Stingray injury: Difference between revisions
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==Background== | ==Background <ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf</ref>== | ||
[[File:Dasyatis pastinaca01.jpg|thumb|Common stingray (''Dasyatis pastinaca'')]] | [[File:Dasyatis pastinaca01.jpg|thumb|Common stingray (''Dasyatis pastinaca'')]] | ||
[[File:Stringray's sting.jpg|thumb|A stingray's stinger (ruler in cm)]] | |||
* | *Stinger contains a retroserrate barb and venom glands located on the tail. | ||
*Generally local symptoms without systemic effects | *There are two phases to injury. | ||
**Phase one is d/t the traumatic injury from the barb, which can inflict injury to vital organs (e.g. Steve Irwin) | |||
**Phase two is d/t heat-labile venom release, which causes vasospasm with possible limb ischemia, cardiotoxicity, seizure, and/or death. | |||
*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== | ==Clinical Features== | ||
[[File:Stingray injury.jpg|thumb|Treatment of stingray injury with hot water.]] | |||
* | *Symptoms can vary by species | ||
* | *Associated with puncture or jagged laceration | ||
*Systemic symptoms can include | *Local pain which can last up to 48 hours | ||
*Limb ischemia secondary to vasospasm | |||
*Cardiotoxicity (e.g. dysrhythmias, heart block, non-ST segment elevation myocardial infarction)<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf</ref> | |||
*Systemic symptoms can include seizures, [[vomiting]], muscle cramps, [[hypotension]], [[weakness|paralysis]], and even [[cardiac arrest]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Marine envenomation DDX}} | {{Marine envenomation DDX}} | ||
== | ==Evaluation== | ||
*Consider x-ray for retained foreign body (stinger) | *Clinical diagnosis | ||
*Consider x-ray to evaluate for retained foreign body (stinger) | |||
==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 | |||
*Remove spines and stinger, if visible | |||
*XR for evaluation of foreign bodies | |||
*[[Tetanus prophylaxis]] | *[[Tetanus prophylaxis]] | ||
*Prophylactic [[antibiotics]] | *Prophylactic [[antibiotics]] are controversial - if used, give [[doxycycline]] or [[ciprofloxacin]] to cover ''[[Vibrio vulnificus]]'' | ||
*Infusion of prostaglandin E1 has resulted in successful salvage of an ischemic leg, but insufficient datat exists to recommend this as routine therapy.<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf</ref> | |||
*There is no antivenom available. | |||
==Disposition== | ==Disposition== | ||
* | *Discharge | ||
==See Also== | ==See Also== | ||
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==External Links== | ==External Links== | ||
== | |||
==References== | |||
<references/> | <references/> | ||
[[Category: | [[Category:Toxicology]] | ||
[[Category:Environmental]] | |||
Latest revision as of 01:20, 1 September 2021
Background [1]
- Stinger contains a retroserrate barb and venom glands located on the tail.
- There are two phases to injury.
- Phase one is d/t the traumatic injury from the barb, which can inflict injury to vital organs (e.g. Steve Irwin)
- Phase two is d/t heat-labile venom release, which causes vasospasm with possible limb ischemia, cardiotoxicity, seizure, and/or death.
- 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 which can last up to 48 hours
- Limb ischemia secondary to vasospasm
- Cardiotoxicity (e.g. dysrhythmias, heart block, non-ST segment elevation myocardial infarction)[2]
- Systemic symptoms can include seizures, vomiting, muscle cramps, hypotension, paralysis, and even 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) [3]
- 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 doxycycline or ciprofloxacin to cover Vibrio vulnificus
- Infusion of prostaglandin E1 has resulted in successful salvage of an ischemic leg, but insufficient datat exists to recommend this as routine therapy.[4]
- There is no antivenom available.
Disposition
- Discharge
See Also
External Links
References
- ↑ Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf
- ↑ Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf
- ↑ 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.
- ↑ Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf