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

    NextPrevious

    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!

    A)

    stingray

    And it’s stony neighbor:

    B)

    stonefish

    • 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

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • renal handling of water

      If you were on a tea & toast diet, how much water would you need to drink before you develop hyponatremia? I haven’t seen anyone work out the numbers before so here are my calculations. AndRead more

    • acute acidemia physiology

      As alluded to in the first post, don’t be fooled by a “normal” potassium in the setting of DKA because osmotic diuresis and H+/K+ exchange means that total body potassium is actually LOW. You all knowRead more

    • renal handling of potassium

      the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates and consider dialysis, but then askRead more

    • bicarbonate revisited

      Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possiblyRead more

    • hyperkalemia and balanced crystalloids

      Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium toRead more

    • hyperkalemia physiology

      You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered byRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more

    NextPrevious