0071643192.pdf

ENVIRONMENTAL EMERGENCIES

MECHANISM OFTOXICITY

■ Special stinger apparatus punctures skin and introduces venom →severe

local symptoms and (rarely) systemic effects.

SYMPTOMS/EXAM

■ Vary with species

■ Most commonly, intense local pain

■ Systemic symptoms may include nausea/vomiting, hypotension, muscle

cramps, paralysis, cardiac arrest.

TREATMENT

■ Supportive therapy

■ Remove spines and stinger (use X-ray to verify).

■ Immediately immerse wound in hot water(45°C for 90 minutes or until

pain is relieved as this breaks down venom).

■ Aggressive cleaning

■ Tetanus prophylaxis

■ Consider antibiotics if deep puncture wound or high-risk patient.

■ Antivenom exists for stonefish toxicity.

Nematocysts

Marine animals with nematocysts include

■ Jellyfish (Cnidaria)

■ Portuguese man-of-war

■ Corals

■ Fire corals

■ Sea anemones

■ Sea wasps

MECHANISM OFTOXICITY

■ Physical contact or osmotic gradient →discharge of nematocysts (“spring

loaded with venom”) →local and (rarely) systemic symptoms.

SYMPTOM/EXAM

■ Vary with species

■ Most commonly, intense local pain

■ Systemic symptoms may include nausea and vomiting, tachycardia, hyper-

tension, respiratory paralysis, cardiac arrest.

TABLE 13.4. Marine Animals That Sting

MARINEANIMAL VENOMDELIVERYAPPARATUS

Stingrays Barbed stinger at end of whiplike tail

Bony fish: Catfish, zebra fish (eg, lionfish), Spines located on their fins

scorpion fish, stonefish

Sea urchins Toxin-coated spines

Cone shells Venom gland and teeth at end of proboscis

Marine animals with a stinger

apparatus include stingrays,

sea urchins, cone shells, and

venomous fish.

Marine animals with

nematocysts include jellyfish,

the Portuguese man-of-war,

fire corals, sea anemones.