Stonefish envenomation - Revision history

Jonrako: /* Management */

2021-09-01T02:03:34Z

Management

← Older revision		Revision as of 02:03, 1 September 2021
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	*Clinical diagnosis		*Clinical diagnosis

	==Management==		==Management <ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf</ref>==
	*Pain management and venom neutralization is accomplished via hot-water (45 C) immersion for 30-60 minutes		*Pain management and venom neutralization is accomplished via hot-water (45 C) immersion for 30-60 minutes
	*Clean wound, update [[tetanus prophylaxis\|tetanus]], remove retained tissue		*Clean wound, update [[tetanus prophylaxis\|tetanus]], remove retained tissue
	One fifth of wounds develop local infection, but prophylactic antibiotics remain controversial <ref>Hobday D, Chadha P, Din AH, Geh J. Denaturing the Lionfish. Eplasty. 2016 May 23;16:ic20. PMID: 27298709; PMCID: PMC4892334.</ref>		One fifth of wounds develop local infection, but prophylactic antibiotics remain controversial <ref>Hobday D, Chadha P, Din AH, Geh J. Denaturing the Lionfish. Eplasty. 2016 May 23;16:ic20. PMID: 27298709; PMCID: PMC4892334.</ref>
	*~~Immerse extremity in hot water~~		*High risk for ''Vibrio vulnificus'' which can lead to necrotizing fasciitis.
	*~~Severe toxicity can be treated with antivenin obtained through poison control~~		*Antivenom includes Commonweatlth Serum Laboratories stonefish antivenom.
			**All doses are intramuscular d/t risk of anaphylactoid reaction.
			**Give 1 vial for 1-2 puncture wounds, 2 vials for 3-4 wounds, etc.
			**1 vial is equivalent to 2,000 units and neutralizes 20mg of venom

	==Disposition==		==Disposition==

Jonrako: /* Disposition */

2021-09-01T01:57:18Z

Disposition

← Older revision		Revision as of 01:57, 1 September 2021
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	==Disposition==		==Disposition==
	*Patients should be observed for 6-12 hours.		*Patients should be observed for 6-12 hours.<ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf</ref>

	==See Also==		==See Also==

Jonrako: /* Disposition */

2021-09-01T01:56:28Z

Disposition

← Older revision		Revision as of 01:56, 1 September 2021
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	==Disposition==		==Disposition==
			*Patients should be observed for 6-12 hours.

	==See Also==		==See Also==

Jonrako: /* Management */

2021-09-01T01:55:43Z

Management

← Older revision		Revision as of 01:55, 1 September 2021
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	==Management==		==Management==
			*Pain management and venom neutralization is accomplished via hot-water (45 C) immersion for 30-60 minutes
	*Clean wound, update [[tetanus prophylaxis\|tetanus]], remove retained tissue		*Clean wound, update [[tetanus prophylaxis\|tetanus]], remove retained tissue
	One fifth of wounds develop local infection, but prophylactic antibiotics remain controversial <ref>Hobday D, Chadha P, Din AH, Geh J. Denaturing the Lionfish. Eplasty. 2016 May 23;16:ic20. PMID: 27298709; PMCID: PMC4892334.</ref>		One fifth of wounds develop local infection, but prophylactic antibiotics remain controversial <ref>Hobday D, Chadha P, Din AH, Geh J. Denaturing the Lionfish. Eplasty. 2016 May 23;16:ic20. PMID: 27298709; PMCID: PMC4892334.</ref>
	*Immerse extremity in hot water ~~(45 C) for 30-60 minutes~~		*Immerse extremity in hot water
	*Severe toxicity can be treated with antivenin obtained through poison control		*Severe toxicity can be treated with antivenin obtained through poison control

Jonrako: /* Background Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf */

2021-09-01T01:53:47Z

Background Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf

← Older revision		Revision as of 01:53, 1 September 2021
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	*Found in the coastal regions of the Indo-Pacific.		*Found in the coastal regions of the Indo-Pacific.
	*This is a grey fish which possesses multiple venomous spines.		*This is a grey fish which possesses multiple venomous spines.
			*The venom remains stable for up to 48 hours after the fish has died.
	*This is the most venomous fish known, with venom likened to that of a cobra.		*This is the most venomous fish known, with venom likened to that of a cobra.
	** The venom blocks cardiac calcium channels, increases systemic catecholamine release, simultaneously causing diffuse vasodilation and increased tissue destruction which propogates uptake of its own venom.		** The venom blocks cardiac calcium channels, increases systemic catecholamine release, simultaneously causing diffuse vasodilation and increased tissue destruction which propogates uptake of its own venom.

Jonrako: /* Clinical Features */

2021-09-01T01:52:46Z

Clinical Features

← Older revision		Revision as of 01:52, 1 September 2021
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	** The venom blocks cardiac calcium channels, increases systemic catecholamine release, simultaneously causing diffuse vasodilation and increased tissue destruction which propogates uptake of its own venom.		** The venom blocks cardiac calcium channels, increases systemic catecholamine release, simultaneously causing diffuse vasodilation and increased tissue destruction which propogates uptake of its own venom.

	==Clinical Features==		==Clinical Features <ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf</ref>==
	[[File:PMC4862076 12995 2016 112 Fig1 HTML.png\|thumb\|Extensive erythema, gross swelling up to the entire index finger, dorsum, and distal third forearm from stonefish envenomation.]]		[[File:PMC4862076 12995 2016 112 Fig1 HTML.png\|thumb\|Extensive erythema, gross swelling up to the entire index finger, dorsum, and distal third forearm from stonefish envenomation.]]
	*Local erythema, ecchymosis, swelling		*Local erythema, ecchymosis, swelling, necrosis
	*Intense, sharp pain		*Intense, sharp pain that peaks at 60 minutes but can lasts for days.
	*Systemic toxicity:		*Systemic toxicity:
	**[[Hypotension]], [[tachycardia]], [[arrhythmia]], [[syncope]], [[vomiting]], and [[pulmonary edema]]		**[[Hypotension]], [[tachycardia]], [[arrhythmia]], [[syncope]], [[vomiting]], [[compartment syndrome]], and [[pulmonary edema]] (cardiogenic)
			*Death can occur in as few as 6 hours.

	==Differential Diagnosis==		==Differential Diagnosis==

Jonrako: /* Background */

2021-09-01T01:49:01Z

Background

← Older revision		Revision as of 01:49, 1 September 2021
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	==Background==		==Background <ref>Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf</ref>==
	[[File:Stone Fish at AQWA SMC2006.jpg\|thumb\|Stonefish]]		[[File:Stone Fish at AQWA SMC2006.jpg\|thumb\|Stonefish]]
	*Synanceia genus of fish of the family Synanceiidae		*Synanceia genus of fish of the family Synanceiidae
	**Venom is dangerous and even fatal to humans (possibly most venomous fish known)
	*Found in the coastal regions of the Indo-Pacific.		*Found in the coastal regions of the Indo-Pacific.
			*This is a grey fish which possesses multiple venomous spines.
			*This is the most venomous fish known, with venom likened to that of a cobra.
			** The venom blocks cardiac calcium channels, increases systemic catecholamine release, simultaneously causing diffuse vasodilation and increased tissue destruction which propogates uptake of its own venom.

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Evaluation */

2021-03-11T19:38:19Z

Evaluation

← Older revision		Revision as of 19:38, 11 March 2021
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	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
			*No specific testing available

	===Diagnosis===		===Diagnosis===
	*Clinical diagnosis~~, no specific testing available~~		*Clinical diagnosis

	==Management==		==Management==

Rossdonaldson1: /* Background */

2021-03-11T19:37:43Z

Background

← Older revision		Revision as of 19:37, 11 March 2021
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	==Background==		==Background==
	[[File:Stone Fish at AQWA SMC2006.jpg\|thumb\|Stonefish]]		[[File:Stone Fish at AQWA SMC2006.jpg\|thumb\|Stonefish]]
	*Synanceia ~~is a~~ genus of fish of the family Synanceiidae~~, the stonefish, whose members are venomous,~~ dangerous, and even fatal to humans~~. They are the~~ most venomous fish known~~.[1][2] They are found~~ in the coastal regions of the Indo-Pacific.		*Synanceia genus of fish of the family Synanceiidae
			**Venom is dangerous and even fatal to humans (possibly most venomous fish known)
			*Found in the coastal regions of the Indo-Pacific.

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Background */

2021-03-11T19:21:02Z

Background

← Older revision		Revision as of 19:21, 11 March 2021
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	==Background==		==Background==
	[[File:Stone Fish at AQWA SMC2006.jpg\|thumb\|Stonefish]]		[[File:Stone Fish at AQWA SMC2006.jpg\|thumb\|Stonefish]]
			*Synanceia is a genus of fish of the family Synanceiidae, the stonefish, whose members are venomous, dangerous, and even fatal to humans. They are the most venomous fish known.[1][2] They are found in the coastal regions of the Indo-Pacific.

	==Clinical Features==		==Clinical Features==