Special Operations Forces Medical Handbook

6-16

Anaphylactic).

6. Administer tetanus prophylaxis.

Cone Shells

1. Place patient supine.


2. Apply pressure bandage to wound and place injury site at a level below the heart. Keep the patient
   from moving.


3. Immediately transport patient to medical treatment facility for intensive care. Be prepared to ventilate
   patient and administer CPR. Treat symptoms with supportive care as they present.


4. Avoid any analgesics that cause respiratory depression (narcotics).


5. Administer tetanus prophylaxis

Sea Snakes

1. Keep victim still.


2. Apply pressure dressing to bite site and place bite in a position below the heart.


3. Incise wound and apply suction if within 2 minutes of time of bite.


4. Transport patient immediately to medical treatment facility for antivenin treatment and intensive care.


5. Place IV and administer a bolus of 1 L normal saline. Continue IV at a rate of 125 ml/hr to keep urine
   output at least 30 cc/hour. Watch patient’s urine looking for smoky color (indicating myoglobinuria, renal
   failure).


6. Be prepared to ventilate patient and perform CPR.


7. Observe patient for at least 12 hours after a bite due to possible latent effects.


8. Administer tetanus prophylaxis.

Patient Education
General: Keep the patient calm and reassure him that he has probably been envenomated and will receive
further treatment.
Activity: Ensure the patient rests and remains calm.
Diet: Keep patient hydrated with IV NS and keep him NPO until you are sure surgery will not be required.
Medications: Antivenins have a high incidence of serum sickness. Treat this with epinephrine and
antihistamines. If at all possible, administer antivenin in a medical treatment facility in order to treat the
serum sickness appropriately with intensive care support.
Prevention and Hygiene: Avoid these types of marine animals.
Wound Care: Keep dressing clean and dry. Antibiotic ointment will help prevent secondary wound infections

Follow-up Actions
Return evaluation: Monitor patients until all symptoms resolve.
Evacuation/Consultation Criteria: Refer to each individual treatment plan above for evacuation guidance.
Consult an emergency medicine specialist, an internist or a Diving Medical Officer (DMO) for unstable patients
after envenomization. Refer recovered divers to a DMO for clearance to return to diving duty.

NOTE: Antivenins are available from Commonwealth Serum Lab; 45 Poplar Rd, Parkville; Melbourne, Victoria,
Australia. Telephone: 011-61-3-389-1911. Telex: AA-32789.

Dive Medicine: Dangerous Marine Life - Biting Animals

CPT Jeffrey Morgan, MC, USA

Introduction: Diving in open water puts a diver in an environment with numerous dangerous sea creatures.
Many of these creatures are predatory and can cause significant harm to humans. This section will only deal
with the marine predators that injure by biting. Other marine life may injure humans through venom (see
preceding section), electrical shock, pinching and other means. Preparedness and avoidance is the best way
to prevent encounters with dangerous marine life. Signs, symptoms, assessment and treatment are all very
similar for the various animals listed.