6-15
to open wound.
- Evacuate urgently to medical treatment facility for administration of antivenin if available and intensive care
support if needed. Envenomizations should not be treated in the field if the patient can be evacuated. - Soak wound in water as hot as patient can tolerate (<122°F) for 30-90 minutes. Use hot compresses if
wound is on the face. - Give diazepam IM 5 mg for muscle spasms.
- Manage pain (see Procedure: Pain Assessment and Control). Do NOT use narcotics in cases of
RESPIRATORY DISTRESS or
FAILURE. Lidocaine may be used in the wound for pain relief, but NEVER use epinephrine. - Explore the wound and clean out any remaining spines or barbs.
- Immobilize the affected extremity.
- Administer tetanus and antibiotic prophylaxis (tetracycline 250 mg po qid, and neomycin or bacitracin
topically). - Consider x-ray to look for any remaining sheaths or barbs.
Coelenterates
- Apply vinegar or a 3-10% solution of acetic acid (or carbonated beverage) to sting site to neutralize
stingers. - Gently remove any remaining tentacles with a towel or cloth.
- For box jellyfish stings, administer antivenin slowly: one container (vial) IV and three containers IM route.
Treat sensitivity reactions to the antivenin with a SC injection of epinephrine, along with corticosteroids
and antihistamines (see Shock: Anaphylactic). Treat hypotension with volume expanders and pressor
medication if available. - Evacuate victims of box jellyfish and Portuguese man-of-war stings immediately.
- Use topical and/or local anesthetic agents (e.g., lidocaine).
Coral
- Control bleeding.
- Promptly clean with hydrogen peroxide or 10% povidone-iodine solution and debride the wound.
Remove all foreign particles. - Cover with a clean dressing.
- Administer tetanus prophylaxis.
- Topical antibiotic ointment.
- Manage pain (see Procedure: Pain Assessment and Control). Do NOT use narcotics in cases of
RESPIRTORY DISTRESS or FAILURE. - Evacuate to medical treatment facility if symptoms are severe.
Octopi
- Control local bleeding with pressure
- Clean and debride wound. Cover with clean dressing.
- If blue-ringed octopus is suspected:
a. Apply pressure bandage and immobilize the bitten extremity. Place extremity lower than the heart.
b. Be prepared to administer CPR and ventilate patient
c. Immediately evacuate patient to medical treatment facility for intensive care. - Administer tetanus prophylaxis.
Sea Urchins
- Remove all protruding spine fragments from wound if possible. Do not break large pieces off in the wound.
- Bathe wound in vinegar, then soak wound in as hot water as can be tolerated (no more than 122°F).
- Clean and debride wound and apply topical antibiotic ointment.
- Surgical removal is often necessary for deep spines. If necessary, evacuate patient to medical treatment
facility to have this performed. X-rays can identify broken spines. - Treat allergic reactions and bronchospasms with SC epinephrine and antihistamines (see Shock: