Derm

Stingray

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Stingray

  • Epidemiology
  1. Stingray Envenomations are common
  2. Other ray-induced injuries (non-Envenomation)
    1. Stingray bites
    2. Electric ray shocks (220 volts)
  • Pathophysiology
  1. One to four venom gland at spine (base of tail)
  2. Retro-serated spine and/or venom gland may embed in wound site
  3. Spines even penetrate wet suits
  4. Stings are most often legs (but may also affect trunk)
  • Symptoms
  1. Intense pain onset at time of sting (out of proportion to wound)
  2. Nausea or Vomiting
  3. Diarrhea
  4. Muscle cramps
  5. Salivation
  6. Dyspnea
  7. Headaches
  8. Arrhythmias
  • Imaging
  1. Consider for determining foreign body
  2. Consider foreign body Ultrasound or XRay
  3. Suspected Retained Foreign Body, not seen on other imaging, is most likely to be seen on MRI
  • Management
  1. Rinse wound site with water
  2. Control bleeding
  3. Apply heat to area
    1. Heat inactivates toxin
    2. Apply not scalding hot water as tolerated to affected area for 30 minutes
    3. Submerse affected hand or foot in 108-113 F (42-45 C) for 30-90 minutes (until pain resolves)
  4. Remove embedded foreign bodies after heat has been applied
    1. Do not remove spines embedded near vital organs
    2. Leave the Stingers in place initially (unless in chest or neck)
  5. Observe for signs of Wound Infection
  6. Antibiotics not indicated unless infection
    1. Consider antibiotics if deep penetrating wound (esp. if immunocompromised)
  7. Update Tetanus Vaccine
  8. Consider observing 4 hours for systemic effects
  • Prognosis
  1. Wound Healing is often prolonged
  • Prevention
  1. Shuffle feet while walking through shallow waters
  • References
  1. Auerbach in Herbert (2017) EM:Rap 17(10): 6-7
  2. Habif (1996) Dermatology, p. 491
  3. Perkins (2004) Am Fam Physician 69(4): 885-90 [PubMed]