About all

Treatment for stingray: First Aid Information for Stingray Injury

by alexxlab

The Treatment of Stingray Injuries | JAMA

The Treatment of Stingray Injuries | JAMA | JAMA Network










[Skip to Navigation]











This Issue


  • Download PDF


  • Full Text



  • Share


    Twitter
    Facebook
    Email
    LinkedIn


  • Cite This


  • Permissions


Article

July 11, 1966


Jorge Hartmann, MD

Author Affiliations

Cúcuta, Colombia


JAMA. 1966;197(2):153. doi:10.1001/jama.1966.03110020141059

Full Text


This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


Abstract

To the Editor:— 
In tropical climates stingray wounds may not heal for months (195:708, 1966), leaving bad scars. Since 1940 a treatment has been used which yields rapid healing without unbearable pains. There is no scarring of significance and a minimum incapacitation during recovery.The sting of the stingray is a bone, like a double-toothed saw, which lies in a small canal over the tail of the fish. This canal contains glands which secrete a sticky liquid, which is strongly alkaline and is highly destructive to soft tissues.The treatment I have followed consists of immersing the affected member in a warm solution of lactic acid in water, 0. 5% to 1.0% depending upon the size of the wounds. This is continued for three to five days. Secondary infection is prevented by the administration of antibiotics.Under this regimen analgesics are needed in minimal amount, if at all. In four


First Page Preview
View Large

Full Text

Add or change institution




  • Academic Medicine

  • Acid Base, Electrolytes, Fluids

  • Allergy and Clinical Immunology

  • Anesthesiology

  • Anticoagulation

  • Art and Images in Psychiatry

  • Assisted Reproduction

  • Bleeding and Transfusion

  • Cardiology

  • Caring for the Critically Ill Patient

  • Challenges in Clinical Electrocardiography

  • Climate and Health

  • Clinical Challenge

  • Clinical Decision Support

  • Clinical Implications of Basic Neuroscience

  • Clinical Pharmacy and Pharmacology

  • Complementary and Alternative Medicine

  • Consensus Statements

  • Coronavirus (COVID-19)

  • Critical Care Medicine

  • Cultural Competency

  • Dental Medicine

  • Dermatology

  • Diabetes and Endocrinology

  • Diagnostic Test Interpretation

  • Drug Development

  • Electronic Health Records

  • Emergency Medicine

  • End of Life

  • Environmental Health

  • Equity, Diversity, and Inclusion

  • Ethics

  • Facial Plastic Surgery

  • Gastroenterology and Hepatology

  • Genetics and Genomics

  • Genomics and Precision Health

  • Geriatrics

  • Global Health

  • Guide to Statistics and Methods

  • Guidelines

  • Hair Disorders

  • Health Care Delivery Models

  • Health Care Economics, Insurance, Payment

  • Health Care Quality

  • Health Care Reform

  • Health Care Safety

  • Health Care Workforce

  • Health Disparities

  • Health Inequities

  • Health Informatics

  • Health Policy

  • Hematology

  • History of Medicine

  • Humanities

  • Hypertension

  • Images in Neurology

  • Implementation Science

  • Infectious Diseases

  • Innovations in Health Care Delivery

  • JAMA Infographic

  • Law and Medicine

  • Leading Change

  • Less is More

  • LGBTQIA Medicine

  • Lifestyle Behaviors

  • Medical Coding

  • Medical Devices and Equipment

  • Medical Education

  • Medical Education and Training

  • Medical Journals and Publishing

  • Melanoma

  • Mobile Health and Telemedicine

  • Narrative Medicine

  • Nephrology

  • Neurology

  • Neuroscience and Psychiatry

  • Notable Notes

  • Nursing

  • Nutrition

  • Nutrition, Obesity, Exercise

  • Obesity

  • Obstetrics and Gynecology

  • Occupational Health

  • Oncology

  • Ophthalmology

  • Orthopedics

  • Otolaryngology

  • Pain Medicine

  • Pathology and Laboratory Medicine

  • Patient Care

  • Patient Information

  • Pediatrics

  • Performance Improvement

  • Performance Measures

  • Perioperative Care and Consultation

  • Pharmacoeconomics

  • Pharmacoepidemiology

  • Pharmacogenetics

  • Pharmacy and Clinical Pharmacology

  • Physical Medicine and Rehabilitation

  • Physical Therapy

  • Physician Leadership

  • Poetry

  • Population Health

  • Professional Well-being

  • Professionalism

  • Psychiatry and Behavioral Health

  • Public Health

  • Pulmonary Medicine

  • Radiology

  • Regulatory Agencies

  • Research, Methods, Statistics

  • Resuscitation

  • Rheumatology

  • Risk Management

  • Scientific Discovery and the Future of Medicine

  • Shared Decision Making and Communication

  • Sleep Medicine

  • Sports Medicine

  • Stem Cell Transplantation

  • Substance Use and Addiction Medicine

  • Surgery

  • Surgical Innovation

  • Surgical Pearls

  • Teachable Moment

  • Technology and Finance

  • The Art of JAMA

  • The Arts and Medicine

  • The Rational Clinical Examination

  • Tobacco and e-Cigarettes

  • Toxicology

  • Translational Medicine

  • Trauma and Injury

  • Treatment Adherence

  • Ultrasonography

  • Urology

  • Users’ Guide to the Medical Literature

  • Vaccination

  • Venous Thromboembolism

  • Veterans Health

  • Violence

  • Women’s Health

  • Workflow and Process

  • Wound Care, Infection, Healing


Save Preferences

Privacy Policy | Terms of Use























Case Series: Stingray Envenomation – Journal of Urgent Care Medicine

Urgent Message: Urgent care providers in coastal areas need to be prepared to treat stingray envenomation. Immersion in water heated to a precise temperature is the key to pain relief.

Authors: George Kamajian, DO, and Blake Singletary, OMS3
George Kamajian, DO, is a Medical Director at Largo Clinic and Adjunct Professor of Emergency Medicine at Lake Erie College of Osteopathic Medicine in Largo, FL. Blake Singletary, OMS4, is a 4th year medical student at Lake Erie College of Osteopathic Medicine in Bradenton, FL. He will be beginning residency training in Internal Medicine at Largo Medical Center this year.

Introduction

Stingray stings and envenomations, though not extremely common in clinical practice, can be both painful and distressing to patients. Literature suggests 1,500 to 2,000 incidents reported in the United States annually and many times that number go unreported.1,2 It is important for urgent care providers in coastal areas to be prepared to treat the associated pain of these stings and envenomations. Current care consists of applying heat to the area of injury to reduce or eliminate pain, although available case studies give little precise information regarding the precise temperature for treatment. We present an accumulation of 21 cases of stingray injuries with accurate temperature levels for optimum treatment of pain.

Mechanics of a Sting

Along with venom, stingrays common to the Florida coastline have serrated, barb-like “stingers” in the proximal one-third of their tails. When an unprotected person steps on a ray, this stinger can be thrust upward with great force through even bone, and most injuries involve the lower extremities. The venom of a stingray, consisting of serotonin and two enzymes (5-nucleotidase and phosphodiesterase), causes immense pain and distress to individuals who encounter a surprised ray.3,4

Treatment for Envenomation

Current medical care for stingray injuries involves control of bleeding, infection prophylaxis, and pain control. Wound exploration should be performed to rule out the presence of any residual foreign body (stingray barb).3,4 Radiologic review is extremely unlikely to be helpful in a clinical setting. Pain relief to this point has been achieved by applying anesthetics or “heat” to the injured area.1-3

Lessons Learned From Cases

Careful observation of our studies has yielded a specific temperature for injuries that occur specifically in the Gulf of Mexico near St. Petersburg, FL. Over the course of the last 2 years we have seen 21 separate incidents of stingray envenomations. These patients presented within 15 to 120 minutes of the injury, and were seen immediately upon arrival at our clinic. All wounds involved the feet only. Both plantar and dorsal aspects of the foot were affected. Patients uniformly rated the pain 10/10 on the patient pain scale upon arrival. Following assessment, therapy using heated water was initiated.

Treatment and observation consisted of the following. A patient’s injured foot was immersed in water that was being evenly heated at the onset of therapy. The temperature of the water was increased at 5-minute intervals until a patient reported a subjective decrease in pain: this was monitored and recorded at regular intervals using an Acu-Rite meat thermometer obtained from our local supermarket. Following a patient’s initial report of pain relief, temperature was increased until the patient reported no additional relief. Our endpoint was a subjective statement that the patient’s pain was reported as “minimum” or “resolved.”

Onset of pain relief was consistently found at 115°F. Optimum temperature was consistently 118°F. Further pain relief was not accomplished with continued escalation in temperature of the water bath but pain returned whenever the water temperature dropped below 115°F. This target temperature was held for 30 to 90 minutes based on return of pain once the foot was removed from hot water bath. After that, patients reported their pain to be 0-1/10 on the patient pain scale, and no patients needed additional management of pain on follow up.

Discussion

To draw novel conclusions on the treatment of stingray injuries from this data set is reasonable. Previous studies have shown the benefits of heat in relieving the pain associated with stingray injuries. No studies have, as of yet, given such an exact therapeutic window for temperature-driven relief of pain. Although this study was conducted on a relatively small patient population, the breadth of stingray injuries across the State of Florida and the southeast United States is vast, and a study such as this has the potential to provide great benefit to patients. Submerging an injured foot or leg in a water bath maintained at 118°F for 90 minutes provides maximal pain relief for individuals envenomated by a stingray, with no return of pain reported.

References

  1. Perkins AR, Morgan SS. Poisoning, envenomation and trauma from marine creatures. Am Fam Physician. 2004;69(4):885-890.
  2. Cline A. Stingray envenomation of the foot: a case report. The Foot & Ankle Journal. 2008;1(6):4.
  3. Ganard S. Stingray Injuries, Envenomation, and Medical Management. Accessed April 10, 2014. http://www.potamotrygon.de/fremdes/stingray%20article. htm
  4. Evans,RJ, Davies RS. Stingray injury. J Accid Emerg Med. 1996;13(3):224-225.

Case Series: Stingray Envenomation

Tagged on: Envenomation Treatment    Mechanics of a Sting    Stingray Envenomation    Stingray Stings    Web Exclusive

StuWilli
Web Exclusive

  • ← Risk Mitigation in Urgent Care: Part I
  • Assessment and Management of Asthma Exacerbation in Urgent Care: Part 2 →

Ray diseases | Aqualover

Stingrays are rather exotic and beautiful representatives of the ichthyofauna, having a number of peculiarities in keeping and their own specific diseases.

Most of the rays kept in aquariums are wild-caught fish, and only a small part of them are bred by aquarists.
Like other representatives of mostly “natural fish”, stingrays caught in natural reservoirs carry a significant number of parasites, which threatens them little in the natural environment, since the influence of pathogenic organisms is balanced there by beneficial microorganisms, as well as significant, in comparison with aquarium, space. Once in a closed biotope, harmful microorganisms can begin to multiply intensively, causing harm to the fish.

A serious injury to stingrays can be a tail injury during transport or other circumstances. A ray with a tail struck behind a needle is almost always incurable. It can be difficult to cure this injury: the injured tail is cauterized with malachite green and therapeutic baths are carried out in baths with chloramphenicol: 13 mg per liter of water, bathing duration: 5 hours. In this case, methylene blue can be added to the water. If the injury is very significant in terms of the affected area and cannot be treated, then the tail is amputated. It is extremely important to keep track of whether the tail of the stingray is injured even when buying fish!

Sometimes the tails are even covered with protective silicone caps before being transported.

Improper feeding and helminths can cause bloating of the digestive tract in the posterior intestine of the stingray. With a slight swelling and a good appetite in fish, ciprofloxacin is added to the feed for 4-8 days. If the fish does not have an appetite, antibiotics are administered to it through a tube.
If this pathology has become irreversible: the stingray is swollen, and it floats to the surface, cannot sink to the bottom, then it is punctured and the gases accumulated in the digestive tract are gradually released, or they are sucked out with a syringe.
This procedure can only be carried out by a specialist who knows the structure and habits of rays well.
If all these measures fail, give the fish a single dose with food or inject praziquantel through a catheter.

Liver pathology is a typical disease of skates entering the Russian market. The liver is yellowish or white. This disease is caused by the fact that American sellers use tetracycline or tropical plants as immune therapy during transportation. Fish with such a disease can live for a maximum of three months; an effective cure for it has not yet been invented. The only thing that can be advised in non-severe cases is to give fish with food vitamin C .

Pathology of the gallbladder: it increases significantly in size and may even burst, which leads to the death of the fish. The cause of the disease is the refusal of fish to feed, often occurring against the background of transportation with the use of strong anesthetics and subsequent malfunctions in the liver: while the bile is not cloudy. You can cure this disease by forcing the fish to take food.
If the bile becomes cloudy, then the reason for the failure of the bladder is parasites: Myxosporidium or Flagellates . Such a disease is treated according to the standard scheme.

Among the pathogenic protozoa found on rays, it is worth highlighting ichthyophthirius of different halo origin, oodinium , concentrating mainly on the gills, trichodin .
At oodinosis rays become very active, trying to jump out of the water.
Trichodins are found both in sea stingrays: in the rectal gland, copulatory sac and bladder, and in freshwater.

In the digestive and respiratory systems, worms can parasitize.

There are different opinions regarding the effect of excess organic matter in the biotope on skates. Some experts argue that if the dose of organic matter in the water is more than 16 mg per liter, and there is also an excess of nitrogenous compounds, stingrays can become infected with bacteria that under other circumstances will be opportunistic pathogens for stingrays or even live in symbiosis with them. Others write that an excess of organic matter is no more pathogenic for stingrays than for other fish.
We can definitely say that it is important for stingrays that the water is fresh, and they do not tolerate stagnant water.

Stingrays are amazingly beautiful and interesting representatives of the ichthyofauna. With their maintenance, special attention should be paid to the quality and water changes. With proper attention to these parameters, stingrays will please the amateur for a long time with their original habits and unusual appearance.

Skat – the progenitor of anesthesia

In ancient Greek, the stingray fish is called nark, from the word “numbness”. Hence, by the way, the word “anesthesia”. Greek fishermen also had to experience the blows of a stingray, from which the affected part of the body goes numb.

In the 1st century AD, the ancient Roman physician Scribonius Largus wrote an essay “Composition of Medicines”. There he first suggested using stingray radiation for medical purposes. He recommended for headaches to put an electric stingray on the patient’s head and hold until the pain disappears. It was this method that was used to treat migraines by the Roman emperor Commodus. The legend also tells of the treatment of another emperor, Tiberius, from gout: he accidentally stepped on a stingray with a sore foot and felt great relief. Of course, the real nature of the mysterious radiation of the stingray was not known at that time.

The doctor of the formidable Emperor Nero treated him for rheumatism with electric massage and electric baths: for this, electric rays were let into a large wooden tub. In the Middle Ages, electric rays were also used in medicine.

Arab healers in the 11th century used electric rays to treat rheumatism. In the 16th century, stingrays were used to treat patients with migraine, melancholy, and epilepsy.

The name “electric ramp” itself appeared much later, when electricity was discovered. Only in 1772 it became known that the electric stingray strikes precisely with the help of electricity.

One-slope power plant

Where does the electricity from the stingray come from and how strong is its discharge? Stingrays have special electrical organs located on the sides of the body. Their mass can be up to 30% of the total mass of the slope. These organs are similar to an electric battery, in which one on top of the other there are up to several thousand plates-electrodes. This complex system is controlled by a special electrical lobe of the brain. The discharge voltage for some types of stingrays reaches 220 volts! One discharge lasts only 0.03 seconds, but the stingray can “shoot in volleys” up to 100 discharges and even more. True, like ordinary batteries, the stingray battery also gradually “sits down” and he needs rest to restore his strength.

Stingrays use their electricity both for attacking prey and for defense. But you can’t call them brave: being frightened of something, they cling to the ground (at the same time, their color is disguised as the color of the surface) and even almost completely dig into the sand.

Curiously, newborn stingrays already know how to generate electricity.

Skate incubator

Reproduction of rays is a very curious process. They have a kind of “conveyor line”: reaching maturity, female stingrays, like ordinary chickens, lay eggs all year long, which are in the ovaries, some of which are the smallest, while others are already ripe and ready to go outside. Instead of a shell, each egg is “dressed” in a strong cornea with four special processes for attaching to the bottom. Such a living incubator has been operating for at least six months. The fry hatch from the eggs completely ready for life, and even with a supply of food in a special yolk sac, in order to gradually adapt to the “adult” diet.

How stingray treats today

In the northwestern part of the Sea of ​​Japan, there are 7 species of stingrays, representatives of 2 families: stingrays and stingrays. About 10 species of stingrays live off the coast of Kamchatka: from small ones, weighing 1-3 kg and up to 80 cm long, to large ones, weighing up to 20 kg and up to one and a half meters in size. Among the large ones is the Aleutian stingray Bathyraja aleutica, which was studied by Far Eastern scientists and found in it, as in other types of stingray, many substances necessary for human health.

Modern medicine does not need to use the discharge of rays, there are more modern methods of electrotherapy. Now other medicinal properties of stingrays are used.

Rays belong to the class of cartilaginous fish, like sharks. It was the cartilaginous tissue of rays that attracted the attention of biologists and doctors, and not in vain.

It, like shark cartilage, contains natural glucosamines, chondroitin sulfates, soluble collagen, hexosamines, non-collagen proteins – a natural component of cartilage tissue, low molecular weight inhibitors of metalloproteinases, free disaccharides and trace elements, free amino acids – substances that nourish cartilage tissue and promote its regeneration . In the enzymatic hydrolyzate (FG) from stingray cartilage tissue has the highest content of hexosamines among other aquatic organisms. Natural chondroitin sulfate and glucosamine are highly digestible, have a wide range of therapeutic effects and a high safety index.