What to do when stung by scorpions

If you expect to know how to treat scorpion sting here, you're mistaken.
Here, I'll outline some of the treatments used for scorpion stings, some of which is proven useless or even dangerous. All cases of stings by unidentified scorpions or medically important ones are to be referred to qualified physician. If you show any of the systemic symptoms written in the symptoms section, go to the nearest hospital.
Some physician in private clinics are not acquainted with scorpion sting treatment/observation so going to hospital is your best bet.

On your part

1) Stay calm.
Going into anxiety only makes things worse. You may not think properly and act rashly resulting in other injuries. It also worsen the circulatory condition by channeling the blood to the wrong areas. It's easier said than done but you may try telling yourself this; less than 0.01% of the stings causes serious envenomation symptoms. That's 1 in 10,000. Ask yourself when you last struck lottery.

2) Signal for help
Since you most likely can't think straight, inform others and let others do the thinking and walking.

3) Move to the nearest shade to rest when help is on the way
Simple as that. Make yourself comfortable despite the pain........

4) Clean the wound.
Keep it clean to prevent infection. However, I must note that stings usually don't have much traumatic damage to tissue. Nevertheless, keep yourself occupied with minor non-energy sapping task.

5) Think positive
Do not start writing your will there and then. It may well be a self fulfiling prophecy. The danger is real for negative thinking is known to weaken the body defence. If nothing else, try to identify the scorpion which stings you to prevent straying into some dark alleys of thoughts. If that causes distress, forget it. How about Mr Bean?
ps: however, don't let the helpers think you've gone delirious

6) Don't touch the scorpion yourself, be it dead or alive.
Supposedly squashed and dead scorpions may be able to give another nasty sting. Someone on the scorpion mailing list got one from his squashed C.exilicauda just like that. Get others to use something other than barehands to pick up dead scorpion for identification.

Some traditional 'treatments' and first aid

1) Slash the site of sting to let the venom flow out.
Sounds effective but it is not. DO NOT slash yourself. You put yourself at risk of secondary infection by bacteria. This can be way worse than the effect of the toxin. Also blood loss will probably worsen your condition. I've seen pictures with gangrenous, decaying hands and legs from such actions and these are avoidable if they do not foolishly slash themselves.
Personal verdict: Dangerous and foolish

2) Amputate the limb.
Hollywood favourite. Actual effectiveness is very questionable.
In snake bites which is intravenous, you must chop off your limb within the first 10 seconds to stem the venom spread. For subcutaneous stings as in that of scorpion, you may have slightly more time. Unless you can find a huge chopper in the first 30 seconds and decisively amputate your limb, it is futile. In any case, you are more likely die from blood loss than any known scorpion stings........... For the 'heros', let's see if they can fix back the missing hand after discovering that it's just a mildly venomous species. When bionic hands like Luke Skywalker's one (Star Wars) is available, I may consider..... (joking)
Personal verdict: Very dangerous and foolish (High entertainment value)

3) Drink alcohol
Another well known 'remedy'. The alcohol which is a barbiturate do help ease the pain and anxiety in sufficient quantity. However, alcohol speeds up blood flow and probably hasten the venom spread. Also alcohol needs to be detoxified by the liver and this competes with detoxification of venom. This may further increase the long biological half life of scorpion toxin. Other than that alcohol which is a depressant may increase the effect of some toxins.
Personal verdict: not recommended and quite dangerous.

4) Tie a tourniquet
Another well known technique extensively practice even in modern first aid. Applied properly, it may help but Australian venom authorities recommend compression immobility method instead. Recent studies shows that the tourniquet applied at the proximal site when released for short interval increase the blood flow many fold and this means that the venom spread may instead be hasten.
The biggest problem is that most of people except qualified first aider DO NOT know the correct pressure, position and time to apply the tourniquet. I'll not deal with the right way here cause I do not recommend it as well. Reason is simple, applied for too long, you basically lose the limb being tied due to lack of blood to it. Applied at wrong site cause more harm than good and even when applied properly, it is not very useful as the Australian researchers (they have more venomous snakes than non-venomous ones and yet have good track record) found out.
Personal verdict: not recommended

5) Give strong narcotics like morphine
Morphine and opiums has been used to 'treat' scorpion stings. They are powerful analgesics (pain reliefer) which reduces the intense pain caused by scorpion stings. This is even recommended in some old books I read. The not-so-recent findings is a big 'NO'. Do not use them even for symptomatic relief. They also cause respiratory depression and this potentiate (increase disproportionately) the effect of neurotoxin. In the past, probably many death each year is directly or indirectly caused by this treatment rather than the scorpion venom.
Personal verdict: NEVER do that. Can lead to death.

6) Rest the victim at home instead of going to hospital
Most of the symptoms of scorpion stings recedes before 72 hours in most cases if the patient is given rest. These looks like miraculous recovery as the symptoms are known to disappear quite suddenly on it's own. As such, not going to hospital is not such a bad option if you are sure the species is not a dangerous one. Being under constant observations of qualified physician is an advantage but is quite costly and troublesome for some.
Personal verdict: Not a bad option if the species is convincingly a non-dangerous one.

7) Drink lots and lots of water
Some people claim that drinking water helps flush the system of the venom. Drinking water probably do temporarily dilutes the venom but it increases the load on the kidney. Kidney is pivotal to elimination and some metabolism of toxin so increasing its load may not be such a great idea. However, do have sufficient water intake at all times.
Personal verdict: Not recommended

8) Suck the venom out.
A rather dangerous act for the one attempting. If it's successful, the venom may enter the rescuer through ulcers in mouth, oesophagus, stomach or even intestine. Many may not be aware of ulcers in stomach and oesophagus. This results in two victims instead of one and the rescuer would be of more use calling for help. In any case, it is quite unlikely to suck out much, if any, venom this way. More probably, one will be just sucking another's blood if done strongly enough. This also increases the risk of infection as mouth has one of the most bacteria (besides the anus) in the body.
Personal verdict: Quite neutral but may be a possible desperate measure. Use something else if available.

9) Use the hemolymph of the scorpion
Scorpions are known to be quite resistant to their own venom. Some kill the scorpion and apply the scorpion's fluid into the site of sting thinking that it will neutralise the venom. On its own, the hemolymph (or bluish blood) of the scorpion is known to be slightly toxic in the test with mice and rabbits. However, the hemolymph seems to have slight beneficial effect when applied to envenomated individuals in a controlled environment. The danger of this treatment is the increased chance of developing allergy as the hemolymph is also a foreign substance.
Personal verdict: Ambiguous

10) Use of some curative herbal plants/ scorpion in tea
This relates more to traditional medicine. Most such practice does not cause harm but one must be aware that some plants are poisonous or may contain the abovestated dangerous narcotics. If there's narcotics, it provides temporary relief as pain is reduced but as mentioned the danger far outweighs the short term benefit except when used in the hands of qualified physicians. As for their effectiveness, I really don't know but it does ease the mental anxiety which plays a role in recovery.
Personal verdict: Don't know

11) Use of talisman burnt in water/ praying
Quite definitely not helpful in actual detoxification but again may give mental reassurance which may be helpful. As for getting help from God, I leave it to one's religious belief to decide
Personal verdict: not for me to say.

12) Apply vinegar
Probably helps because scorpion venom is basic and vinegar is acidic. I really don't know if the salt which results is for the better or the worse.
Personal verdict: ??

In short, my opinion is that many traditional treatments is useless or downright dangerous. Resting is perhaps the best the traditional practice has.

Modern treatment

1) Cold compression
Application of ice packs and slight and continuous wide area compression (big wide bandage covering the site of sting and areas distal and proximal to it as well) has been advocated. This can probably slow down the spread of venom so that medical attention can be reached.
Personal verdict: Good idea! But do not waste time trying to get ice if it's not readily available. Doing elaborate bandaging is also counter-productive as medical attention is what is required.

2) Local analgesics (eg codeine or aspirin)
Codeine though is a opioid narcotic which can cause respiratory depression at high dose is generally quite safe to use with proper knowledge of dosage. Aspirin is safer but is actually one of the more dangerous non steroidal anti-inflammatory(NSAID) drug. However, being over the counter (OTC) and quite a familiar drug, it is more readily available. It may help reduce the symptoms a little.
Personal verdict: Passable

3) Barbiturates other than alcohol
Phenobarbitones may be quite a useful anti-anxiety drug for the nervous when given at non-hypnotic dose. Other drugs like atropine (not a barbiturate) may sometimes be used as a blocker. Choice is dependent on the school of thought
Personal verdict: I don't know. If the physician administer it, let's hope he knows his work.

4) Antivenom
Most must think that 'yes, this is the one'. The hard fact is that it's use is limited, unpredictable and not very effective. In snake antivenom, there is a relative success but scorpion is another story altogether.
First, a scorpion's toxin is a very bad antigen. The antibodies produced against it, unlike in snakes, usually is so specific that even different sub species or geographic race needs different anti-venom. This means that antivenom produce in one country is not effective in another country by the same species. Also it is species specific such that each species requires a different antivenom.
Another reason is that scorpion produces very little venom with each milking and many thousands is required to induce immunity in the antivenom producing animal. It also takes a long time. The effectiveness of the antivenom for scorpion today has not been proven to be very effective. Then again different researchers differs on this. Normally, the producer of antivenom claims it to be very effective through scientifically sound studies. However, this is open to question.
Also positive identification of species must be done for the proper antivenom to be selected. This is at best an educated guess as few people can identify any scorpion to the subspecies level which is necessary for antivenom selection. For identification to be possible, the scorpion must be brought in and by the time the experts identifies the scorpion, it may be too late or useless to use the antivenom. Of course, if the doctor happen to be knowledgeable in scorpion, all the better.
Another point is that the goat or horse producing the antibodies (antivenom) is considered as a foreign body. As a result, one may develop allergy against the antivenom and subsequent administration may prove to be dangerous as a result of anaphylaxis to the antivenom. It's possible some victims are killed by the antivenom this way.
Dosage is another controversial area. The recommended dose is often insufficient to have much therapeutic effect and the actual dosage is really the discretion of the doctor.
Personal verdict: The only known treatment but effectiveness is questioned. Still, it is widely used.

5) Seeing a qualified physician
It really depends on who you approach. Generally this is helpful as physician even if they are unable to help in detoxification, can monitor your condition and give appropriate symptomatic relief and advice.
Personal verdict: Recommended for not very severe cases

6) Hospitalisation
This depends on your condition. In any case, being in hospital is your best bet. There, you may be observed, given antivenom, local analgesics and resuscitation if necessary. Even if the antivenom is ineffective, the facilities can put one on life substaining machines to stall time for self-detoxification. Anaphylaxis which is a one of the causes of death can also be managed with anti histamines etc. Symptomatic relief also helps to boost the victim's survival chance.
The disadvantage of hospitalisation is that the cost may be forbidding and unnecessary. It may not be recommended for victims stung by non-dangerous species and no signs of serious envenomation to go to hospital. This helps other people who really needs medical help.
Personal verdict: Recommended for potentially serious case.

7) Immobilisation
Thought to reduce spread and may have truth in it. However, if immobilisation means staying there without being attended by qualified physician, get going. Running, however, is not recommended.
Personal verdict: Okay but must weigh the benefits.

8) Apply antiseptic
Yes, a good first aid. It does not neutralise the venom but sure helps to reduce chance of infection at the site. The last thing you want is to have infection compounded on envenomation.
Personal verdict: Great idea.

We see here that modern treatment like antivenom is not bombproof.
The fortunate thing is that even stings by the most venomous species like Leiurus quinquestriatus or Androctonus australis very rarely results in death. This is applicable even to healthy children but children already suffering from serious illness (esp. respiratory or cardiovascular problems) MUST seek medical attention. Death among this particular group may exceed 50%. In most adults, death from stings of A.australis is not likely to exceed 2%. This already represents a significant percentage so stings by the 30 or so species should be referred to hospital.

Symptoms of scorpion sting are known to recede 'mysteriously' on its own (without treatment). Most envenomation does not last longer than 72 hours. In general, if the patient survive over 48 hours, the prognosis is very good. Many traditional remedies are thought to be useful because of this property.

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