Diferencia entre revisiones de «Stingray injury»
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==Background== | ==Background== | ||
[[File:Dasyatis pastinaca01.jpg|thumb|Common stingray (''Dasyatis pastinaca'')]] | |||
[[File:Stringray's sting.jpg|thumb|A stingray's stinger (ruler in cm)]] | |||
*Stinger punctures skin to introduce heat-labile venom | *Stinger punctures skin to introduce heat-labile venom | ||
*Generally causes local symptoms without systemic effects | *Generally causes local symptoms without systemic effects | ||
*Often occurs when swimmers accidentally step on stingray in shallow water. Can be avoided by shuffling feet along bottom. | *Often occurs when swimmers accidentally step on stingray in shallow water. Can be avoided by shuffling feet along bottom. | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Stingray injury.jpg|thumb|Treatment of stingray injury with hot water.]] | |||
*Symptoms can vary by species | *Symptoms can vary by species | ||
*Associated with puncture or jagged laceration | *Associated with puncture or jagged laceration | ||
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==Management== | ==Management== | ||
*'''Immediately immerse wound in hot water (45°C for 30-90min)''' <ref>Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.</ref> | *'''Immediately immerse wound in hot water (45°C for 30-90min)''' <ref>Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.</ref> | ||
**Hot water is thought to denature the thermolabile venom | **Hot water is thought to denature the thermolabile venom | ||
Revisión del 17:48 11 mar 2021
Background
- Stinger punctures skin to introduce heat-labile venom
- Generally causes local symptoms without systemic effects
- Often occurs when swimmers accidentally step on stingray in shallow water. Can be avoided by shuffling feet along bottom.
Clinical Features
- Symptoms can vary by species
- Associated with puncture or jagged laceration
- Local pain, irritation, erythema
- Systemic symptoms can include vomiting, muscle cramps, hypotension, paralysis, cardiac arrest
Differential Diagnosis
Marine toxins, envenomations, and bites
- Toxins
- Ciguatera
- Scombroid
- Tetrodotoxin (e.g. pufferfish)
- Shellfish poisoning
- Amnesic shellfish poisoning
- Diarrheal shellfish poisoning
- Neurotoxic shellfish poisoning
- Paralytic shellfish poisoning
- Stingers
- Venomous fish
- Cone shell
- Lionfish
- Sea urchins
- Crown-of-Thorns Starfish
- Stonefish
- Other: Catfish, zebrafish, scorpion fish
- Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Sea anemones
- Seabather's eruption
- Phylum porifera (sponges)
- Bites
- Infections
Evaluation
- Clinical diagnosis
- Consider x-ray to evaluate for retained foreign body (stinger)
Management
- Immediately immerse wound in hot water (45°C for 30-90min) [1]
- Hot water is thought to denature the thermolabile venom
- Supportive care
- Remove spines and stinger, if visible
- XR for evaluation of foreign bodies
- Tetanus prophylaxis
- Prophylactic antibiotics are controversial - if used, give ciprofloxacin to cover Vibrio vulnificus
Disposition
- Discharge
See Also
External Links
References
- ↑ Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.