Stingray Envenomation
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Stingrays (ie, elasmobranchs) are bottom-dwelling cartilaginous fish that have a flattened body, one or more stout spines on the tail, gill slits on the lower surface of the head, teeth modified into 2 large crushing plates, and no dorsal fin. They are not aggressive toward humans; however, injuries from these animals are very common. Stingrays are shown in the images below.
Stingrays from the northern hemisphere make up the family Dasyatidae. These fish are marine creatures (ie, live in salt water) but also have been found in brackish waters and bays. Another ray family (Potamotrygonidae) [1] contains poisonous species known as freshwater stingrays. These freshwater stingrays live in lakes and rivers of South America.
See Deadly Sea Envenomations, a Critical Images slideshow, to help make an accurate diagnosis.
Also see Cutaneous Manifestations Following Exposures to Marine Life.
Stingray injuries (eg, puncture wounds, lacerations, envenomations) tend to have good outcomes. If patients do not develop infection or other complications, they can expect to have minimal pain in 24-48 hours and healing within 1-2 weeks.
Following is an example of discharge instructions that could be given to patients after treatment of stingray injuries.
Because so many areas of water are nearby, many types of injuries associated with being in or near the water are encountered. These injuries may occur while fishing, walking on the beach, playing in the surf, diving, or working with a home aquarium.
Stingrays often cause lacerations and puncture wounds when the tail whips up and thrusts its barbed spine into the victim, depositing venom (poison). The pain is severe immediately and worsens over the next hour. The pain may last 48 hours. Although rare, deaths have occurred from stingray injuries.
As soon as possible, the wound should be soaked for 30-90 minutes in very hot water (as hot as can be endured without causing burns). The heat inactivates the poison and dramatically relieves the pain. The physician may prescribe pain medication. Also, because the risk of infection is very high, antibiotics are given to prevent infection.
Despite the best of care, any wound can develop infection or other complications. If any of the following occur, it is recommended that patients call their own doctor, the referral physician, or clinic (If a physician cannot be contacted, return to the ED is advised.):
Wound drainage increases, shows pus, or develops a foul odor
Wound bleeds heavily
Wound becomes more sore or swollen
Wound develops increasing redness, or red streaks develop
A fever develops
Wound does not appear to be healing properly
Any other new or worsening symptoms that are of concern
For patient education resources, see the Bites and Stings Center, as well as Stingray Injury.
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Guenin DG, Auerbach PS. Trauma and envenomations from marine fauna. Tintinalli JE, et al, eds. Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill; 1996. 868-73.
Otten EJ. Venomous animal injuries. Rosen P, et al, eds. Emergency Medicine: Concepts and Clinical Practice. Mosby-Year Book; 1998. 924-40.
John L Meade, MD CEO, Statdoc Consulting, Inc
John L Meade, MD is a member of the following medical societies: American College of Emergency Physicians, Medical Association of the State of Alabama
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John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph’s Hospitals
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Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine
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Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center
Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine
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Richard S Krause, MD Senior Clinical Faculty/Clinical Assistant Professor, Department of Emergency Medicine, University of Buffalo State University of New York School of Medicine and Biomedical Sciences
Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine
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Stingray Envenomation
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