Ver el código de «Crown-of-Thorns starfish envenomation»

==Background <ref>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.</ref>==
[[File:CrownofThornsStarfish Fiji 2005-10-12.jpg|thumb|Crown-of-thorns starfish in Fiji.]]
[[File:Acanthaster ellisii.jpg|thumb|Short-spined form from Gulf of California.]]
[[File:COTS aboral surface.jpg|thumb|Spines at closeup view.]]
*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 bright colors to warn predators
*Range from 9-14 inches in diameter

===Mechanism<ref>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.</ref>===
*Spines pierce the skin and cause severe pain
**Lasting <3 hours
*Spines are coated with a slime that is extremely toxic

==Clinical Features<ref>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.</ref>==
*In severe cases can cause paralysis, hemolysis, & hepatotoxicity
*Paresthesia
*Nausea & vomiting
*Secondary infection

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

==Management<ref>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.</ref>==
*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==
*[[Marine toxins and envenomations]]

==References==

[[Category:Environmental]]
[[Category:Dermatology]]