SPONGES
Phylum porifera is the most harmless. Three species produce contact dermatitis, including the red-beard sponge (Micronia prolifera), fire sponge (Tedania ignis) and poison-bun sponge (Fibulila sp.). Of the 5000 species, only twelve are thought to be toxic.
Symptoms include: erythema (redness), arthralgias (joint pain), and edema (swelling).
Treatment: symptomatic with soothing lotions and topical steroids.
Links to Lionfish Injuries
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The seven principle marine predators are barracuda, moray eels, large grouper, killer whales, sea snakes, salt water crocodiles and sharks. Actual attacks and fatalities are rare, and occur when a diver is mistaken as a food source or intrudes into territory. Ditampilkan ulang oleh dr.Erick Supondha (Hyperbaric&Diving Medicine consultant) Jakarta, Indonesia. Emergency Diving&Hyperbaric Hotline 021 99070050 (indonesia) sumber :Ernest Campbell, MD, FACS, Diving Medicine Online, Scubadoc,s.com
Symptoms include: erythema (redness), arthralgias (joint pain), and edema (swelling).
Treatment: symptomatic with soothing lotions and topical steroids.
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SEA ANEMONES, CORALS
Phylum coelenterata (Cnidaria), Class Anthozoa. These possess nematocysts with potential for envenomation but primarily cause mechanical trauma to the skin, resulting in abrasions and lacerations that become easily infected.
Symptoms: pain, burning sensation and/or itching, erythema, edema and increased warmth.
Treatment: Thorough cleansing of the area involved (including debridement, if necessary). Debridement is excision of dead, avulsed tissue. Provide tetanus prophylaxis and topical antibiotics.
Treatment: Thorough cleansing of the area involved (including debridement, if necessary). Debridement is excision of dead, avulsed tissue. Provide tetanus prophylaxis and topical antibiotics.
Coral Dermatitis
Photos of anchor line contact dermatitis from nematocyst envenomation and direct trauma.
Photos of anchor line contact dermatitis from nematocyst envenomation and direct trauma.
JELLYFISH and HYDROIDS
- Phylum coelenterata, Class Scyphozoa (true jellyfish, sea wasp) and Class Hydrozoa (hydroids, Man-of -War). These possess nematocysts, a stinging apparatus formed within the cnidoblast and discharged on contact. Floating tentacles retain active nematocysts, which remain active even after drying. There is a wide range of toxicity, from mild to severe (Portugese Man-o-War, Physalia utriculus), and sea wasp, genera Chironex. (photo)The venom is complex, and includes proteins, enzymes, polypeptides and tetramine. Pain and local histamine release attributed to 5-hydroxytryptamine; the nerve conduction effects are due to tetramine (similar to curare).
- Symptoms: Rapid onset of pain, varying from mild to severe. A rash that is red, hot and swollen, usually linear. There is frequent pustule and vesicle formation. Anaphylaxis (circulatory collapse) is possible in sensitized individuals. Severe stings may cause muscle cramps, abdominal pain, fever, chills, nausea, vomiting, respiratory distress, and cardiovascular collapse. Fatalities are increased if there is pre-existing cardiac and respiratory disease. Chironex may cause death in healthy individuals in less than 15 minutes.
- Treatment: For Chironex, use topical vinegar to neutralize undischarged nematocysts and removal of remaining tentacles. There is some disagreement about using vinegar for removal of Physalia nematocytes - sea water being preferred. Topical analgesics and steroids or IV analgesics and hydrocortisone 100 mg IV every two hours are given. (Chironex).Cardiovascular monitoring and/or support are provided. Sea wasp antivenin is available (Australia Commonwealth Serum Lab.)
- Treatment of Severe Allergic Reaction to Jellyfish Remove any remnant of allergen (i.e., jellyfish tentacles, foreign material) Epinephrine injection, if available Decadron injection or tablets Antihistamine, if available Wash out wounds or injury with alcohol, vinegar or sea water Call for help and immediate transport Treat for shock CPR if no pulse or respirations Keep warm Oxygen Pain relief, if available References to Jellyfish stings SafeSea - Getting nailed by Jellies, by DocVikingo, printed with permission from Undercurrent
CROWN OF THORNS
- Phylum echinodermata, Class Asteroidea. Acanthaster planci. This is the only known venomous starfish, its arms having large spines with venom producing integument. The composition of the venom is unknown.
- Symptoms: Rapid onset of edema, erythema and pain.
- Cleanse the wound and apply topical antibiotics. Give tetanus protection.
SEA URCHIN (photo)
- Phylum echinodermata, Class Echinoidea. Multiple slender spines puncture the skin and break off.
- Symptoms: Immediate pain, joint pain edema and numbness.
- Treatment: Remove spines, cleanse, topical antibiotics and tetanus protection. Occasional surgical removal of spine fragments.
- There are about as many treatments for sea urchin puncture wounds as there are species of sea urchins (600--80 are thought to be venomous to humans). The long-spined black sea urchin is probably the culprit most often responsible, as the spines break off in the dermis, leaving a painful black spot. The black spot is only black pigment, the proteinaceous spine is the part that needs removal. (vertically).
Soaking in hot water for 60-90 minutes (see below) is said to offer relief from the pain and swelling (Cianci). Others espouse magnesium sulfate pastes (Edmonds). Snake bite suction cups are used by some to remove the spines while others go ahead and excise the area conservatively under local anesthesia.
Edmonds describes a treatment that he says works, "apply extra trauma and movement to the area involved in order to break up the spines in the tissue". Surgery is indicated for a foreign body reaction and intra-articular puncture, the latter being probably the most serious consequence of the accident. Topical antibiotics and tetanus protection should be offered.
Edmonds describes a treatment that he says works, "apply extra trauma and movement to the area involved in order to break up the spines in the tissue". Surgery is indicated for a foreign body reaction and intra-articular puncture, the latter being probably the most serious consequence of the accident. Topical antibiotics and tetanus protection should be offered.
Hand injuries from sea urchin spines
AUTHOR: Strauss MB; MacDonald RI
SOURCE: Clin Orthop 1976 Jan-Feb;(114):216-8
AUTHOR: Strauss MB; MacDonald RI
SOURCE: Clin Orthop 1976 Jan-Feb;(114):216-8
ABSTRACT: Sea urchin spine injury is usually a benign process that rarely comes to the attention of a physician. Aside from the transient episode of excruciating pain which responds dramatically to hot water soaks, there is usually no residual disability. As in any puncture wound, tetanus prophylaxis and observation for latent infection is advised. Complications arise, however, when spines are embedded over bony prominences, within joints, or in contact with nerves. Cases are reported herein of the latter two problems occurring in the hand. A case of a neuropathy associated with sea urchin injuries has not been previously reported in the literature. When such injuries necessitate exploration, aseptic surgical technique is required.
The following is from the Merck Manual: "Echinoderms: Pedicellariae stings are treated by washing the area and applying anantihistamine-analgesic-corticosteroid balm. Sea urchin spines should be removed immediately. A bluish discoloration at the site of entry may help in locating the spine, which may sometimes be seen by xeroradiogram. Vinegar dissolves most superficial spines, and soaking the wound in vinegar several times/day and covering the area with a wet vinegar compress may be sufficient; surgery is seldom necessary at this point. If a small incision needs to be made to extract the spine, care must be taken as it is very fragile. In time, a spine may migrate into deeper tissues and require surgical removal. "
Sam Shelanski, MD, Rodales Scuba Diving Doctor has these instructions for stingray, sea urchin and other toxic puncture wounds: "Rx: If possible, elevate the affected area and apply a pressure bandage. Both techniques will help slow the absorption of any venom in the wound. Do not apply a tourniquet. This will generally result in more damage than it will prevent.
Immerse the wound in 45C/115F water, or as hot as you can tolerate, for 30 to 90 minutes. Many marine toxins are proteins which are destroyed by heat, much like what happens to an egg when it's hard-boiled. A hot soak can dramatically reduce the pain, and amount of damage, caused by a sting.
Control the pain. The pain from marine stings can be excruciating and lead to shock, making pain control an important early step in wound care. This can generally be done with local anesthetics, and very rarely will require the use of systemic pain relievers or narcotics.
Cleanse the wound with an antiseptic solution. Washing out remaining venom and pieces of spine will help minimize damage, speed healing and prevent infection. Leave an inaccessible spine alone only if it hasn't penetrated a joint, nerve or blood vessel.
Seek appropriate medical care. Despite doing all of the above, some wounds will require surgical cleansing and repair, antibiotics for infection control, as well as antivenins and life support for severe
stings. It is not always immediately obvious which stings will need more intensive medical care, so if at all possible, get care for all stings."
stings. It is not always immediately obvious which stings will need more intensive medical care, so if at all possible, get care for all stings."
SEA CUCUMBER
- Phylum echinodermata, Class Holothurioidea. Some species eject a visceral liquid, causing dermatitis and blindness.
- Symptoms: Redness, itching and pain. If eyes are involved, symptoms are similar to chemical burns.
- Treatment: Copious irrigation of the affected area.
INJECTED TOXINS CONE SHELLS
- Phylum Mollusca, Class Gastropoda, Family Conidae. These cones possess a detachable, dart-like radicular tooth or muscular proboscis. The venom is complex composed of two or more substances, one neuromuscular (causing sustained contractions), the other inhibits nerve excitability.
- Symptoms: Small puncture wound with localized ischemia (blanching), cyanosis (pale, bluish color), and edema (swelling). Severe pain, numbness, and tingling (paresthesias) of the mouth and lips is noted. Sometimes there is respiratory distress and paralysis.
- Treatment: Immobilize the limb, apply a pressure dressing, administer CPR if needed. Cleanse the puncture site, give analgesics and give tetanus prevention. Be prepared to support and monitor respiratory function.
- BLUE-RINGED OCTOPUS (photo)
- Phylum Mollusca, Class Cephalopeda. The salivary glands of the blue-ringed octopus produce a venom, maculotoxin, that has effects similar to tetradotoxin (fuji).
- Symptoms: The bite is usually painless, then is followed by painless paralysis. The pattern begins with abnormal sensations of the mouth, neck and head; followed by nausea, vomiting, shortness of breath and sometimes apnea ((lack of respirations).There can be visual disturbances, impaired speech and swallowing, and generalized weakness and paralysis. The duration is from 4 to 12 hours.
- Treatment: Immobilize the limb, apply pressure dressings, cleanse the bite, treat for tetanus and monitor the respiratory functions.
STINGRAY
- Phylum Chordata, Class Chondrichthyes. These possess a serrated bony spine at the base of the dorsal surface of the tail. An integumentary sheath discharges venom when ruptured. Most injuries occur when the ray is stepped on, the tail is thrust upward and forward and fired into the foot or leg. The venom is thermolabile (deactivated with heat) and induces severe vasoconstriction.
- Symptoms: Intense pain is felt at the site; there is local ischemia (loss of blood supply), and edema. Edges are jagged, may contain pieces of spine and secondary infection is common. Systemic effects include salivation, sweating, vomiting, diarrhea, cramps, hypotension (low blood pressure), and cardiovascular collapse.
- Treatment: Irrigate and remove remaining spine. Immerse in hot (50 C) water until pain subsides. Give local or systemic pain relief. Cleanse, debride and suture the wound. Give tetanus protection, infection prophylaxis and monitor / support cardio-respiratory system as indicated.
- Salt Water Catfish
The fins of the saltwater catfish have a complex toxin made up of a mix of high molecular weight proteins and low molecular weight compounds. Like many marine toxins, this venom is believed to be denatured at temperatures above 105 F.
Besides intense pain that appears to be out of proportion for the physical injury, systemic symptoms can occur but are rare. They include muscle cramps, tremor, fatigue, syncope and even CV collapse. Treatment in the ER consists of immersion of the body part in hot water at approx. 110 F, debridement (cleansing) of the wound completely and liberal irrigation with hot water. Tetanus coverage is provided. It's a good idea to treat with antibiotics that cover Vibrio vulnificus, usually a 3rd gen cephalosporin.
Severe allergic reactions can occur. If you are in a boat and cannot get to hot water, a good preparation to use is a paste of baking soda and meat tenderizer. This paste is also said to be effective for jelly fish stings.
SCORPIONFISH
- Phylum Chordata, Class Osteich, Family Scorpaenidae. There are many species, including lionfish and stonefish. The venom is similar to stingray, is thermolabile and the stonefish is the most toxic. An antivenin is available throughthe Australia Commonwealth Serum Lab.
- Symptoms: Immediate intense pain, erythema, edema, cyanosis. Nausea, vomiting, hypotension, delirium and cardiovascular collapse.
- Treatment: Irrigate and remove debris. Immerse in hot water 30 to 90 minutes. Give analgesia and inject 1 ml. Emetine if available (50 mg/ml). Give stonefish antivenin if available. Provide antibiotics and tetanus prophylaxis
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SEA SNAKES
- Phylum Chordata, Class Reptilia, Order Squamata. The sea snake is an inquisitive but usually nonaggresive air-breathing snake. The venom is extremely toxic (2-10 times the cobra), and many bites are not envenomated. The venom is heat stable, is a nonenzymatic protein, and blocks acetylcholine.
- Symptoms: The bite is noted without symptoms as there is an initial latent period varying from 10 minutes to 6-8 hours. . There is the onset of malaise (bad feeling), anxiety and stiffness. Followed by aching and paralysis. Trismus (Jaw paralysis), ptosis (paralysis of eyelids) are common. Ten percent of untreated cases are fatal.
- Treatment: Immobilize the site of the bite. Hospitalize, obtain the antivenin and give CPR if needed. Try polyvalent land snake antivenom if specific not available. Hemodialysis can be helpful and respiratory support and control are often needed.
PARALYTIC SHELLFISH POISONING
- This derives from dinoflagellates contaminating shellfish (clams, scallops, oysters, etc.). The toxin, saxotoxin, is water soluble, heat and base stabile, and is therefore not affected by steaming or cooking. It inhibits sodium channels of excitable membranes, blocking propagation of nerve and muscle action potentials.
- Symptoms: These usually occur within 30 minutes, and include parasthesias of the lips, tongue, gums and face. This process proceeds to the trunk and may progress to paralysis and respiratory arrest. The gastrointestinal form may appear hours or days after ingestion with nausea, vomiting, diarrhea and abdominal pain.
- Treatment: No specific treatment. Stop eating if oral sensations are perceived. Empty stomach if systemic symptoms are noted, using emetic or lavage. Give respiratory support and monitoring if needed.
SCOMBROID
- Occurs in tuna, mackerel, skipjack and other members of the family scombridae. Fish left at room temperature undergo bacterial breakdown of tissue histidine to histamine and saurine. Spoiled fish have a sharp, peppery taste.
- Symptoms: Occur in the first hour, and a histamine-like intoxication is seen. There is headache, flushing, dizziness, palpitations and tachycardia. One may see hypotension, bronchospasm, urticaria and anaphylaxis. GI symptoms include nausea, vomiting, diarrhea, abdominal pain, thirst and dysphagia.
- Treatment: Gastric lavage, respiratory and circulatory support. Antihistamines appear to be helpful.
TETRADOTOXIN(photo)
- Derived from algae covered with bacteria Alteromonas sp.Being ingested by pufferfish. The toxin concentrates in the liver and gonads. The toxin inhibits sodium transport, affects neuronal transmission in the CNS and periphery and also affects cardiac nerve conduction and contraction.
- Symptoms: Entirely dose dependent-can have oral paresthesias, muscular fasciculations then a flaccid type of paralysis occurs. (curare-like).
- Treatment: Gastric lavage and respiratory support, usually for 24 hours or more. Consider sedation because cognitive function intact. There will be spontaneous remission if the patient is otherwise supported.
CIGUATERA
- The toxin, icthyosarcotoxin, is heat stable, lipid soluble and comes from the dinoflagellate Gambierdiscus toxicus. It is common in the tropics, concentrated up the food chain and is seen in eels, red snapper, amberjack and so forth.
- Symptoms: vary, the usual onset occurs in the first 12 hours and can last for ten to twelve days. The GI symptoms are followed by myalgias, arthralgias and paresthesias. There is the heat/cold reversal phenomenon and this is supposed to be diagnostic. Neurological symptoms may take months to resolve and occasionally may be permanent. Symptoms are aggravated by alcohol and by eating a fish only slightly affected.
Treatment: nonspecific, primarily supportive. Suggested treatment has included calcium gluconate, corticosteroids, atropine, vitamin B, pyroxidine, amitriptyline and mannitol. Mannitol treatment is 250 cc 20% Mannitol (1mg/kg), this usually relieves the neurological symptoms in minutes and the rest of the symptoms in 3 days.
