Stingray bite pictures: First Aid, Symptoms & Infection Signs
Mild-Mannered Stingrays Can Inflict A World Of Hurt : Shots
Mild-Mannered Stingrays Can Inflict A World Of Hurt
About 16,000 stingrays live along the shoreline of Seal Beach in Southern California, inflicting around 400 injuries each year.
Frederic J. Brown/AFP/Getty Images
Frederic J. Brown/AFP/Getty Images
About 16,000 stingrays live along the shoreline of Seal Beach in Southern California, inflicting around 400 injuries each year.
Frederic J. Brown/AFP/Getty Images
Want to get away? Thinking about a place with warm water and soft sand? Sounds nice. But think twice before you wade into that inviting surf. Chances are there are stingrays in the area.
Every year, these timid, shellfish-eating cousins of the shark inflict excruciating injuries on thousands of swimmers and surfers from the Bahamas to Bahrain to both coasts of the United States.
… a much deeper, darker migrainous-type pain — almost like you put your foot or ankle in a vise and twisted it.
Eric Stern, physician stung by a stingray
One of last year’s victims was Eric Stern, a doctor from Washington, D.C., who was giving a surfing lesson to his sister in August near Santa Monica, Calif. He remembers casually hopping off his board into waist-deep water.
“The moment my foot hit sandy bottom, just, strike! Bam!” he says. “I mean, immediate … knifelike pain.”
Stern wondered at first whether a shark had bitten him. “The bleeding was so pronounced from what appeared to be a 2-inch to 3-inch gash,” he says. “I still wasn’t thinking stingray.”
But when lifeguards arrived, they told him he was the third stingray victim they’d seen that day. And by that time, Stern says, the injury no longer felt like a bite or a cut.
“The pain had transitioned already to a much deeper, darker migrainous-type pain,” he says. “Almost like you put your foot or ankle in a vise and twisted it.”
The round stingray is native to the eastern Pacific coast and is notorious for injuring swimmers and surfers.
A Painful Toxin
In a marine lab at California State University, Long Beach — an hour’s drive south of where Stern got injured — marine biologist Chris Lowe says the intense pain of a stingray injury comes from a powerful toxin secreted by the animal’s tail.
“That toxin causes blood vessels to constrict, reducing blood flow,” Lowe says. “It causes this intense pain sensation — a throbbing, kind of aching pain sensation. And it literally takes hours to go away.”
But if you’ve ever been unlucky enough to feel that pain, don’t blame the stingray, Lowe says. They only sting in self-defense. And the round stingray that probably got Stern is especially shy, he adds.
In Lowe’s lab, a round stingray hides at the sandy bottom of a tank. At first, it’s hard to tell that there is a stingray there because, as Lowe says, “the name of their game is disappearing.”
But eventually, you can make out a faint outline in the sand about the size of a dinner plate, along with two eyes and two nostrillike openings called spiracles.
As he scoops the stingray into a net, Lowe explains how Eric Stern’s foot got filleted. He points to the inch-long spine that’s almost concealed in a sheath at the end of the animal’s whiplike tail.
“When you … harass this ray or accidentally step on it,” Lowe says, “it has the ability to quickly flick its tail up. And that barb comes up like an arrow point.”
Larger stingrays, like the Australian bull ray, can have spines “the size of a steak knife,” Lowe says. It was one of these large rays on Australia’s Great Barrier Reef that killed Steve Irwin, host of The Crocodile Hunter TV show, in 2006.
“Believe it or not, Steve Irwin was not the only fatality,” Lowe says. “About every five or six years or so, somebody is killed by one of those large stingrays.”
Although there are no good statistics on stingray injuries, what data there are suggest that thousands of people are stung each year worldwide and that the number may be rising.
In places like California, stingray populations appear to be growing because there are fewer predators, like sharks, seals and sea lions, Lowe says. Also, more and more people around the world are spending time at the beach.
“I get calls from resort owners on the East Coast — [and] even in the Middle East, where they have really high-end resorts,” Lowe says. “They have stingrays in those areas. They have had injuries, and they call us up asking us what should they do.”
People have been asking that question for a long time at Seal Beach, which is just a couple of miles from Lowe’s lab. Several years ago, a census of rays on this beach found that about 16,000 rays live along just a few hundred yards of shoreline. And, not surprisingly, the area reports more stingray injuries than any place on Earth — about 400 a year.
Michael Pless, an instructor at M&M Surfing School in Seal Beach, says he’s been stung 21 times in the past 30 years.
Take a stroll down Seal Beach, and there’s a good chance you’ll run into Michael Pless, an instructor at M&M Surfing School. “I’m known as the king of stingray stings,” he says.
In the past 30 years, Pless says, he’s been stung 21 times.
He says he gives all of his surfing students a lesson in how to do the “stingray shuffle,” which involves shuffling your feet along the sand so the stingrays know you’re coming and you don’t step on one.
Signs in parking lots around Seal Beach warn of stingrays, and lifeguards also try to help beachgoers avoid a painful sting. But many still learn about the dangers the hard way, says Nick Bolin, a marine safety officer.
“Usually our tower guards will spot them seconds after they’ve been stung because they’ll come hopping out of the water,” he says. “We’ll take them back to our lifeguard headquarters, where we have a dedicated lifeguard assigned to the stingray shift, and we soak the foot in hot water until the pain subsides enough that they can go on their own way.”
When the beach is busy and the tide is low, there may be dozens of victims, Bolin says. “We’ve had days where our hot water heater actually can’t even keep up with the [number of] stings.”
Soaking a sting in very hot water is critical, as the heat neutralizes the stingray toxin.
“The moment you take your foot out of the hot water, the pain just shoots back up within five to 10 seconds,” says Stern, the doctor who got stung while surfing near Santa Monica. “It’s really quite remarkable.”
Unfortunately for Stern, several hours of hot water treatment wasn’t the end of his stingray adventure. The gash on his foot had to be sewn up at a local emergency room. And once the wound healed, Stern realized he had another problem.
“I began to notice that I didn’t have any sensation in the dorsum — the top — of my foot around the base of my fourth and fifth toes,” he says.
The sting had caused nerve damage, and Stern eventually needed surgery. But he’s better now and ready to get back in the California surf. “This time,” he says, “I think I’m going to stay on my board until I’m out in deep waters. “
emDOCs.net – Emergency Medicine EducationTOXCard: Stingray Injuries – emDOCs.net
Author: Kathleen Yip MD (Harbor-UCLA Medical Center) // Edited by: David Tanen MD (Harbor-UCLA Medical Center), Cynthia Santos (Rutgers New Jersey Medical School), Alex Koyfman, MD (@EMHighAK, UTSW / Parkland Memorial Hospital), and Brit Long, MD (@long_brit)
A 26-year-old male walks with an antalgic gait into the emergency department. He reports running in the shallow waters at the beach nearby about an hour ago when he felt sudden pain in the back of his right ankle. When he looked down, he saw a stingray swimming away and a thin trail of blood from his ankle dissipating into the water. The bleeding has stopped, but now he reports excruciating pain, even after taking a Tylenol his friend gave him.
- What is the management of stingray injuries?
- What are potential complications?
- What prevention strategies are there to avoid future injuries?
- Stingrays live in temperate and tropical oceans. They are often found buried in the sand and are docile creatures that would rather swim to escape than attack.1
- Most injuries are due to unintentional contact (stepping on the wings) or from unraveling fishing equipment.2
- The bilaterally serrated spine is located dorsally on the tail; it is contained within the integumentary sheath, which holds the venom.1
- The injury occurs in two steps: 1) mechanical injury from the sharp and jagged spine, causing a laceration or puncture wound, and 2) envenomation, resulting in systemic symptoms.3
- There are approximately 2000 reported stingray injuries per year in the United States.4
Clinical signs and symptoms
- Intense pain and edema peaks around 30 minutes to 90 minutes and lasts up to 48 hours.2
- Systemic signs of venom toxicity include nausea, vomiting, diarrhea, diaphoresis, hypotension, arrhythmias, and seizures. 5
- Hot water immersion
- There is a risk of sustaining a thermal burn, but this can be mitigated by testing the uninjured limb in the hot water bath first.
- Water as hot as tolerated should be used; one study used 110°-114°F (43.3°-45.6°C).3
- One retrospective study showed that 88% of patients who were treated with hot water immersion alone achieved complete pain relief within 30 minutes.6
- Wound care
- Consider removing the spine if it is superficially embedded in the wound; do not remove any spines causing through and through penetrations or any located in the neck, thorax, or abdomen (consult surgery for penetrating injuries in these regions).
- Even if the spine or sheath does not break off into the wound, irrigation is key to removing debris such as sand.
- Tetanus prophylaxis.
- Stingrays have cartilaginous exoskeletons, so spine fragments may not be seen on radiographs.
- One study suggested that radiographs were low yield; of the 68 patients that received an X-ray, two had radio-opaque foreign bodies (sand as well as an unidentified object that was unsuccessfully removed in the ED).6
- One case report described the development of tenosynovitis in a patient who had a retained stingray spine that was not imaged on multiple visits.7
- Antibiotic prophylaxis
- In a retrospective chart review, 17% of patients who did not receive antibiotic prophylaxis versus 1.4% who did receive antibiotics returned with an infection. There was no information on the patients who developed infections (e.g. risk factors, age, wound characteristics, etc.).6
- In a prospective study that consisted of mostly healthy young males in which none received antibiotic prophylaxis, 4.5% of patients returned with an infection.8
- If antibiotics are prescribed, a 5-day course of quinolones to cover for Vibrio, Streptococcus, and Staphylococcus is recommended. 6
- Observation for patients experiencing systemic manifestations of stingray envenomation.
Mechanism of toxicity
- For a variety of reasons, stingray venom is difficult to study.
- Based on one study, the venom contains cardiotoxic and heat labile proteins9, which explains why hot water is key to pain management.
- Retained foreign body
- Avoid touching marine life.
- Wear gear that covers exposed skin.
- Do the “stingray shuffle” —shuffle feet when walking in shallow sandy areas to alert nearby stingrays.5
Take home points
- Hot water is very effective at treating pain.
- Consider radiographs and antibiotics, and regardless, provide patients with good return precautions for the development of infections.
- Diaz JH. The evaluation, management, and prevention of stingray injuries in travelers. J Travel Med 2008;15:102-9.
- Balhara KS, Stolbach A. Marine envenomations. Emerg Med Clin North Am 2014;32:223-43.
- Clark RF, Girard RH, Rao D, Ly BT, Davis DP. Stingray envenomation: a retrospective review of clinical presentation and treatment in 119 cases. J Emerg Med 2007;33:33-7.
- Auerbach PS. Envenomation by aquatic vertebrates: Stingrays. 6 ed. Philadelphia, PA: Elsevier; 2011.
- Hornbeak KB, Auerbach PS. Marine Envenomation. Emerg Med Clin North Am 2017;35:321-37.
- Clark AT, Clark RF, Cantrell FL. A Retrospective Review of the Presentation and Treatment of Stingray Stings Reported to a Poison Control System. Am J Ther 2017;24:e177-e80.
- O’Malley GF, O’Malley RN, Pham O, Randolph F. Retained Stingray Barb and the Importance of Imaging. Wilderness Environ Med 2015;26:375-9.
- Myatt T, Nguyen BJ, Clark RF, Coffey CH, O’Connell CW. A Prospective Study of Stingray Injury and Envenomation Outcomes. J Emerg Med 2018;55:213-7.
- Russell FE, Van Harreveld A. Cardiovascular effects of the venom of the round stingray, Urobatis halleri. Arch Int Physiol Biochim 1954;62:322-33.
Stingray Envenomation of the Foot: A case report
by Al Kline, DPM1
The Foot & Ankle Journal 1 (6): 4
Stingrays are docile marine animals that only strike their victim when provoked or startled. Lower extremity and foot envenomation is common when fishing in shallow waters off the beach. The stingray tail has a sharp, serrated barb along the proximal third of the tail that is usually hidden and encased in an integumentary sheath and can deliver painful enzymes causing tissue necrosis. Immediate treatment including rapid cleansing and heat submersion of the foot is recommended after injury. If treatment is delayed, infection from marine bacteria often requires hospitalization including intravenous antibiotics and surgical treatment.
Key words: Stingray envenomation
This is an Open Access article distributed under the terms of the Creative Commons Attribution License. It permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ©The Foot & Ankle Journal (www.faoj.org)
Accepted: May 2008
Published: June 2008
Stingray envenomation of the foot is a common marine injury. There is an estimated 1500 stingray injuries reported annually in the United States.  Usually, a person will be fishing in shallow water and accidentally step on the stingray. This causes an instinctive, defense mechanism of the stingray. The tail will lash upward like a scorpion and penetrate a sharp bard in the lower extremity or foot. The stingray tail has a sharp, serrated barb along the proximal third of the tail that is usually hidden and encased in an integumentary sheath. The stinger barb is made of cartilage and the serrations are directed proximally.
This means, that as the barb penetrates, the barb can rip tissue or even lacerate tendons, ligaments and other soft tissue as it pulls away from the puncture site. (Fig. 1) The integumentary sheath that encases the barb also contains a venomous protein that is released into a wound when the barb strikes and the sheath ruptures. This will cause intense pain and tissue necrosis. The barb can remain or break off in the wound. Fortunately, this only occurs in about 5% of reported cases. [2,6]
Figure 1 The serrated stingray barb. The barb is encased in an integumentary sheath. The serrated spines are directed proximally and can cause extensive tissue damage when pulled from a wound.
Envenomation occurs in up to 75% of reported stingray injuries.  The stingray venom contains the neurotransmitter serotonin and two enzymes; 5-nucleotidase, and phosphodiesterase.  Serotonin is responsible for the intense pain associated with the sting and the 5-nucleotidase and phosphodiesterase enzymes cause intense tissue necrosis.
Fatal envenomation is extremely rare and has recently come to light due to the death of “The Crocodile Hunter”, Steve Irwin, on September 4th, 2006. Steve Irwin was snorkeling in water and swam close to an Australian bull ray. (Fig. 2) The ray was startled and lashed its tail upward and pierced Steve Irwin’s heart. He died shortly after pulling the barb from his chest. It was reported at that time that only three fatal envenomations in Australia’s history had been reported before Irwin’s death.
Figure 2 The Australian bull ray or Southern eagle ray (Myliobatis australis).
Interestingly, one month later in October 2006, James Bertikas from Florida was stung by a ray as the barb also pierced his heart. However, he did not remove the barb, and survived his injury. In his case, a 2 ½ inch barb penetrated his left lung and migrated into his heart crossing both the left and right ventricle.  Most deaths occur from the actual laceration of a major artery or organ such as the heart from the barb and not the venomous effects.
However, in one report, a 12 year old boy died after envenomation from a freak accident when an ‘airborne’ ray slammed against his chest penetrating the barb into the boys left lung and piercing the pericardium.
The boy was relatively asymptomatic and initially treated for a puncture wound to the chest and knee, but he died six days later from sequestered venom and myocardial necrosis causing right ventricular rupture and fatal cardiac tamponade. [2,6] Another reported case involved a man who sustained a laceration to his femoral artery and bled to death.  In most cases, stingray injuries are not life-threatening, but can cause long-term complications. In one report, osteomyelitis of the malleolus resulted from an ankle strike seven months after injury. 
The effects of envenomation are not clearly understood as to reported systemic effects. Common reported symptoms can include diaphoresis, nausea, cardiac arrhythmias,tremors, skin rash, headache,delirium, fever, hypertension, syncope, anxiety and a host of other common allergic reactions.
Another complication from injury is the seawater and bacteria that can enter a wound on penetration during this injury.
We present the case of a 31 year old male who stepped on a stingray while fishing. He delayed initial treatment, continued to fish and developed cellulitis with a painful foot which required hospitalization and surgical treatment.
A 31 year-old male presented to the emergency room with a hot, swollen foot. He was fishing in shallow water the day before and was stung by a stingray. He felt a sharp pain to the top of his foot. He continued to fish most of the day. In the evening, his foot swelling and pain got progressively worse. His wife went to the internet and realized that submerging the foot in hot water would eliminate the pain. He submerged the foot in water and his pain dissipated that evening. In the morning, he had a progressive increase in pain and presented to the emergency room for treatment.
Clinical evaluation revealed a small puncture wound to the dorsolateral aspect of the right foot. (Fig. 3) There was increased soft tissue swelling with slight tissue crepitus. His laboratory data revealed a 16,000 white count with a left shift. Routine radiographic evaluation showed an area of gas in the region of the puncture wound, but no sign of barb. (Fig. 4)
Figure 3 A small puncture wound is see to the dorsolateral aspect of the foot consistent with a stingray envenomation. The central puncture wound will have signs of tissue necrosis.
Figure 4 Radiographic evaluation reveals soft tissue gas formation in the subcutaneous tissues of the dorsal foot. No barb is seen on radiograph.
It was recommended he go directly to the operating room for incision and drainage with exploration of the wound.
Surgical exploration revealed soft tissue necrosis through the subcutaneous layer from the initial envenomation. All soft tissue was removed and sent for deep tissue culture. Some local debris was flushed from the wound, but no barb was located. The wound was thoroughly irrigated with Betadine solution and Bacitracin irrigation. The wound was then loosely packed and the edges of the incision were loosely approximated. (Fig. 5)
Figure 5 It is important to open the puncture site and remove any necrotic tissue and explore for foreign material that may cause continued infection. Necrotic tissue is removed, the edges of the wound can be loosely approximated and the central injury point may granulate and heal by secondary intention.
Tissue cultures revealed Staphylococcus aureus. He was placed on IV Levaquin. His initial infection took about a week to resolve and he was discharged from the hospital. He continued local wound care and within 2 weeks of his injury, the wound closed. (Fig. 6)
Figure 6 The wound is now closed and the patient has returned to work without incident.
It is important to initially submerge the foot into hot water after the incident. Rapid application of heat will denature the enzymes causing the pain and limit the effects of tissue necrosis. It is recommended that immediate submersion into hot, but not scalding, water will also help to ease the pain of this injury.
It is recommended to submerge the foot into a water temperature of 42 to 45 degrees Celsius (108-113 degrees Fahrenheit) for 30 to 90 minutes, or until the pain resolves.  Infection of the wound can usually be avoided with aggressive wound cleansing and oral antibiotics.
In cases where cellulites results in delayed treatment or is not responsive to oral antibiotics, hospitalization and intravenous antibiotics is recommended. The most common pathogens to infect the wound include Staphylococcus aureus and streptococcus species. Water-borne pathogens of concern include Vibrios vulnificans in salt water and Aeromonas species in fresh water.
In more serious lacerations, it is important to immediately control hemorrhage from the laceration by applying direct pressure to the wound. Applying a tourniquet to the extremity is not recommended because swelling and systemic effects are rare in extremity wounds.  The wound should always be cleansed thoroughly with an antibacterial wound cleanser immediately after injury. Hexachlorophene in 70% alcohol (pHisoHex®) or Betadine solution will provide good antibacterial cleansing of the wound. 
Although there is no antidote or anti-venom , it has also been reported that direct injection of 1% lignocaine (or lidocaine) may have an anti-venomous affect to the venom that remains in the wound.  If the patient presents some time after injury to the emergency room with a hot, swollen foot, it is important to incise and open the puncture site, even if no barb is present. Intravenous antibiotic therapy is recommended until the cellulites has resolved. Hyperbaric oxygen in the treatment of stingray envenomation has also proved to be beneficial. 
Tetanus prophylaxis should also be current. Levofloxin or Levaquin is the drug of choice against Vibrio species and will cover Staphylococcus aureus and multi-drug, gram-negative organisms common to penetration injuries. Bactrim and Doxycyline are also good against Vibrio species, although the coverage is not as good for staph and strep species. 
Of course, antibiotic treatment can be tailored to the results of deep tissue samples taken at time of surgery to determine the infective organism. At time of surgery, it is recommended to inspect the wound for foreign material, remove any necrotic tissue, take deep tissue biopsy for culture and leave the wound packed open. Packing can include Betadine gauze or calcium alginate. Calcium alginate dressing or Kaltostat® has been reported to absorb toxin in one report. 
Stingrays belong the the class Chondrichthyes meaning cartilaginous fishes. These are usually docile creatures that only strike when provoked or feel threatened. In this case, medical treatment after initial injury was delayed which required surgical treatment and prolonged hospitalization. The delay in initial treatment caused progressive tissue necrosis and secondary infection after injury.
It is important to treat these injuries promptly. If the injury is not life-threatening, it is important to quickly cleanse the wound and submerge the foot in hot water to deactivate the tissue enzymes that cause pain and tissue necrosis. Ideally, medical treatment will consist of radiographs to eliminate the possibility of a barb that may remain in the wound. In the emergency room setting, the wound can be injected with 1% lidocaine and lanced at the puncture site. The wound should then be aggressively irrigated with Betadine. A calcium alginate dressing can then be applied to the open wound and allowed to heal by secondary intention. Oral antibiotics with coverage for gram positive and negative organisms are prescribed at discharge.
1. Perkins, A.R., Morgan, S.S.: Poisoning, Envenomation and Trauma from Marine Creatures. American Family Physician, February, 2004 [Online]
2. Ganard, S. Stingray Injuries, Envenomation, and Medical Mangement. [Online article]
3. Meade, J.L. Stingray Envenomations, Emedicine article [Online]
4. Rocca, A.F. Hyperbaric Oxygen Therapy in the treatment of soft tissue necrosis resulting from a stingray puncture wound. Foot Ankle Int. 22 (4): 318-323, April 2001. [PubMed]
5. Perkins, A.R., Morgan, S.S.: Poisoning, Envenomation and Trauma from Marine Creatures. American Family Physician, February, 2004 [Online]
6. Fenner, P.J. et al: Fatal and Non-Fatal Stingray Envenomation. Med Journal Australia : 151:621-625. 1989. [PDF]
7. Fenner, P.J.: Stingray Envenomation: A Suggested New Treatment. Med Journal Australia: 163: 665. 1995 [PDF]
8. St. Petersburg Times [Online news wire], October, 2006.
Address correspondence to: Dr. Al Kline, DPM, 3130 South Alameda, Corpus Christi, Texas 78404. E-mail: [email protected]
1Adjunct Clinical Faculty, Barry University School of Podiatric Medicine. Private practice, Chief of Podiatry, Doctors Regional Medical Center. Corpus Christi, Texas, 78411.
© The Foot & Ankle Journal, 2008
Stingrays | National Geographic
- Common Name:
- Scientific Name:
- Average Life Span In The Wild:
- 15 to 25 years
- Up to 6.5 feet
- Up to 790 pounds
Stingrays are commonly found in the shallow coastal waters of temperate seas. They spend the majority of their time inactive, partially buried in sand, often moving only with the sway of the tide.
The stingray’s coloration commonly reflects the seafloor’s shading, camouflaging it from predatory sharks and larger rays. Their flattened bodies are composed of pectoral fins joined to their head and trunk with an infamous tail trailing behind.
While the stingray’s eyes peer out from its dorsal side, its mouth, nostrils, and gill slits are situated on its underbelly. Its eyes are therefore not thought by scientists to play a considerable role in hunting. Like its shark relatives, the stingray is outfitted with electrical sensors called ampullae of Lorenzini. Located around the stingray’s mouth, these organs sense the natural electrical charges of potential prey. Many rays have jaw teeth to enable them to crush mollusks such as clams, oysters, and mussels.
When they are inclined to move, most stingrays swim by undulating their bodies like a wave; others flap their sides like wings. The tail may also be used to maneuver in the water, but its primary purpose is protection.
Barb and Venom
The stingray’s spine, or barb, can be ominously fashioned with serrated edges and a sharp point. The underside may produce venom, which can be fatal to humans, and which can remain deadly even after the stingray’s death. In Greek mythology, Odysseus, the great king of Ithaca, was killed when his son, Telegonus, struck him using a spear tipped with the spine of a stingray.
You may have heard that the ability to chew food separates mammals from other animals. But new footage reveals that stingrays—at least the ocellate river stingray—chew their food too. Watch how one stingray chomps down on dragonfly larvae.
What to Know About Stingray Stings
Well it is still time for surf, sand, sun, and… Stingrays! Our southern beaches are home for thousands of Round Rays. Seal Beach itself has more than 400 stingray injuries per year and populated by nearly 20,000 rays. Stingrays also love Santa Monica, Newport Beach and are numerous all the way down to San Diego. They are mild-mannered and shy little guys that are the size of dinner plates. They hide in the sand from predators (sharks and seals) and prefer the shallow warm water. They lay there quietly minding their own business until they get stepped on by an inadvertent bather and… BAM! Stingrays have an inch-long barb filled with venom shoots that out and stabs a foot or ankle. The barb can cause a significant laceration and can break off into the wound. Immediately the victim feels an excruciating pain which quickly starts to spread up the injured limb.
Most people don’t know what hit them until they are seen by the lifeguards hopping out of the water in a panic. Fortunately, most of our local lifeguard’s stations are equipped with immersion tanks filled with hot water. Soaking the limb immediately with water as hot as one can stand (113 degrees F) neutralizes the venom but may take 60 to 90 minutes to do the job thoroughly.
Any victim of stingray wounds should seek medical care as soon as possible after the pain is controlled with hot water treatment. Whether or not barb fragments are seen in the wound, an X-ray should be obtained to visualize any deep fragments below the skin. The wound should be irrigated well. The doctor can inject local anesthesia to help with pain relief and facilitate barb removal. Tetanus vaccine should be given if needed. Everyone needs antibiotics to prevent nasty infections from ocean bacteria as well as skin staph and strep bacteria. Most wounds will be sore for a few days but the initial venom-induced pain can only be relieved by hot water immersion, so obtain that treatment any possible way that you can right away.
How to avoid sting ray wounds? Don’t think that surf booties or other footwear will help. Barbs can penetrate even thick leather boots. Do the “stingray shuffle” when entering the water and stir up the sand well. Make sure they know you are “in the house!” If you are fishing and catch a ray, cut the line before they can get you in the hand, arm, or worse- the torso. Venom injected above the waist can be deadly. Rays are flexible and can direct that barb all the way over their heads in defense.
So be careful, watchful, and shuffle those feet when entering the ocean this season and everyone will have fun in the sun!
The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.
Self-Care / First Aid
For Poisonous Snake Bites Before Medical Care
•Carefully move the person away from the snake. Calm the person. Have him or her rest. Moving about can help spread the venom.
•Gently wash the bite area with soap and water. Keep the limb of the bite site level with the heart (or just below this). Apply a splint to the limb of the bite site to keep it from moving.
•Being careful, note, if you can, the shape of the snakes eyes, pupils, and head, the colors it is, and if it has rattles.
•Don’t try to kill the snake, cut the fang mark, or suck out the venom.
•Don’t apply a tourniquet, a bandage, or ice to the bite.
For Non-Poisonous Snake Bites
•Gently wash the site with soap and water.
•Treat the bite as a minor wound. (See For Minor Cuts and Scrapes.)
•If you notice signs of an infection, call your doctor.
For Poisonous Spider Bites Until Emergency Care Arrives
•Perform rescue breathing, if needed. (See Rescue Breath.)
•If you can, keep the bitten area lower than the level of the heart.
•Calm the person and keep him or her warm.
•Gently clean the site of the bite with soap and water or rubbing alcohol.
•Put an ice pack over the bite site for pain relief.
•If you can, catch the spider in a closed container to show what kind it is.
For Poisonous Spider and Scorpion Bites Before Medical Care
•Do rescue breathing, if needed.
•If you can, keep the bitten area lower than the level of the heart.
•Calm the victim and keep him or her warm.
•Gently clean the site of the bite with soap and water or rubbing alcohol.
•Put an ice pack over the bite site to relieve pain.
•If you can, catch the spider in a closed container to show the doctor.
•Get emergency care!
For Human Bites Before Medical Care
•Wash the wound area with soap and water for at least 5 minutes. Don’t scrub hard. Rinse with running water or with an antiseptic solution, such as Betadine.
•Cover the wound area with sterile gauze. Tape only the ends of the gauze in place. Then get medical care.
For Deer Tick Bites
•Remove any ticks found on the skin. Use tweezers to grasp the tick(s) as close to the skin as you can. Firmly, but gently begin rotating the head part in a counterclockwise manner until the whole headpiece comes out. Or, pull gently and carefully in a steady upward motion at the point where the tick’s mouthpart enters the skin. Try not to crush the tick. The secretions released may spread disease.
•After you remove the ticks, wash the wound area and your hands with soap and water. Apply rubbing alcohol to help disinfect the area.
•Use an ice pack over the bite area to relieve pain.
•Save one tick in a closed jar with rubbing alcohol to show the doctor.
For Dog and Cat Bites
•Wash the bite area right away with soap and warm water for 5 minutes. If the bite is deep, flush the wound with water for 10 minutes. Dry the wound with a clean towel. Then get medical care.
•If the wound is swollen, apply ice wrapped in a towel for 10 minutes.
•Get a tetanus shot, if needed.
•If the bite hurts, take an over-the-counter (OTC) medicine for pain.
•Report the incident to the animal control department. If a pet’s immunizations are not current, arrange with the animal control department for the pet to be observed for the next 10 days to check for rabies.
•Observe the wound for a few days. Look for signs of infection. Often, cat bite wounds need an antibiotic.
Marine Stings and Scrapes | HealthLink BC
Walking on a beach or swimming in the ocean can be fun and relaxing. But just like any other activities, injuries can happen. This topic will help you determine the next steps to take if you have a jellyfish or Portuguese man-of-war sting, seabather’s eruption, or a coral scrape.
Jellyfish and Portuguese man-of-wars are members of a large group of venomous marine animals that also includes fire coral and sea anemones. They are present all over the world and cause injury and illness through the release of venom when their tentacles come in contact with skin (stinging). Tentacles are long, slender, flexible growths found on jellyfish, Portuguese man-of-wars, squid, and octopuses. Tentacles are used for grasping, feeling, moving, and killing prey by stinging. While the sting of a jellyfish or Portuguese man-of-war can cause severe illness and extreme pain, documented deaths are rare.
Jellyfish are often present in coastal waters, having been brought ashore by winds or ocean currents. They are most common in warm ocean waters, especially along the Atlantic coast of the United States. Stings result from contact with the tentacles, which trail from the jellyfish’s see-through body. Jellyfish swimming in the water are often hard to see. Beached jellyfish, which may look like the cellophane wrapper from a cigarette pack, can sting if touched.
Jellyfish stings cause immediate, intense pain and burning that can last for several hours. Raised, red welts develop along the site of the sting, which may look like you have been hit with a whip. The welts may last for 1 to 2 weeks, and itchy skin rashes may appear 1 to 4 weeks after the sting. Fortunately, most jellyfish stings are not severe. Extensive stings, allergic reactions, or severe reactions are not common but do occur. To avoid the risk of drowning, swimmers should get out of the water as soon as they realize they have been stung.
The box jellyfish, which is found in the Indian Ocean and South Pacific, can cause a fatal reaction. It is the only jellyfish for which a specific antidote (antivenom) exists. If you get this antidote, it may save your life.
Seabather’s eruption is a rash that develops from the stings of jellyfish or sea anemone larvae. The rash can be quite itchy and annoying, but it usually goes away without medical treatment in 10 to 14 days.
Portuguese man-of-wars (hydrozoans) live in warm seas throughout the world but are most common in the tropical and subtropical regions of the Pacific and Indian oceans and in the Gulf Stream of the North Atlantic Ocean. They float on the surface of the water with their long, stinging tentacles trailing in the water below. Detached tentacles that wash up on the beach may remain dangerous for months.
Portuguese man-of-war stings produce immediate burning pain and redness where the tentacles touched the skin. The affected area develops a red line with small white lesions. In severe cases, blisters and welts that look like a string of beads may appear. Stings that involve the eye may cause pain, swelling, excessive tears, blurred vision, or increased sensitivity to light. Severe reactions are most likely to occur in children and small adults. Severe toxic reactions to the venom can also occur.
Stingrays are members of the shark family. They have sharp spines in their tails that can cause cuts or puncture wounds. The spines also have venom. Stingrays do not bite but can suck with their mouths and leave a bruise.
Coral scrapes and cuts are common injuries that may occur when you walk on a beach or swim, snorkel, or dive in warm water. Coral polyps, the soft living material that covers the surface of coral, can be easily torn away from the rigid and abrasive structure underneath if you touch, bump, or fall on coral. A skin infection may develop when small pieces of coral, other debris, and bacteria get inside the wound. Scrapes and cuts from sharp-edged coral may take weeks or even months to heal.
Consequences of a poisonous stingray prick with a thorn
Spines of the Southern Stingray (Dasyatis americana)
Stingrays form one of the largest and most important groups of venomous marine animals. There are 2,000 stingray shots reported annually in the United States. They inhabit warm, subtropical and tropical waters. The favorite habitat of these passive, secretive animals is the sandy or muddy bottom of closed lagoons and estuaries, where they feed on crustaceans and molluscs.
Stingrays have one to four venomous stings on the back of an elongated, tail-like whip-like appendage.This tail is a cartilaginous process studded with serrated spines. It is covered with a thin layer of skin that hides two ventrolateral areas with venom glands. When the tail sticks into the victim, the epithelial membrane of the glands breaks open, releasing poison. Like other poisonous fish, the shell breaks on contact with the victim, allowing the venom to enter the wound. The poison contains at least 10 amino acids and toxic substances, including phosphodiesterase, 5′-nucleotidase and serotonin. When extracted, the poison is destroyed very quickly, as it is very unstable and thermolabile.
Stingrays attack only for defense purposes, and this usually happens when people inadvertently touch or step on the animal. If you touch the wings of the stingray, then it throws its tail forward, plunging it into the victim. Outside the water, a stingray can also prick a person while in a net or on a hook. There has been a documented case of injury by a person stepping on a dead, decomposing animal.
Stingrays periodically appear on the coast of Wales. The following describes the case of a fisherman receiving a laceration of the lower leg from contact with the slope.
Description of Case
Stingrays appeared on the coast of Wales in July 1994. An angler caught a 19 kilogram (42 lb) stingray in South Wales but was able to avoid contact with the poisonous sting. On the west coast of Wales, a fisherman caught an 18 kg (40 lb) stingray during a fishing event hosted by the Wales Fire Department. Several colleagues helped him carry the animal ashore, and, unfortunately, one of them hit the stingray, which sank its tail into the fisherman. The sting pierced the boots (modified rubber) and trousers, severing the shin of the left leg.The patient reported acute pain in the wound area. Later, the pain spread to the ankle. The fisherman went to the nearest emergency department. The doctor who examined him reported the incident to the Welsh National Poisons Unit, whose experts provided advice on trauma management. The wound was washed with warm water to neutralize thermolabile poisons. It was then disinfected and the edges of the wound were treated surgically under general anesthesia. The wound was not sutured, but bandaged, and the patient was left overnight for further observation.The patient was prescribed antibiotics and did not need a tetanus vaccine. The fisherman was discharged the next morning and was seen by his therapist. Follow-up showed that the patient again went to the emergency room as the leg was swollen and reddened. The soft tissues of the leg were examined several times, and the wound healed after two months. An 8 cm scar remained on the lower leg.
Symptoms of the injection appear immediately.In the area of the wound, severe pain appears, proportional to the severity of the injury. Swelling around the wound is persistent, but the severity may vary. The wound turns blue, then erythema (or reddening of the skin caused by the expansion of capillaries) and petechiae (minute hemorrhages) may appear. As a result, local tissue necrosis, ulceration, gangrene may occur. The peak of pain occurs within 90 minutes. Without medical treatment of the wound, the pain lasts up to 48 hours. Systemic manifestations and signs can vary significantly and include nausea and vomiting, muscle cramps and fasciculations, sweating, fainting, and headaches.Cases of manifestations of cardiac arrhythmias, arterial hypotension, convulsions and, in rare cases, death were also recorded.
Soft tissue damage from stingray pricks can be extensive. In addition to the puncture wound, the cutting action of the thorns leads to damage and rupture of the underlying soft tissue. Most often, people injure the lower and upper limbs. Severe injuries and fatalities from stingray sting are described in Cooper’s article, including fatalities from tail striking to the chest and abdomen.Foreign components (cartilage and epithelium) can get into the wound. Secondary infection occurs quite often due to the unique environment created by the sea water. Pathogenic marine bacteria can be halophilic (bacteria that live in environments with high salt concentrations), heterotrophic (bacteria that need complex compounds for nutrition, since the possibilities of their synthesis are limited), mobile, gram-negative. The genus of bacteria Vibrio is quite common and can be very dangerous for immunocompromised people.
The goal of treatment is to neutralize the local and systemic effects of the poison, reduce pain and prevent infection. The wound should be immediately treated with any available liquid. In practice, this is usually sea water. Any visible pieces of sting or epithelial tissue should be removed. As soon as the opportunity arises, the wound should be rinsed with warm water (about 40 ° C) for 30-90 minutes, avoiding possible thermal damage. Heat will inactivate any thermolabile poisons.If pain persists, it can be relieved by flushing with warm water, regional anesthesia, or wound infiltration. Vesicular fluid should be removed in a timely manner under sterile conditions. Then the wound is washed again, examined, and necrotic tissues and foreign bodies are removed. With the help of X-ray, the remains of radiopaque cartilaginous spines can be determined. You may need to leave the wound open for a while or perform additional surgery. Antibiotic prophylaxis is controversial, but antibiotics can be prescribed for people with low immunity or for very serious wounds.Tetanus prophylaxis should always be kept in mind. Patients should be monitored for four hours after the injection to detect possible systemic reactions. Sometimes the ingress of poison is accompanied by an allergic reaction, in which case prompt treatment of anaphylaxis will be required.
Fortunately, a large number of stingrays lose or tear the epithelial membrane of the glands (45% of 4000 in one study), so the attacks of stingrays are limited only to soft tissue injury without the ingress of poisons.
based on RJ Evans, R S Davies. Stingray injury. Accid EmergMed 1996; 13: 224-225
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