Diferencia entre revisiones de «Sea urchins»
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==Background== | ==Background== | ||
*Sea urchins are marine invertebrate echinoderms | *Sea urchins are marine invertebrate echinoderms | ||
*Anatomy consists of soft viscera surrounded by a hard plated body with protruding spines and pedicellariae | *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> | *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 | **Nonvenomous species have blunt, rounded spines | ||
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===Mechanism=== | ===Mechanism=== | ||
*Nonvenomous spines cause direct trauma | *Nonvenomous spines cause direct trauma | ||
**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> | |||
*Venoms are known to contain proteases, hemolysins, steroid glycosides, serotonin, cholinergic substances, and rarely neurotoxins | *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 | *Pedicellariae attach to the victim and break off from the urchin, releasing venom for several hours | ||
Revisión del 03:54 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
- They commonly break off, causing hyperpigmentation of the skin and secondary infection[2]
- 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
- Minor to severe pain the the site of the embedded spine
- 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
- 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
- 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
- Prompt removal of pedicellariae
- 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
- Depends on the extent and location of injury and degree of envenomation
Complications
- Retained spines
- Infection (Vibrio species)
- Granuloma and cyst formation