Shalita Eric A, Wells Ryan D
332nd Expeditionary Medical Group, Balad Air Base, Iraq.
J Am Pharm Assoc (2003). 2007 Sep-Oct;47(5):616-9. doi: 10.1331/JAPhA.2007.07051.
To report the treatment given to a 26-year-old Air Force medic who was stung twice by a yellow scorpion (Leiurus quinquestriatus) while stationed in Iraq and to describe the problems and issues related to the use of the scorpion antivenin.
The patient presented 2 hours after envenomation to the local military treatment facility, where she was minimally symptomatic initially. Shortness of breath and anxiety developed, and the patient was sedated, intubated, and evacuated to a large Air Force medical facility for more advanced care. Vasopressor support was required during flight. At the medical facility, antivenin was administered, and the patient's cardiac condition was stabilized with norepinephrine drip, mild hydration, and vasopressor support. A second dose of antivenin diluted in sodium chloride and further pressor support were required. ST-segment depression eventually resolved, and the patient was gradually taken off norepinephrine and extubated. She recovered fully within 2 weeks and returned to active duty.
Because the antivenin used is not licensed by the Food and Drug Administration, informed consent was needed; however, it could not be obtained because the patient was unconscious, intubated, and in a life-or-death situation. Antivenin selection is based on the species of scorpion and symptom severity; therefore, the scorpion should be, with great care, killed for identification. In the military setting, inventory control, storage, and accountability are vital issues surrounding antivenin use, and these are discussed in this article.
Immediate action and effective communication, along with timely antivenin administration and well-equipped intensive care facilities, were integral in saving the life of this victim of a yellow scorpion envenomation. All level 3 facilities in Southwest Asia must be familiar with ordering, administering, and documenting this antivenin because it is difficult to obtain and infrequently available.
报告一名26岁驻伊拉克空军医务人员被黄蝎子（Leiurus quinquestriatus）蜇伤两次后的治疗情况，并描述与使用蝎子抗毒血清相关的问题。
患者在被蜇伤2小时后被送往当地军事治疗机构，最初症状轻微。随后出现呼吸急促和焦虑，患者被镇静、插管，并被空运至一家大型空军医疗设施接受更高级别的护理。飞行途中需要血管活性药物支持。在医疗设施中，给予了抗毒血清，患者的心脏状况通过去甲肾上腺素滴注、轻度补液和血管活性药物支持得以稳定。需要第二剂用氯化钠稀释的抗毒血清和进一步的升压支持。ST段压低最终得以缓解，患者逐渐停用去甲肾上腺素并拔管。她在2周内完全康复并重返现役。
由于所用抗毒血清未获美国食品药品监督管理局批准，需要获得知情同意；然而，由于患者昏迷、插管且处于生死攸关的状态，无法获得同意。抗毒血清的选择基于蝎子的种类和症状严重程度；因此，应极其小心地杀死蝎子以进行鉴定。在军事环境中，抗毒血清使用的库存控制、储存和问责是至关重要的问题，本文对此进行了讨论。
立即采取行动和有效沟通，以及及时给予抗毒血清和配备完善的重症监护设施，对于挽救这名黄蝎子蜇伤受害者的生命至关重要。西南亚所有三级设施都必须熟悉这种抗毒血清的订购、给药和记录，因为它难以获得且供应稀少。
