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AVRU - Health Professionals - Stinging Fish

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frstaid_sml.gif First aid for stonefish sting is hot water immersion.

Stonefish have 13 hollow dorsal spines which conduct venom into the puncture when the spine is pressed. Although deaths have occurred, no fatalities have been recorded in Australian waters. Other fish have similar structures and cause a similar syndrome, but their envenomation cannot be treated with stonefish antivenom. These include stingrays.

Signs and Symptoms

stonefishspines.jpg
Photo: L. Greisman, AVRU

The severity of symptoms is related to the depth of penetration and number of spines involved.

  • Immediate extremely severe pain extending rapidly to adjacent areas
  • Associated rapid local swelling
  • Muscle weakness
  • Shock
  • Paralysis


Treatment

  • Immersing the stung area in hot (not scalding) water is usually very effective in reducing pain.
  • Hospitalisation for intravenous narcotic analgesia with or without local anaesthetic infiltration (without adrenaline) or regional block.
  • Removal of all foreign material is particularly important. This may require examination for debris on several occasions. X-rays can be useful in detecting foreign material.
  • Definitive management consists of IM administration of stonefish antivenom. Indications for antivenom include severe pain, systemic signs (weakness, paralysis), and multiple punctures.
  • Tissue necrosis may occur, requiring surgical debridement or even skin grafting.
  • Tetanus immunisation status should be checked and updated if necessary.


Antivenom

As a working rule, a greater number of spine punctures indicates the discharge of a greater number of spines and thus the injection of a larger amount of venom. Therefore the recommended antivenom dosage is one ampoule for 1 or 2 spines, two ampoules for 3 or 4 spines, and three ampoules for greater than four spine punctures).

Stonefish antivenom supplied by CSL Ltd is equine in origin.

avfish1.jpg Photo: R. Lowe, AVRU

Stingray

frstaid_sml.gif First aid for stingray sting is wound management or hot water immersion.

Stingrays have a venomous barb on the dorsal surface of their tails. Although they are venomous, the major clinical problem is often related to mechanical trauma from the barb, which may produce deep penetrating injuries or severe lacerations, with or without subsequent infection including tetanus

Signs and Symptoms

  • Increasing local pain which may spread to involve surrounding areas
  • Swelling and a characteristic bluish-white coloration of the wound
  • Nausea and vomiting
  • Excessive salivation
  • Diarrhoea
  • Sweating
  • Muscle cramps
  • Syncope
  • Cardiac arrhythmias
  • Convulsions



Treatment

  • If any major bleeding, apply local pressure
  • Immerse the stung area in hot water
  • Transfer patient to a medical facility if indicated
  • Give appropriate analgesia
  • Inspect, X-ray, surgically explore and debride as necessary to ensure the wound is clean
  • Review tetanus immunisation status and update as necessary
  • All penetrating chest and abdominal wounds need to be explored (this should be deemed a medical emergency until proven otherwise)
  • Consideration should be given to antibiotic prophylaxis in contaminated wounds



No antivenom exists for stingray venom.