Centipede Envenomation Treatment & Management

Updated: May 04, 2017
  • Author: Robert L Norris, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Treatment

Prehospital Care

No specific first aid measures are available for centipede stings. Seek medical care if pain persists or systemic symptoms occur. Local application of ice may reduce some of the discomfort; however, others have anecdotally found that local heat application or immersion in hot (nonscalding) water is more comforting. [12, 13]  This may reflect the thermolabile properties of a number of centipede venom constituents.

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Emergency Department Care

Management of centipede stings is entirely supportive.

Pain may be managed with systemic analgesics, as necessary. Pain may be managed with local injectable anesthetics (eg, lidocaine, bupivacaine). These can be injected locally or used in performing a regional nerve block. A standard text should be consulted regarding techniques of regional anesthesia.

Tetanus status should be updated as needed.

Prophylactic antibiotics are not necessary, but secondary infections should be cultured and treated with appropriate antibiotics (to cover gram-positive bacteria).

Antihistamines can be used for patients with significant pruritus.

Patients should be observed for approximately 4 hours for evidence of systemic toxicity.

Patients presenting with anaphylaxis should be managed in standard fashion (Anaphylaxis).

If soft tissue swelling is severe or rhabdomyolysis is evident after centipede envenomation, the patient should be admitted and observed for development of compartment syndrome and management of myoglobinuria as needed.

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Consultations

Most centipede stings are minor and do well with conservative management. In rare, more severe cases, consultation with a regional poison control center specialist may be helpful. Occasionally, a specialist will need to be involved, such as the following:

  • Surgeon: When there is concern for a possible developing compartment syndrome (for compartmental pressure testing and, if elevated, fasciotomy)
  • Cardiologist: If the patient has findings concerning for cardiac complications
  • Nephrologist: If rhabdomyolysis occurs and is complicated by acute renal injury
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Prevention

Never touch or handle centipedes.

Use caution when gardening, turning soil, or picking up rocks.

Work gloves may be very helpful in preventing stings.

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Long-Term Monitoring

Observe patients for evidence of infection or necrosis. Manage local necrosis by sound conservative wound care.

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