Bored Review in the Sonoran

For this week’s Bored Review we are taking a little trip to my arid hometown of Phoenix, Arizona! You are out on a desert hike with your little rascal 8 year old cousin, whose curiousity got the best of him. He was reaching under a rock and suddenly screams in pain and withdraws his hand. He complains of severe pain in his hand but you don’t see anything particularly abnormal on his hand, but he says the pain traveling all the way up his arm and that it is also numb and tingling. He then develops roving eye movements and slurred speech. You notice him drooling and excessively salivating, and then he arches his back and has myoclonic jerking movements.

You may only be a weekend desert warrior, but you know something is extremely wrong here…..

Was this caused by: a rattlesnake, a rusty nail, a rabid prairie dog, a scorpion, or an alien?

Indeed! A scorpion! More specifically, the bark scorpion, or C. Exilicada, at home in Arizona, New Mexico, and Texas. This scorpion’s venom contains neurotoxins that cause incomplete inactivation of sodium channels leading the hyperexcitability which affects cranial nerves and skeletal muscles.

There are 4 grades of envenemation severity, 1 being minor pain at the sting site, and grade 4 being both cranial nerve and skeletal muscle involvement.

You are the provider at the hospital when he rolls in. What are you going to do?

Most importantly is supportive care, which may include intubation. For hypersalivation and excess secretions, use atropine. Short acting benzos for muscle spasms. And the crown jewel: antivenom! While you probably won’t find antivenom stocked in the KCH pharmacy, it can be obtained through the poison center in Phoenix but is only used in severe envenomations.

Before your hike went terribly wrong, you thought you saw a camel wandering in the Sonoran desert. Was that all a mirage?

Probably. But in the 1860s a Jordanian man named Hadji Ali, and affectionately known to Arizonans as Hi Jolly, brought camels from Egypt to Arizona to test them as cargo carriers in the grueling desert. When it failed, they were released into the desert and have been wandering around ever since…..

Refs

Uptodate.com

Tintinalli’s 7th Ed.

By Ky Jolly Birnbaum