6-13
Patient Education
General: Symptoms should resolve quickly by taking deep breaths of fresh air.
Activity: Rest until all symptoms resolve.
Diet: Drink plenty of replacement fluids.
Prevention and Hygiene: Change CO 2 absorbent material in LAR V prior to each dive. Work slowly in
water, especially if water is very cold. Avoid skip breathing. Ventilate frequently if in a chamber or diving
surface-supplied rigs.
No Improvement/Deterioration: Return promptly for reevaluation.
Follow-up Actions
Return evaluation: See one day after treatment to ensure there are no residual symptoms.
Evacuation/Consultation Criteria: Evacuate if patient does not respond to treatment within 30 minutes.
Consult a Diving Medical Officer at the earliest opportunity after beginning therapy to confirm diagnosis and
treatment plan.
Dive Medicine: Dangerous Marine Life - Venomous Animals
CPT Jeffrey Morgan, MC, USAIntroduction: There are a variety of creatures encountered in the water that injure through venom. Some of
the venoms are mild and easily treated. Others are very toxic and extremely life threatening. Divers are often
unaware of the type of animal that bit or injured them. The medical caregiver must be prepared for a variety
of signs and symptoms. This section does not address all the many creatures that can envenomate humans,
but does include the noteworthy ones. Medical personnel routinely covering dives should have a text on
dangerous marine life that includes animals that can envenomate.
Subjective Symptoms/Objective Signs: Discussed under each animal species.
Highly Toxic Fish (Stonefish, Zebrafish, and Scorpionfish): Stings by these fish can kill, and are usually
accidental-- a diver steps on the fish or handles it. These fish carry venom in their spines much like other
venomous fish, but their venom is much more toxic. Initial local symptoms: severe pain followed by numbness
and/or hypersensitivity around the wound site lasting for days. Generalized reactions include respiratory
failure and cardiovascular collapse. There is an antivenin for stonefish toxin that seems to be somewhat
effective for zebrafish and scorpionfish toxins (see below for ordering information).
Other Venomous Fish: Most fish envenomate through fin spines, while a diver is stepping on or handling
the fish. Venom will continue to flow into the injury while the spine sheath is still in the patient. The venom
is usually heat labile and may decompose in hot water (about 115°F). Initial local symptoms: severe pain
followed by numbness and/or hypersensitivity around the wound site lasting for hours. General symptoms
may include nausea, vomiting, sweating, mild fever, respiratory distress and collapse. Serious anaphylactic
reactions are possible.
Stingrays: Stingrays are common in tropical and temperate areas. They hide in the ocean floor sand with
eyes and tail exposed. Most attacks from stingrays occur from swimmers or divers stepping on them. The tail
will whip up in self-defense and impale the diver/swimmer’s leg with a barbed spine. The wound area has a
blue rim and is typically swollen, painful, and pale. Generalized reactions can include fainting, nausea, vomit-
ing, frequent urination and salivation, sweating, respiratory difficulty, and cardiovascular collapse. Symptoms
may take months to resolve. Secondary infections and necrotic lesions often develop. The toxin is heat labile
(113°F). No antivenin is available.
Coelenterates: Hazardous coelenterates include Portuguese man-of-war, sea wasp or box jellyfish, sea
nettle, sea blubber, sea anemone, and rosy anemone. The most common stinging injury is the jellyfish sting,