Stonefish envenomation

Revision as of 02:03, 1 September 2021 by Jonrako (talk | contribs) (Management)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)

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