Stonefish envenomation: Difference between revisions

(Created page with "==Background== ==Clinical Features== ==Differential Diagnosis== ==Evaluation== ===Workup=== ===Diagnosis=== ==Management== ==Disposition== ==See Also== ==Externa...")
 
 
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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:Stone Fish at AQWA SMC2006.jpg|thumb|Stonefish]]
 
*Synanceia genus of fish of the family Synanceiidae
==Clinical Features==
*Found in the coastal regions of the Indo-Pacific.
*This is a grey fish which possesses multiple venomous spines.
*The venom remains stable for up to 48 hours after the fish has died.
*This is the most venomous fish known, with venom likened to that of a cobra.
** The venom blocks cardiac calcium channels, increases systemic catecholamine release, simultaneously causing diffuse vasodilation and increased tissue destruction which propogates uptake of its own venom.


==Clinical Features <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:PMC4862076 12995 2016 112 Fig1 HTML.png|thumb|Extensive erythema, gross swelling up to the entire index finger, dorsum, and distal third forearm from stonefish envenomation.]]
*Local erythema, ecchymosis, swelling, necrosis
*Intense, sharp pain that peaks at 60 minutes but can lasts for days.
*Systemic toxicity:
**[[Hypotension]], [[tachycardia]], [[arrhythmia]], [[syncope]], [[vomiting]], [[compartment syndrome]], and [[pulmonary edema]] (cardiogenic)
*Death can occur in as few as 6 hours.


==Differential Diagnosis==
==Differential Diagnosis==
 
{{Marine envenomation DDX}}


==Evaluation==
==Evaluation==
===Workup===
===Workup===
*No specific testing available


===Diagnosis===
===Diagnosis===
*Clinical diagnosis


==Management==
==Management <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>==
 
*Pain management and venom neutralization is accomplished via hot-water (45 C) immersion for 30-60 minutes
*Clean wound, update [[tetanus prophylaxis|tetanus]], remove retained tissue
*One fifth of wounds develop local infection, but prophylactic antibiotics remain controversial <ref>*Hobday D, Chadha P, Din AH, Geh J. Denaturing the Lionfish. Eplasty. 2016 May 23;16:ic20. PMID: 27298709; PMCID: PMC4892334.</ref>
*High risk for ''Vibrio vulnificus'' which can lead to necrotizing fasciitis.
*Antivenom includes Commonweatlth Serum Laboratories stonefish antivenom.
**All doses are intramuscular d/t risk of anaphylactoid reaction.
**Give 1 vial for 1-2 puncture wounds, 2 vials for 3-4 wounds, etc.
**1 vial is equivalent to 2,000 units and neutralizes 20mg of venom


==Disposition==
==Disposition==
 
*Patients should be observed for 6-12 hours.<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>


==See Also==
==See Also==
 
*[[Marine toxins and envenomations]]


==External Links==
==External Links==
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==References==
==References==
<references/>
<references/>
[[Category:Environmental]]
[[Category:Toxicology]]

Latest revision as of 02:03, 1 September 2021

Background [1]

Stonefish
  • Synanceia genus of fish of the family Synanceiidae
  • Found in the coastal regions of the Indo-Pacific.
  • This is a grey fish which possesses multiple venomous spines.
  • The venom remains stable for up to 48 hours after the fish has died.
  • This is the most venomous fish known, with venom likened to that of a cobra.
    • The venom blocks cardiac calcium channels, increases systemic catecholamine release, simultaneously causing diffuse vasodilation and increased tissue destruction which propogates uptake of its own venom.

Clinical Features [2]

Extensive erythema, gross swelling up to the entire index finger, dorsum, and distal third forearm from stonefish envenomation.

Differential Diagnosis

Marine toxins, envenomations, and bites

Evaluation

Workup

  • No specific testing available

Diagnosis

  • Clinical diagnosis

Management [3]

  • Pain management and venom neutralization is accomplished via hot-water (45 C) immersion for 30-60 minutes
  • Clean wound, update tetanus, remove retained tissue
  • One fifth of wounds develop local infection, but prophylactic antibiotics remain controversial [4]
  • High risk for Vibrio vulnificus which can lead to necrotizing fasciitis.
  • Antivenom includes Commonweatlth Serum Laboratories stonefish antivenom.
    • All doses are intramuscular d/t risk of anaphylactoid reaction.
    • Give 1 vial for 1-2 puncture wounds, 2 vials for 3-4 wounds, etc.
    • 1 vial is equivalent to 2,000 units and neutralizes 20mg of venom

Disposition

  • Patients should be observed for 6-12 hours.[5]

See Also

External Links

References

  1. ↑ 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
  2. ↑ 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
  3. ↑ 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
  4. ↑ *Hobday D, Chadha P, Din AH, Geh J. Denaturing the Lionfish. Eplasty. 2016 May 23;16:ic20. PMID: 27298709; PMCID: PMC4892334.
  5. ↑ 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
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