Crown-of-Thorns Starfish

Background [1]

  • A central disk with radiating arms
    • More than 15 arms
  • Densely covered with spines
  • Adults are often dull brown to green colored
    • some may have vright colors to warn predators
  • Range from 9-14 inches in diameter

Mechanism[2]

  • Spines pierce the skin and cause severe pain
    • Lasting <3 hours
  • Spines are coated with a slime that is extremely toxic

Clinical Features[3]

  • In severe cases can cause paralysis, hemolysis, & hepatotoxicity
  • Paresthesia
  • Nausea & vomiting
  • Secondary infection

Differential Diagnosis

Marine toxins, envenomations, and bites

Management[4]

  • Emersion in non-scalding water up to 45°C & Local lidocaine for pain control
  • 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

  • If hemodynamically stable, patient may be discharged home

See Also

  • Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.
  • Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.
  • Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.
  • Hauglid, Christopher, DO, et al. “EMERGEN-SEA MEDICINE: An Overview of Sea Urchins, Coral, Starfish, and More.” ACEP Now, vol. 40, no. 7, 2021, pp. 8–9.