Difference between revisions of "Sea urchins"
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==Background== | ==Background== | ||
| + | *Sea urchins are marine invertebrate echinoderms | ||
| + | *Anatomy consists of soft viscera surrounded by a hard plated body with protruding spines and pedicellariae | ||
| + | *Around 950 known species and some are venomous<ref>Auerbach P. Chapter 73. Envenomation by aquatic invertebrates. In: Auerbach P. Wilderness Medicine.</ref> | ||
| + | **Nonvenomous species have blunt, rounded spines | ||
| + | **Venomous species have sharp, hollow, thin spines | ||
| + | **Some have pedicellariae with sharp jaws and venom glands | ||
| + | ===Mechanism=== | ||
| + | *Nonvenomous spines cause direct trauma | ||
| + | *Venoms are known to contain proteases, hemolysins, steroid glycosides, serotonin, cholinergic substances, and rarely neurotoxins | ||
| + | *Pedicellariae attach to the victim and break off from the urchin, releasing venom for several hours | ||
==Clinical Features== | ==Clinical Features== | ||
| + | [[File:PMC3760923 abd-88-0496-g09.png|thumb|Black sea urchins (''Echinometra lucunter''). Below: spinesin the feet of bathers. Right: hyperkeratotic noduleson the hands of a diver who suffered several injuries caused by black sea urchins (foreign body granuloma).]] | ||
| + | |||
| + | *Minor to severe pain the the site of the embedded spine | ||
| + | *Venomous spines and pedicellariae generally cause much more severe pain and may be accompanied by systemic signs and symptoms with a significant envenomation including [[pruritus]], [[nausea]], vomiting, [[abdominal pain]], [[respiratory distress]], [[paresthesias]], muscle [[weakness]], and [[hypotension]] | ||
| + | *Rarely severe envenomations can lead to death | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| − | + | {{Marine envenomation DDX}} | |
==Evaluation== | ==Evaluation== | ||
| + | *Clinical diagnosis | ||
| + | *Plain films of the injured areas to locate embedded spines | ||
| + | **Evaluate for intraarticular spines | ||
| + | **Ultrasound may be useful if none are seen but radiolucent FB is suspected | ||
| + | **MRI can also locate spines not seen on plain film | ||
==Management== | ==Management== | ||
| + | *Emersion in non-scalding water up to 45°C | ||
| + | *Prompt removal of pedicellariae | ||
| + | *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== | ||
| + | *Depends on the extent and location of injury and degree of envenomation | ||
| + | ==Complications== | ||
| + | *Retained spines | ||
| + | *Infection ('''[[Vibrio]]''' species) | ||
| + | *Granuloma and cyst formation | ||
==See Also== | ==See Also== | ||
| − | + | *[[Marine toxins and envenomations]] | |
| + | *[[Cone shells]] | ||
| + | *[[Lionfish]] | ||
==External Links== | ==External Links== | ||
| Line 25: | Line 59: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
| + | [[Category:Environmental]] | ||
Latest revision as of 17:49, 25 October 2020
Contents
Background
- Sea urchins are marine invertebrate echinoderms
- Anatomy consists of soft viscera surrounded by a hard plated body with protruding spines and pedicellariae
- Around 950 known species and some are venomous[1]
- Nonvenomous species have blunt, rounded spines
- Venomous species have sharp, hollow, thin spines
- Some have pedicellariae with sharp jaws and venom glands
Mechanism
- Nonvenomous spines cause direct trauma
- Venoms are known to contain proteases, hemolysins, steroid glycosides, serotonin, cholinergic substances, and rarely neurotoxins
- Pedicellariae attach to the victim and break off from the urchin, releasing venom for several hours
Clinical Features
- Minor to severe pain the the site of the embedded spine
- Venomous spines and pedicellariae generally cause much more severe pain and may be accompanied by systemic signs and symptoms with a significant envenomation including pruritus, nausea, vomiting, abdominal pain, respiratory distress, paresthesias, muscle weakness, and hypotension
- Rarely severe envenomations can lead to death
Differential Diagnosis
Marine toxins, envenomations, and bites
- Toxins
- Stingers
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish)
- Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Sea anemones
- Seabather's eruption
- Phylum porifera (sponges)
- Bites
- Infections
Evaluation
- Clinical diagnosis
- Plain films of the injured areas to locate embedded spines
- Evaluate for intraarticular spines
- Ultrasound may be useful if none are seen but radiolucent FB is suspected
- MRI can also locate spines not seen on plain film
Management
- Emersion in non-scalding water up to 45°C
- Prompt removal of pedicellariae
- 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
- Depends on the extent and location of injury and degree of envenomation
Complications
- Retained spines
- Infection (Vibrio species)
- Granuloma and cyst formation
See Also
External Links
References
- ↑ Auerbach P. Chapter 73. Envenomation by aquatic invertebrates. In: Auerbach P. Wilderness Medicine.