche N et al. Scorpionen venomation: state of the art. Intensive Care Med. 2020 Mar;46(3):401-410. doi: 10.1007/s00134-020-05924-8.
• Isbister GK, Bawaskar HS. Scorpionen venomation. New Engl J Med. 2014;371(5):457–63.
• Aksel, G., Güler, S., Doğan, N., &Çorbacioğlu, Ş. (2014). A randomized trial comparing intravenous paracetamol, topical lidocaine, and ice application for treatment of pain associated with scorpion stings. Human &Experimental Toxicology, 34(6), 662–667.
• Bosnak, M., Ece, A., Yolbas, I., Bosnak, V., Kaplan, M., &Gurkan, F. (2009). Scorpion Sting Envenomation in Children in South east Turkey. Wilderness&Environmental Medicine, 20(2), 118–124
• Godoy DA.,Badenes R., Seifi S. et al. Neurological and Systemic Manifestations of Severe Scorpion Envenomation. Cureus . 2021 Apr 27;13(4):e14715. doi: 10.7759/cureus.14715.
• Fereidooni R., Shirzadi S., Ayatizadeh SH. et al. Scorpion envenomation-associated myocarditis: A systematic review. PLoSNegl Trop Dis. 2023 Apr 5;17(4):e0011219. doi: 10.1371/ journal.pntd.0011219. eCollection 2023 Apr.
• Şahin A., Arıcı MA., Hocaoğlu N. et al. Antivenomuse in bite and sting cases presenting to a public hospital. Ulus Travma Acil Cerrahi Derg, July 2018, Vol. 24, No. 4 doi: 10.5505/ tjtes.2017.99692
• Fılazı A., Özkan Ö., The history of scorpion serum in Turkey. Turk Hij. Den. Biyol. Derg, 2021; 78(1): 107 – 116 doi: 10.5505/TurkHijyen.2020.69937
• TC. Sağlık Bakanlığı Türkiye İlaç ve Tıbbi Cihaz Kurumu Arşiv https://titck.gov.tr/storage/Archive/2019/kubKtAttachments/ T%C4%B0TCK%20K%C3%9CB.pdf_0d70a1ef-7018-40cda44b- b8adc533687c.pdf
• Acsera Scorpion Antiserum Summary Of Product Characterıstıcs (SmPC revision:8) Vetal Sera Production İnd.Trade.Co.Ltd. http://www.vetalserum.com.tr/en/urunler/ acsera-scorpion-antiserum
• Shamoon Z, Peterfy JR, Hammoud S,.et al. ScorpionToxicity. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. 2023 Aug 8. PMID: 28613678
• Kumar R., An update on epidemiology and management practices of Scorpion envenomation in India. J FamilyMed Prim Care. 2022 Sep; 11(9): 4932–4935. Published online 2022 Oct 14. doi: 10.4103/jfmpc.jfmpc_2300_21
• Erickson TB.,Cheema N., Arthropod Envenomation in North America. Emerg Med Clin N Am 35 (2017) 355–375 http:// dx.doi.org/10.1016/j.emc.2017.01.001
• Boyer L, Degan J, Ruha AM, et al. Safety Of İntravenous Equine F(Ab’)2: İn Sights Following Clinical Trials İnvolving 1534 Recipients Of Scorpion Antivenom. Toxicon 2013;76:386–93.
• Gümüştekin M.,Sarıçoban B., Gürkan MA., Antıvenoms And Prıncıples Of Applıcatıon J. DEU Med 2019;34(1):73-83 doi: 10.5505/deutfd.2020.15238
• Klotz SA.,Yates S, Smith SL. et al. Anti venom for Severe Scorpion Envenomation in Arizona. N Engl J Med. 2023 Mar 2;388(9):853-854. doi: 10.1056/NEJMc2029813.
• T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Zoonotik ve Vektörel Hastalıklar Dairesi Başkanlığı. Kuduz Profilaksi Rehberi. ISBN: 978-975-590-728-4 (Ankara, 2019) https:// hsgm.saglik.gov.tr/depo/birimler/zoonotik-ve-vektorelhastaliklar- db/Dokumanlar/Rehberler/Kuduz_Profilaksi_ Rehberi.pdf
• Vaucel JA.,Larréché S., Paradis C., French Scorpionism (Mainlandand OverseaTerritories): Narrative Review of Scorpion Species, ScorpionVenom, and Envenoming Management. Toxins (Basel). 2022 Oct 21;14(10):719. doi: 10.3390/toxins14100719
• Yüksel M., Eryiğit V., Erimşah ME., et al. The Attitudes of Emergency Physicians in Turkey towards the Snakebites. Kocaeli Med J 2020; 9; 1:76-82