Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Wilderness and Rescue Medicine 180

Marine Toxins In the marine environment, toxins are most com- monly infiltrated by spines or injected by nema- tocysts. They range in potency from the merely annoying to the rapidly fatal. Again, the recogni- tion of species is not as important as the recogni- tion and treatment of a critical system problem. Spiny Injury Spines are used for defense and some are coated with toxins. Examples of marine life with spines include stingrays, scorpion fish, catfish, lion fish, and some sea urchins. The species found in waters around North America generally produce only the localized pain and swelling of tissue toxins. In Indo-Pacific waters, the organisms can be more dangerous, carrying significant neurotoxic effects as well.

Coral Snakes Coral snake (family Elapidae) venom is neuro- toxic. The fangs of the coral snake are quite small, and the snake must chew its way into your skin to inject venom successfully. Coral snakes do not bite unless they are handled, resulting in fewer than 25 envenomations per year in the United States. The venom’s effects may be delayed for several hours.

Coral Snake Envenomation

General Principles

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S/sx: • Indistinct teeth marks, no discrete fangs • Delayed onset of neurotoxic symptoms • Numbness, tingling, cramping, respiratory paralysis Treatment: • Evacuate to medical care • BLS / PROP

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Symptoms of coral snake bite include tingling of the extremity, possibly progressing to the whole body. Fatalities are exceedingly rare, but when they occur they are usually due to respira- tory failure. Treatment is symptomatic and sup- portive. The production of a specific coral snake antivenin has been discontinued in the United States and all remaining stock has had its expira- tion date extended by the USFDA. Antivenin is still produced in other countries but has yet to be approved by the United States Food and Drug Administration. In parts of the world outside of North America, fang-bearing snakes possess more destructive forms of venom. A lymphatic compression ban- dage is sometimes employed in the field treat- ment of envenomation known to involve potent neurotoxins. It is worth research into the types of snakes, recommended treatments, and loca- tion of antivenin for the region in which you will be traveling. You may find, for example, that the nearest antivenin for the Fer de Lance in Trinidad is actually in Miami. Check before you need it.

The lion fish is a rapidly spreading invasive species in the Atlantic basin. The toxin on its defensive barbs is painful but not lethal. The sting of a poisonous ray, urchin, or fish is easy to distinguish from a nontoxic puncture. The pain caused by the wound itself is minimal com- pared to the quickly increasing discomfort caused by the toxin, which may possess both tissue toxic and neurotoxic characteristics. The barbed stinger or spine will often remain in the wound. Because the spine is coated with a sheath of tissue that contaminates the wound, infection is likely. Treatment includes spine or stinger removal and aggressive wound debridement.