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