Crown-of-Thorns starfish envenomation: Difference between revisions
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==Background <ref>Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.</ref>== | ==Background <ref>Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.</ref>== | ||
[[File:CrownofThornsStarfish Fiji 2005-10-12.jpg|thumb|Crown-of-thorns starfish in Fiji.]] | |||
[[File:Acanthaster ellisii.jpg|thumb|Short-spined form from Gulf of California.]] | |||
[[File:COTS aboral surface.jpg|thumb|Spines at closeup view.]] | |||
*A central disk with radiating arms | *A central disk with radiating arms | ||
**More than 15 arms | **More than 15 arms | ||
*Densely covered with spines | *Densely covered with spines | ||
*Adults are often dull brown to green colored | *Adults are often dull brown to green colored | ||
**some may have | **some may have bright colors to warn predators | ||
*Range from 9-14 inches in diameter | *Range from 9-14 inches in diameter | ||
===Mechanism<ref>Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.</ref>=== | ===Mechanism<ref>Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.</ref>=== | ||
*Spines pierce the skin and cause severe pain | |||
**Lasting <3 hours | |||
*Spines are coated with a slime that is extremely toxic | |||
==Clinical Features<ref>Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.</ref>== | ==Clinical Features<ref>Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.</ref>== | ||
*In severe cases can cause paralysis, hemolysis, & hepatotoxicity | |||
*Paresthesia | |||
*Nausea & vomiting | |||
*Secondary infection | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management<ref>Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.</ref>== | ==Management<ref>Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.</ref>== | ||
*Emersion in non-scalding water up to 45°C & Local lidocaine for pain control | |||
*Remove spines/foreign bodies | |||
**If spines are intraarticular or near neurovascular structures they need to be carefully removed in the OR | |||
*Thorough irrigation | |||
*Update [[tetanus vaccination]] if needed | |||
*Prophylactic [[antibiotics]] for deep puncture wounds | |||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Marine toxins and envenomations]] | *[[Marine toxins and envenomations]] | ||
==References== | |||
[[Category:Environmental]] | |||
[[Category:Dermatology]] | |||
Latest revision as of 14:44, 25 November 2021
Background [1]
- A central disk with radiating arms
- More than 15 arms
- Densely covered with spines
- Adults are often dull brown to green colored
- some may have bright colors to warn predators
- Range from 9-14 inches in diameter
Mechanism[2]
- Spines pierce the skin and cause severe pain
- Lasting <3 hours
- Spines are coated with a slime that is extremely toxic
Clinical Features[3]
- In severe cases can cause paralysis, hemolysis, & hepatotoxicity
- Paresthesia
- Nausea & vomiting
- Secondary infection
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
Management[4]
- Emersion in non-scalding water up to 45°C & Local lidocaine for pain control
- Remove spines/foreign bodies
- If spines are intraarticular or near neurovascular structures they need to be carefully removed in the OR
- Thorough irrigation
- Update tetanus vaccination if needed
- Prophylactic antibiotics for deep puncture wounds
Disposition
- If hemodynamically stable, patient may be discharged home
See Also
References
- ↑ Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.
- ↑ Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.
- ↑ Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.
- ↑ Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.