- 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.
- 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
- Venomous fish
- Phylum porifera (sponges)
- Clinical diagnosis
- Consider x-ray to evaluate for retained foreign body (stinger)
- Immediately immerse wound in hot water (45°C for 30-90min) 
- 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
- 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.