Stingray injury: Difference between revisions
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==Management== | ==Management== | ||
*'''Immediately immerse wound in hot water (45°C for 30-90min)''' <ref>Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.</ref> | *'''Immediately immerse wound in hot water (45°C for 30-90min)''' <ref>Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.</ref> | ||
**Hot water is thought to denature the thermolabile venom | |||
*Supportive care | *Supportive care | ||
*Remove spines and stinger, if visible | *Remove spines and stinger, if visible | ||
Revision as of 02:02, 10 March 2021
Background
- Stinger punctures skin to introduce heat-labile venom
- Generally causes local symptoms without systemic effects
- Often occurs when swimmers accidentally step on stingray in shallow water. Can be avoided by shuffling feet along bottom.
Clinical Features
- Symptoms can vary by species
- Associated with puncture or jagged laceration
- Local pain, irritation, erythema
- Systemic symptoms can include vomiting, muscle cramps, hypotension, paralysis, cardiac arrest
Differential Diagnosis
Marine toxins, envenomations, and bites
- Toxins
- Ciguatera
- Scombroid
- Tetrodotoxin (e.g. pufferfish)
- Shellfish poisoning
- Amnesic shellfish poisoning
- Diarrheal shellfish poisoning
- Neurotoxic shellfish poisoning
- Paralytic shellfish poisoning
- Stingers
- Venomous fish
- Cone shell
- Lionfish
- Sea urchins
- Crown-of-Thorns Starfish
- Stonefish
- Other: Catfish, zebrafish, scorpion fish
- Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Sea anemones
- Seabather's eruption
- Phylum porifera (sponges)
- Bites
- Infections
Evaluation
- Clinical diagnosis
- Consider x-ray to evaluate for retained foreign body (stinger)
Management
- Immediately immerse wound in hot water (45°C for 30-90min) [1]
- Hot water is thought to denature the thermolabile venom
- Supportive care
- Remove spines and stinger, if visible
- XR for evaluation of foreign bodies
- Tetanus prophylaxis
- Prophylactic antibiotics are controversial - if used, give ciprofloxacin to cover Vibrio vulnificus
Disposition
- Discharge
See Also
External Links
References
- ↑ Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.