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Poisonous animals
 
Cnidarians (Jellyfish, Corals and Anemones)
 
Venomous fish
 
Scorpions
 
Spiders
 
Hymenopterans (Bees, Wasps and Ants)
 
Sea snakes
 
Terrestrial snakes
 
Miscellaneous animals
 
 
 
 
 
 
 
 

Diagnosis & Treatment — Hospital

 

General problems

At particular risk are: children, elderly people, patients with pre-existing conditions, such as coronary heart disease, arterial hypertension, lung disease, kidney disease, allergies (sensitisation), and patients taking particular drugs, such as beta-blockers and anti-coagulants.

Patient presents with a deep, possibly penetrating injury

D  Diagnostics

X-ray: in order to detect foreign matter, such as parts of the spine.

Wound exploration:

  • to detect foreign matter, such as parts of the spine and spine sheath;
  • to exclude injury to nerves, vessels and tendons;
  • to exclude penetration of the abdominal, pleural or pericardial cavities and internal organs.

Possibly laparoscopy or laparotomy.

Possibly thoracoscopy or thoracotomy.

(Grainiger 1985, Fenner et al. 1989b)

T  Treatment
  • Treatment of pain,
  • wound cleaning and disinfection,
  • removal of foreign matter, such as parts of the spine and spine sheath,
  • surgical treatment and reconstruction of damaged vessels, nerves, tendons etc. (see Wound exploration above),
  • tetanus prophylaxis,
  • antibiotic treatment.

(Grainiger 1985, Fenner et al. 1989b)

C  Comments

Stingray venom contains venom components that cause necrosis. This may have disastrous consequences, in particular in the case of penetrating injuries (Fenner et al. 1989b). Complications during wound healing are common, and wound revision as well as wound care and monitoring are important. See also the Comments below in the section "Local effects".

Which venomous fish cause extensive and deep, possibly penetrating injuries?

Is it likely that injection of venom has taken place?

D  Diagnostics

Inquire re:

  • time of the sting,
  • local, possibly regional pain,
  • nausea, vomiting, diarrhoea.

Assess:

  • state of consciousness.

Measure:

  • blood pressure/pulse,
  • respiratory rate.

Observe/investigate:

  • puncture sites,
  • number of puncture sites (important in Stonefish stings for assessment of the amount of venom injected and to determine the antivenom dose),
  • local/regional swelling,
  • clinical signs of cardiovascular disturbances, such as cardiac dysrhythmias, arterial hypotension,
  • signs of paralysis.

Local effects

S  Signs & Symptoms
  • Acute, possibly very severe pain that can radiate throughout the region of the injury,
  • local and regional swelling, 
  • necrosis.
D  Diagnostics

Clinical.

T  Treatment

Pain management: injection of a local anaesthetic without the addition of a vasoconstrictor directly into the wound or around it (lignocaine 1%, or preferably bupivacaine because it has a longer duration of action).

Wound management: exploration for removal of foreign matter, such as parts of the spine and spine sheath. Disinfection, wound care, possibly antibiotic treatment, tetanus prophylaxis (Fenner et al. 1989b).

C  Comments

The venom of venomous fish contains venom components that cause necrosis. Thus complications during wound healing are common, and wound revision as well as wound care and monitoring are important. Blisters should be opened and drained. Venom components and inflammatory mediators have been detected in fluid from blisters (Auerbach et al. 1987a). An additional reason for possible wound healing complications are bacterial contaminants from the seawater. The choice of antibiotics must take into consideration the entire spectrum of marine bacteria. Special culture media may be necessary to culture these bacteria (Auerbach et al. 1987a).

Which venomous fish cause local envenoming?

All venomous fish (see Biomedical database entries).

Systemic effects

S  Signs & Symptoms
  • Nausea, vomiting, diarrhoea,
  • clinical signs of cardiovascular disturbances, such as cardiac dysrhythmias, arterial hypotension,
  • signs of paralysis.
D  Diagnostics
  • Clinical,
  • ECG.
T  Treatment
  • Symptomatic treatment,
  • antivenom (only available for Stonefishes!).

For antivenom indications, efficacy and adverse reactions, see Biomedical database entry: Synanceiidae: Clinic.

C  Comments

Systemic effects of venom from venomous fish are not very well documented in the literature. Primarily the Stonefishes and Lionfishes are attributed with causing severe systemic effects. However, in those case reports and small studies in which the cause of the sting was clearly identified, such a course of envenoming was not observed.

Which venomous fish cause systemic envenoming?

Follow-up
1. Wounds, in particular necrosis

D  Diagnostics
  • Clinical,
  • bacterial smears.
T  Treatment

See above.

2. If antivenom was administered: serum sickness

D  Diagnostics
T  Treatment