Diferencia entre revisiones de «Sea urchins»

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==Background==
==Background==
*Sea urchins are marine invertebrate echinoderms
*Found world wide in both shallow and deep waters
*Anatomy consists of soft viscera surrounded by a hard plated body ( called a "test") with protruding venomous spines and venomous pedicellariae
*Around 950 known species and some are venomous<ref>Auerbach P. Chapter 73. Envenomation by aquatic invertebrates. In: Auerbach P. Wilderness Medicine.</ref>
**Nonvenomous species have blunt, rounded spines
**Venomous species have sharp, hollow, thin spines
**Some have pedicellariae with sharp jaws and venom glands


===Mechanism===
*Nonvenomous spines cause direct trauma
*Venoms are known to contain proteases, hemolysins, steroid glycosides, serotonin, cholinergic substances, and rarely neurotoxins
*Pedicellariae attach to the victim and break off from the urchin, releasing venom for several hours


==Clinical Features==
==Clinical Features==
[[File:PMC3760923 abd-88-0496-g09.png|thumb|Black sea urchins (''Echinometra lucunter''). Below: spinesin the feet of bathers. Right: hyperkeratotic noduleson the hands of a diver who suffered several injuries caused by black sea urchins (foreign body granuloma).]]
*Minor to severe pain the the site of the embedded spine
**They commonly break off, causing hyperpigmentation of the skin and secondary infection<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>
*Venomous spines and pedicellariae generally cause much more severe pain and may be accompanied by systemic signs and symptoms with a significant envenomation including [[pruritus]], [[nausea]], vomiting, [[abdominal pain]], [[respiratory distress]], [[paresthesias]], muscle [[weakness]], and [[hypotension]]
*Rarely severe envenomations can lead to death




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


==Evaluation==
==Evaluation==


*Clinical diagnosis
*Plain films of the injured areas to locate embedded spines
**Evaluate for intraarticular spines
**Ultrasound may be useful if none are seen but radiolucent FB is suspected
**MRI can also locate spines not seen on plain film


==Management==
==Management==


*Emersion in non-scalding water up to 45°C & Local lidocaine for pain control
*Prompt removal of pedicellariae
*Remove spines/foreign bodies
**Attempts to remove spines are often futile due to their fragile and friable nature.
**Some areas may have an appearance of a spine due to "tattooing" of the skin<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>
**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==
==Disposition==
*Depends on the extent and location of injury and degree of envenomation


==Complications==
*Retained spines
*Infection ('''[[Vibrio]]''' species)
*Granuloma and cyst formation


==See Also==
==See Also==
 
*[[Marine toxins and envenomations]]
*[[Cone shells]]
*[[Lionfish]]


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

Revisión actual - 03:59 17 ago 2021

Background

  • Sea urchins are marine invertebrate echinoderms
  • Found world wide in both shallow and deep waters
  • Anatomy consists of soft viscera surrounded by a hard plated body ( called a "test") with protruding venomous spines and venomous pedicellariae
  • Around 950 known species and some are venomous[1]
    • Nonvenomous species have blunt, rounded spines
    • Venomous species have sharp, hollow, thin spines
    • Some have pedicellariae with sharp jaws and venom glands

Mechanism

  • Nonvenomous spines cause direct trauma
  • Venoms are known to contain proteases, hemolysins, steroid glycosides, serotonin, cholinergic substances, and rarely neurotoxins
  • Pedicellariae attach to the victim and break off from the urchin, releasing venom for several hours

Clinical Features

Black sea urchins (Echinometra lucunter). Below: spinesin the feet of bathers. Right: hyperkeratotic noduleson the hands of a diver who suffered several injuries caused by black sea urchins (foreign body granuloma).
  • Minor to severe pain the the site of the embedded spine
    • They commonly break off, causing hyperpigmentation of the skin and secondary infection[2]
  • Venomous spines and pedicellariae generally cause much more severe pain and may be accompanied by systemic signs and symptoms with a significant envenomation including pruritus, nausea, vomiting, abdominal pain, respiratory distress, paresthesias, muscle weakness, and hypotension
  • Rarely severe envenomations can lead to death


Differential Diagnosis

Marine toxins, envenomations, and bites

Evaluation

  • Clinical diagnosis
  • Plain films of the injured areas to locate embedded spines
    • Evaluate for intraarticular spines
    • Ultrasound may be useful if none are seen but radiolucent FB is suspected
    • MRI can also locate spines not seen on plain film

Management

  • Emersion in non-scalding water up to 45°C & Local lidocaine for pain control
  • Prompt removal of pedicellariae
  • Remove spines/foreign bodies
    • Attempts to remove spines are often futile due to their fragile and friable nature.
    • Some areas may have an appearance of a spine due to "tattooing" of the skin[3]
    • 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

  • Depends on the extent and location of injury and degree of envenomation

Complications

  • Retained spines
  • Infection (Vibrio species)
  • Granuloma and cyst formation

See Also

External Links

References

  1. ↑ Auerbach P. Chapter 73. Envenomation by aquatic invertebrates. In: Auerbach P. Wilderness Medicine.
  2. ↑ 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.
  3. ↑ 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.
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