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10.22 Marine envenomations


Presentation

After swimming in the ocean and coming into contact with marine life, the patient may seek medical attention because of local pain or swelling or skin discoloration. Marine animal envenomations can be divided into two major categories: puncture wounds and focal rashes. Severe envenomations can be accompanied by systemic symptoms like vomiting, paralysis, seizures, respiratory distress and hypotension, but this review is limited to the more common local injuries.

What to do:

What not to do:

Discussion

Any wound acquired in the marine environment can become infected, and this is particularly likely if the wound is large, a puncture, or contaminated with bottom sediment or organic matter.

Stingray victims are generally innocent beach walkers who step on the back of the ray, which reflexively strikes upward with its tail, inflicting a penetrating wound along the upper foot, ankle, or lower leg. The anatomical structure of the stingray's back causes a deep, jagged, painful wound that may contain fragments of barb located proximal to the tail.

Scorpionfish, lionfish and stonefish stings occur in divers and fisherman, and sometimes keepers of marine aquariums or those involved in illegal tropical fish trade. Catfish stings are common when the fish are handled or kicked. Certain catfish species produce a venom in glands at the base of the dorsal spine, but most do not, and catfish venom causes only mild local pain, redness and swelling. Of more concern is the wound caused by the spine and the likelihood of infection.

Sea urchin victims are stung when the step on, handle, or brush up against these sessile creatures. The sea urchin secretes a toxin on the surface of its spines, which is transferred into the wound when they penetrate the skin. The brittle spines also tend to break off and remain in the wound.

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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