It’s Back! Name That Poisonous Beast! (reprise)


    It’s Back! Name That Poisonous Beast! (reprise)

    And back by popular demand, it’s another installment of “Name that Poisonous Beast!”

    Name this poisonous beast!



    And it’s stony neighbor:



    • A) Stingray (Dasyatidae):
      • Tail with one or more barbed stingers and 2 ventrolateral venom-containing grooves
      • Local effects:
        • Puncture wounds: severe pain, edema, cyanosis, erythema, petechaie, local necrosis, ulceration and delayed wound healing
          • Often in lower extremity, but mortality can occur if barb penetrates major vessels, heart or other vital organs (think Steve Irwin – a barb to the heart!)
            • Treat abdominal/thorax wounds as any other penetrating trauma
      • XR for foreign body (i.e. retained barb); ensure removal
      • Rarely, systemic symptoms:
        • Syncope, nausea/vomiting, diarrhea, diaphoresis, muscle cramps, fasciculations, abdominal pain, seizures, hypotension
      • Treatment:
        • Immerse affected area in hot water (110-115 F) for 30-90 minutes (direct effect on heat-sensitive toxin)
        • Supportive care/ensure tetanus UTD
        • For deep puncture wounds, especially w/foreign bodies, prophylactic antibiotics
          • Cover staph/strep and vibrio: first-generation cephalosporin (or clindamycin + levaquin if MRSA concern/penicillin allergy) + doxycycline
        • No antivenom
    • B) Stonefish (Synanceia); of the Scorpaenidae family, which also includes the less poisonous Pterois (lionfish, zebrafish, butterfly cod), Scorpaena (scorpionfish, bullrout, sculpin)
      • Stout, powerful spines with highly developed venom glands
        • Reported mortalities, but likely 2/2 sepsis from superinfection
      • Local effects:
        • Puncture wounds similar to sting rays, surrounded by cyanotic tissue
        • Excruciating pain which may spread to entire limb and regional lymph nodes, peaking at 60-90 minutes and lasting up to 12 hours; mild subsequent pain may persist for days to weeks
        • Subsequent edema, erythema, warmth; may involve entire limb, rarely w/tissue necrosis (as opposed to stingray)
        • Possible vesicle formation, which may be followed by tissue sloughing, cellulitis and hypesthesia
      • XR for foreign body (i.e. retained barb); ensure removal
      • Systemic effects (less common):
        • Nausea, vomiting, headache, diaphoresis, muscle weakness, dyspnea, hypotension, syncope
      • Treatment:
        • Immerse affected area in hot water (110-115 F)
        • Supportive care/ensure tetanus UTD
        • Antivenom: 1 ampule for every 1-2 punctures, up to 3 ampules for more than 4 punctures; diluted in 50-100ml NS and run over >15min
          • Provide if adequate relief not obtained from hot water immerse and parenteral analgesia; may also be effective for systemic effects
          • Equine antisera with allergy risks; can pretreat w/antihistamine, steroids, and/or epinephrine
        • Excepting deep puncture wounds and the immunocompromised, prophylactic antibiotics are not warranted

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