species produce contact dermatitis, including the red-beard sponge
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
(joint pain), and edema (swelling).
Treatment: symptomatic with
and topical steroids.
These possess nematocysts with potential for envenomation but primarily
cause mechanical trauma to the skin, resulting in abrasions and
that become easily infected.
itching, erythema, edema and increased warmth.
of the area
involved (including debridement, if necessary). Debridement is excision
of dead, avulsed tissue. Provide tetanus prophylaxis and topical
Photos of anchor line contact dermatitis from nematocyst
envenomation and direct trauma.
JELLYFISH and HYDROIDS
- Phylum coelenterata, Class
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
which remain active even after drying. There is a wide range of
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
Pain and local histamine release attributed to 5-hydroxytryptamine; the
nerve conduction effects are due to tetramine (similar to curare).
- Symptoms: Rapid onset of
from mild to severe. A rash that is red, hot and swollen, usually
There is frequent pustule and vesicle formation. Anaphylaxis
collapse) is possible in sensitized individuals. Severe stings may
muscle cramps, abdominal pain, fever, chills, nausea, vomiting,
distress, and cardiovascular collapse. Fatalities are increased if
is pre-existing cardiac and respiratory disease. Chironex may cause
in healthy individuals in less than 15 minutes.
- Treatment: For Chironex,
vinegar to neutralize undischarged nematocysts and removal of
tentacles. There is some disagreement
about using vinegar for removal of Physalia nematocytes - sea water
preferred. Topical analgesics and steroids or IV analgesics and
100 mg IV every two hours are given. (Chironex).Cardiovascular
and/or support are provided. Sea wasp antivenin is available (Australia
Commonwealth Serum Lab.)
- Treatment of Severe
Remove any remnant of allergen
jellyfish tentacles, foreign material)
injection, if available
or injury with alcohol, vinegar or sea water
and immediate transport
pulse or respirations
to Jellyfish stings
SafeSea - Getting nailed
by Jellies, by DocVikingo, printed with
CROWN OF THORNS
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.
Multiple slender spines puncture the skin and break off.
antibiotics and tetanus protection. Occasional surgical removal of
about as many
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
pigment, the proteinaceous spine is the part that needs removal.
Soaking in hot
(see below) is said to offer relief from the pain and swelling
Others espouse magnesium sulfate pastes (Edmonds). Snake bite suction
are used by some to remove the spines while others go ahead and excise
the area conservatively under local anesthesia.
Edmonds describes a treatment
says works, "apply extra trauma and movement to the area involved in
to break up the spines in the tissue". Surgery is indicated for a
body reaction and intra-articular puncture, the latter being probably
most serious consequence of the accident. Topical antibiotics and
protection should be offered.
AUTHOR: Strauss MB; MacDonald RI
SOURCE: Clin Orthop 1976
usually a benign process that rarely comes to the attention of a
Aside from the transient episode of excruciating pain which responds
to hot water soaks, there is usually no residual disability. As in any
puncture wound, tetanus prophylaxis and observation for latent
is advised. Complications arise, however, when spines are embedded over
bony prominences, within joints, or in contact with nerves. Cases are
herein of the latter two problems occurring in the hand. A case of a
associated with sea urchin injuries has not been previously reported in
the literature. When such injuries necessitate exploration, aseptic
technique is required.
are treated by washing the area and applying
balm. Sea urchin spines should be removed immediately. A bluish
at the site of entry may help in locating the spine, which may
by xeroradiogram. Vinegar
most superficial spines, and soaking the wound in vinegar several
and covering the area with a wet vinegar compress may be sufficient;
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
a spine may migrate into deeper tissues and require surgical removal. "
Doctor has these instructions for stingray, sea urchin and other toxic
If possible, elevate the affected
and apply a pressure bandage. Both techniques will help slow the
of any venom in the wound. Do not apply a tourniquet. This will
result in more damage than it will prevent.
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.
stings can be excruciating and lead to shock, making pain control an
early step in wound care. This can generally be done with local
and very rarely will require the use of systemic pain relievers or
solution. Washing out remaining venom and pieces of spine will help
damage, speed healing and prevent infection. Leave an inaccessible
alone only if it hasn't penetrated a joint, nerve or blood vessel.
doing all of the above, some wounds will require surgical cleansing and
repair, antibiotics for infection control, as well as antivenins and
support for severe
stings. It is not always
obvious which stings will need more intensive medical care, so if at
possible, get care for all stings."
Some species eject a visceral liquid, causing dermatitis and blindness.
eyes are involved, symptoms are similar to chemical burns.
- Phylum Mollusca, Class
Conidae. These cones
possess a detachable, dart-like radicular tooth or muscular proboscis.
The venom is complex composed of two or more substances, one
(causing sustained contractions), the other inhibits nerve excitability.
wound with localized
ischemia (blanching), cyanosis (pale, bluish color), and edema
Severe pain, numbness, and tingling (paresthesias) of the mouth and
is noted. Sometimes there is respiratory distress and paralysis.
- Treatment: Immobilize
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.
salivary glands of the blue-ringed
produce a venom, maculotoxin, that has effects similar to
is followed by painless paralysis. The pattern begins with
sensations of the mouth, neck and head; followed by nausea, vomiting,
of breath and sometimes apnea ((lack of respirations).There can be
disturbances, impaired speech and swallowing, and generalized weakness
and paralysis. The duration is from 4 to 12 hours.
cleanse the bite, treat for tetanus and monitor the
These possess a serrated bony spine at the base of the dorsal surface
the tail. An integumentary sheath discharges venom when ruptured. Most
injuries occur when the ray is stepped on, the tail is thrust upward
forward and fired into the foot or leg. The venom is thermolabile
with heat) and induces severe vasoconstriction.
Intense pain is
at the site;
there is local ischemia (loss of blood supply), and edema. Edges are
may contain pieces of spine and secondary infection is common. Systemic
effects include salivation, sweating, vomiting, diarrhea, cramps,
(low blood pressure), and cardiovascular collapse.
in hot (50 C) water until pain subsides. Give local or
pain relief. Cleanse, debride and suture the wound. Give tetanus
infection prophylaxis and monitor / support cardio-respiratory system
the saltwater catfish have a complex toxin made up of
mix of high molecular weight proteins and low molecular weight
Like many marine toxins, this venom is believed to be denatured at
above 105 F.
that appears to be out of proportion for the
injury, systemic symptoms can occur but are rare. They include muscle
tremor, fatigue, syncope and even CV collapse. Treatment in the ER
of immersion of the body part in hot water at approx. 110 F,
(cleansing) of the wound completely and liberal irrigation with
water. Tetanus coverage is provided. It's a good idea to treat with
that cover Vibrio vulnificus, usually a 3rd gen cephalosporin.
can occur. If you are in a boat and
get to hot water, a good preparation to use is a paste of baking soda
meat tenderizer. This paste is also said to be effective for jelly fish
Links to Lionfish Injuries
Scorpaenidae. There are many species, including lionfish and
The venom is similar to stingray, is thermolabile and the stonefish is
the most toxic. An antivenin is available throughthe Australia
edema, cyanosis. Nausea, vomiting, hypotension, delirium and
- Phylum Chordata, Class
Squamata. The sea snake
is an inquisitive but usually nonaggresive air-breathing snake. The
is extremely toxic (2-10 times the cobra), and many bites are not
The venom is heat stable, is a nonenzymatic protein, and blocks
- Symptoms: The bite is
as there is an initial latent period varying from 10 minutes to 6-8
. There is the onset of malaise (bad feeling), anxiety and stiffness.
by aching and paralysis. Trismus (Jaw paralysis), ptosis (paralysis of
eyelids) are common. Ten percent of untreated cases are fatal.
- Treatment: Immobilize
of the bite.
Hospitalize, obtain the antivenin and give CPR if needed. Try
land snake antivenom if specific not available. Hemodialysis can be
and respiratory support and control are often needed.
- This derives from
shellfish (clams, scallops, oysters, etc.). The toxin, saxotoxin, is
soluble, heat and base stabile, and is therefore not affected by
or cooking. It inhibits sodium channels of excitable membranes,
propagation of nerve and muscle action potentials.
- Symptoms: These
minutes, and include parasthesias of the lips, tongue, gums and face.
process proceeds to the trunk and may progress to paralysis and
arrest. The gastrointestinal form may appear hours or days after
with nausea, vomiting, diarrhea and abdominal pain.
- Treatment: No specific
eating if oral sensations are perceived. Empty stomach if systemic
are noted, using emetic or lavage. Give respiratory support and
- Occurs in tuna,
other members of the family scombridae. Fish left at room temperature
bacterial breakdown of tissue histidine to histamine and saurine.
fish have a sharp, peppery taste.
- Symptoms: Occur in the
a histamine-like intoxication is seen. There is headache, flushing,
palpitations and tachycardia. One may see hypotension, bronchospasm,
and anaphylaxis. GI symptoms include nausea, vomiting, diarrhea,
pain, thirst and dysphagia.
- Treatment: Gastric
and circulatory support. Antihistamines appear to be helpful.
- Derived from algae
Alteromonas sp.Being ingested by pufferfish. The toxin concentrates in
the liver and gonads. The toxin inhibits sodium transport, affects
transmission in the CNS and periphery and also affects cardiac nerve
- Symptoms: Entirely
oral paresthesias, muscular fasciculations then a flaccid type of
- Treatment: Gastric
support, usually for 24 hours or more. Consider sedation because
function intact. There will be spontaneous remission if the patient is
The seven principle marine
eels, large grouper, killer whales,
water crocodiles and sharks.
fatalities are rare, and occur when a diver is
as a food source or intrudes into territory.
- The toxin,
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
in the first 12 hours and can last for ten to twelve days. The GI
are followed by myalgias, arthralgias and paresthesias. There is the
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
Treatment: nonspecific, primarily
Suggested treatment has included calcium gluconate, corticosteroids,
vitamin B, pyroxidine, amitriptyline and mannitol. Mannitol treatment
250 cc 20% Mannitol (1mg/kg), this usually relieves the neurological
in minutes and the rest of the symptoms in 3 days.