Stinging fish
Pressure immobilisation is NOT recommended for stinging fish injuries. Most types of stinging fish have a specific recommended first aid treatment.
Stonefish First aid consisting of bathing or immersing the stung area in hot water may be effective in reducing pain. Do not attempt to restrict the movement of the injected toxin. Hospitalization for intravenous narcotic analgesia +/- local anaesthetic infiltration or regional block may be required. Definitive management consists of administration of stonefish antivenom, which is usually given intramuscularly. Indications for antivenom include severe pain, systemic symptoms or signs of envenomation (weakness, paralysis) or multiple punctures indicating the discharge of several spines and thus injection of a large amount of venom. Tetanus prophylaxis should be undertaken depending on the patient's immunization status. Tissue necrosis may may require surgical debridement or even skin grafting. Consideration should also be given to the presence of a foreign body (i.e. broken spines) within the wound, which should be X-rayed if possible.
Stingrays Although stingrays are venomous, often the major clinical problem is related to mechanical trauma from the sting itself. The sting, which is a spine(s) or barb at the end of the tail, may produce deep penetrating injuries, severe lacerations, or subsequent infection, including tetanus. Envenomation may result in increasing local pain which may spread to involve the entire limb, with swelling and a characteristic bluish white appearance of the wound. Systemic symptoms are rare, but may include nausea and vomiting, salivation, diarrhoea, sweating, muscle cramps, syncope, cardiac arrhythmias and convulsions. Treatment consists of analgesia, tetanus prophylaxis, X ray and surgical exploration and debridement if necessary. Infection of the contaminated wound may develop, and may involve poorly characterized marine bacteria requiring special culture media. Consideration should be given to antibiotic prophylaxis in contaminated wounds, particularly if there has been delay between the sting and medical treatment. There is no antivenom for stingray envenomation.
Other Stinging Fish Immediate severe pain may be prolonged and difficult to manage, even with narcotic analgesia. The pain will usually subside within 24 hours, but swelling may persist for several days. First aid consists of immersion of the affected area (almost always a hand or foot) in hot water. This is thought to inactivate the venom and to improve local blood flow thus dispersing the venom. Infiltration of the wound with local anaesthetic agents provides dramatic relief in most cases, although occasionally a regional nerve block may be required. Tetanus prophylaxis should be updated if required, and the wound should be examined for signs of infection or retained foreign material in the form of broken spines. Xrays should be performed if possible.