Stingray injury - Revision history

Jonrako: /* Clinical Features */

2021-09-01T01:20:20Z

Clinical Features

← Older revision		Revision as of 01:20, 1 September 2021
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	*Limb ischemia secondary to vasospasm		*Limb ischemia secondary to vasospasm
	*Cardiotoxicity (e.g. dysrhythmias, heart block, non-ST segment elevation myocardial infarction)<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf</ref>		*Cardiotoxicity (e.g. dysrhythmias, heart block, non-ST segment elevation myocardial infarction)<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf</ref>
	*Systemic symptoms can include [[vomiting]], muscle cramps, [[hypotension]], [[weakness\|paralysis]], [[cardiac arrest]]		*Systemic symptoms can include seizures, [[vomiting]], muscle cramps, [[hypotension]], [[weakness\|paralysis]], and even [[cardiac arrest]]

	==Differential Diagnosis==		==Differential Diagnosis==

Jonrako: /* Clinical Features */

2021-09-01T01:19:29Z

Clinical Features

← Older revision		Revision as of 01:19, 1 September 2021
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	*Symptoms can vary by species		*Symptoms can vary by species
	*Associated with puncture or jagged laceration		*Associated with puncture or jagged laceration
	*Local pain, ~~irritation~~, ~~[[rash\|erythema]]~~		*Local pain which can last up to 48 hours
			*Limb ischemia secondary to vasospasm
			*Cardiotoxicity (e.g. dysrhythmias, heart block, non-ST segment elevation myocardial infarction)<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf</ref>
	*Systemic symptoms can include [[vomiting]], muscle cramps, [[hypotension]], [[weakness\|paralysis]], [[cardiac arrest]]		*Systemic symptoms can include [[vomiting]], muscle cramps, [[hypotension]], [[weakness\|paralysis]], [[cardiac arrest]]

Jonrako: /* Management */

2021-09-01T01:11:31Z

Management

← Older revision		Revision as of 01:11, 1 September 2021
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	*[[Tetanus prophylaxis]]		*[[Tetanus prophylaxis]]
	*Prophylactic [[antibiotics]] are controversial - if used, give [[doxycycline]] or [[ciprofloxacin]] to cover ''[[Vibrio vulnificus]]''		*Prophylactic [[antibiotics]] are controversial - if used, give [[doxycycline]] or [[ciprofloxacin]] to cover ''[[Vibrio vulnificus]]''
	*Infusion of prostaglandin E1 has resulted in successful salvage of an ischemic leg, but insufficient datat exists to recommend this as routine therapy.		*Infusion of prostaglandin E1 has resulted in successful salvage of an ischemic leg, but insufficient datat exists to recommend this as routine therapy.<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf</ref>
	*There is no antivenom available.		*There is no antivenom available.

Jonrako: /* Management */

2021-09-01T01:10:56Z

Management

← Older revision		Revision as of 01:10, 1 September 2021
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	*[[Tetanus prophylaxis]]		*[[Tetanus prophylaxis]]
	*Prophylactic [[antibiotics]] are controversial - if used, give [[doxycycline]] or [[ciprofloxacin]] to cover ''[[Vibrio vulnificus]]''		*Prophylactic [[antibiotics]] are controversial - if used, give [[doxycycline]] or [[ciprofloxacin]] to cover ''[[Vibrio vulnificus]]''
			*Infusion of prostaglandin E1 has resulted in successful salvage of an ischemic leg, but insufficient datat exists to recommend this as routine therapy.
			*There is no antivenom available.

	==Disposition==		==Disposition==

Jonrako: /* Background */

2021-09-01T01:08:27Z

Background

← Older revision		Revision as of 01:08, 1 September 2021
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	==Background==		==Background <ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf</ref>==
	[[File:Dasyatis pastinaca01.jpg\|thumb\|Common stingray (''Dasyatis pastinaca'')]]		[[File:Dasyatis pastinaca01.jpg\|thumb\|Common stingray (''Dasyatis pastinaca'')]]
	[[File:Stringray's sting.jpg\|thumb\|A stingray's stinger (ruler in cm)]]		[[File:Stringray's sting.jpg\|thumb\|A stingray's stinger (ruler in cm)]]
	*Stinger ~~punctures skin~~ to ~~introduce~~ heat-labile venom		*Stinger contains a retroserrate barb and venom glands located on the tail.
			*There are two phases to injury.
			**Phase one is d/t the traumatic injury from the barb, which can inflict injury to vital organs (e.g. Steve Irwin)
			**Phase two is d/t heat-labile venom release, which causes vasospasm with possible limb ischemia, cardiotoxicity, seizure, and/or death.
	*Generally causes local symptoms without systemic effects		*Generally causes local symptoms without systemic effects
	*Often occurs when swimmers accidentally step on stingray in shallow water. Can be avoided by shuffling feet along bottom.		*Often occurs when swimmers accidentally step on stingray in shallow water. Can be avoided by shuffling feet along bottom.

Athorne: /* Management */

2021-07-31T02:22:39Z

Management

← Older revision		Revision as of 02:22, 31 July 2021
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	*XR for evaluation of foreign bodies		*XR for evaluation of foreign bodies
	*[[Tetanus prophylaxis]]		*[[Tetanus prophylaxis]]
	*Prophylactic [[antibiotics]] are controversial - if used, give [[ciprofloxacin]] to cover ''[[Vibrio vulnificus]]''		*Prophylactic [[antibiotics]] are controversial - if used, give [[doxycycline]] or [[ciprofloxacin]] to cover ''[[Vibrio vulnificus]]''

	==Disposition==		==Disposition==

Rossdonaldson1 at 17:48, 11 March 2021

2021-03-11T17:48:10Z

← Older revision		Revision as of 17:48, 11 March 2021
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	==Background==		==Background==
			[[File:Dasyatis pastinaca01.jpg\|thumb\|Common stingray (''Dasyatis pastinaca'')]]
			[[File:Stringray's sting.jpg\|thumb\|A stingray's stinger (ruler in cm)]]
	*Stinger punctures skin to introduce heat-labile venom		*Stinger punctures skin to introduce heat-labile venom
	*Generally causes local symptoms without systemic effects		*Generally causes local symptoms without systemic effects
	*Often occurs when swimmers accidentally step on stingray in shallow water. Can be avoided by shuffling feet along bottom.		*Often occurs when swimmers accidentally step on stingray in shallow water. Can be avoided by shuffling feet along bottom.

	~~[[File:Dasyatis pastinaca01.jpg\|thumb\|Common stingray (''Dasyatis pastinaca'')]]~~
	~~[[File:Stringray's sting.jpg\|thumb\|A stingray's stinger (ruler in cm)]]~~

	==Clinical Features==		==Clinical Features==
			[[File:Stingray injury.jpg\|thumb\|Treatment of stingray injury with hot water.]]
	*Symptoms can vary by species		*Symptoms can vary by species
	*Associated with puncture or jagged laceration		*Associated with puncture or jagged laceration
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	==Management==		==Management==
	~~[[File:Stingray injury.jpg\|thumb\|Treatment of stingray injury with hot water.]]~~
	*'''Immediately immerse wound in hot water (45°C for 30-90min)''' <ref>Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.</ref>		*'''Immediately immerse wound in hot water (45°C for 30-90min)''' <ref>Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.</ref>
	**Hot water is thought to denature the thermolabile venom		**Hot water is thought to denature the thermolabile venom

Rossdonaldson1: /* Management */

2021-03-11T17:47:19Z

Management

← Older revision		Revision as of 17:47, 11 March 2021
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	==Management==		==Management==
			[[File:Stingray injury.jpg\|thumb\|Treatment of stingray injury with hot water.]]
	*'''Immediately immerse wound in hot water (45°C for 30-90min)''' <ref>Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.</ref>		*'''Immediately immerse wound in hot water (45°C for 30-90min)''' <ref>Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.</ref>
	**Hot water is thought to denature the thermolabile venom		**Hot water is thought to denature the thermolabile venom

Bobbycarey: /* Management */

2021-03-10T02:02:49Z

Management

← Older revision		Revision as of 02:02, 10 March 2021
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	==Management==		==Management==
	*'''Immediately immerse wound in hot water (45°C for 30-90min)''' <ref>Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.</ref>		*'''Immediately immerse wound in hot water (45°C for 30-90min)''' <ref>Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.</ref>
			**Hot water is thought to denature the thermolabile venom
	*Supportive care		*Supportive care
	*Remove spines and stinger, if visible		*Remove spines and stinger, if visible

ClaireLewis at 22:02, 28 September 2019

2019-09-28T22:02:27Z

← Older revision		Revision as of 22:02, 28 September 2019
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	*Symptoms can vary by species		*Symptoms can vary by species
	*Associated with puncture or jagged laceration		*Associated with puncture or jagged laceration
	*Local pain, irritation, erythema		*Local pain, irritation, [[rash\|erythema]]
	*Systemic symptoms can include vomiting, muscle cramps, hypotension, paralysis, cardiac arrest		*Systemic symptoms can include [[vomiting]], muscle cramps, [[hypotension]], [[weakness\|paralysis]], [[cardiac arrest]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	*XR for evaluation of foreign bodies		*XR for evaluation of foreign bodies
	*[[Tetanus prophylaxis]]		*[[Tetanus prophylaxis]]
	*Prophylactic [[antibiotics]] are controversial - if used, give [[~~Ciprofloxacin~~]] to cover ''[[Vibrio vulnificus]]''		*Prophylactic [[antibiotics]] are controversial - if used, give [[ciprofloxacin]] to cover ''[[Vibrio vulnificus]]''

	==Disposition==		==Disposition==