I've Been Stung: What Should I Do? Part 2

By Paul S. Auerbach, M.D., M.S..
LIonfish
Lionfish
Lionfish

Dr. Paul Auerbach answers questions about treating various hazardous marine life envenomations, including lionfish, scorpionfish, stonefish, and stingrays.

Lionfish, Scorpionfish & Stonefish Envenomations

Question

Last week I got a saltwater aquarium with an anemone and a small lionfish. I saw the lionfish swimming through the anemone and thought it was going to hurt the anemone, so I reached in the tank and pushed the lionfish away. It nailed me on the fingers, and now they're all swollen and blistered. Is there anything I can do?

Answer

Lionfish (as well as scorpionfish and stonefish) possess dorsal, anal and pelvic spines that transport venom from venom glands into puncture wounds. Common reactions include redness or blanching, swelling, and blistering. The injuries can be extraordinarily painful and occasionally life-threatening (in the case of a stonefish).

The Treatment

Soaking the wound in non-scalding hot water to tolerance (110 to 113° F / 43.3 to 45° C):

If the injured person appears intoxicated or is weak, vomiting, short of breath or unconscious, seek immediate advanced medical care.

Wound care is standard, so, for the blistering wound noted above, appropriate therapy would be a topical antiseptic (such as silver sulfadiazene [Silvadene] cream or bacitracin ointment) and daily dressing changes. A scorpionfish sting frequently requires weeks to months to heal, and therefore requires the attention of a physician. There is an antivenin available to physicians to help manage the sting of the dreaded stonefish.

Stingray Envenomation

Question

My daughter was walking in the surf near Panama City, Fla., when she got stung. She was barefooted and said something wrapped up around her foot right before she felt the pain. One of the lifeguards pulled out a small spine, and then she saw a doctor. He put her on an antibiotic, but the cut on her foot doesn't seem to be healing. What should she do?

Answer

A stingray does its damage by lashing upward in defense with a muscular tail-like appendage, which carries up to four sharp, swordlike stingers. The stingers are supplied with venom, so that the injury created is both a deep puncture or laceration and an envenomation

The pain from a stingray wound can be excruciating and accompanied by bleeding, weakness, vomiting, headache, fainting, shortness of breath, paralysis, collapse and occasionally, death. Most wounds involve the feet and legs, as unwary waders and swimmers tread upon the creatures hidden in the sand.

The Treatment

  1. Rinse the wound with whatever clean water is available. Immediately immerse the wound in non-scalding hot water to tolerance (110 to 113° F / 43.3 to 45° C). This may provide some pain relief. Generally, it is necessary to soak the wound for 30 to 90 minutes in the hot water, but take care not to create a burn wound. Gently extract any obvious piece(s) of stinger.
  2. Scrub the wound with soap and water. Do not try to sew or tape it closed - doing so could promote a serious infection by "sealing in" harmful bacteria.
  3. Apply a dressing and seek medical help. If more than 12 hours will pass before a doctor can be reached, start the injured person on an antibiotic (ciprofloxacin, trimethoprim-sulfamethoxazole, or doxycycline) to oppose Vibrio bacteria.
  4. Administer pain medication sufficient to control the pain.

Prevention of Stingray Injuries

Paul Auerbach, M.D., M.S., is a consultant on hazardous marine life to DAN, medical editor for Dive Training magazine, advisor to numerous medical, recreational and scientific organizations and recognized internationally as a leading expert on the clinical management of hazardous marine encounters.

You may also like I've Been Stung (Part 1) and (Part 3).

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