Dr. M.J. Bazos, MD Patient Handout


About Your Diagnosis
There are literally thousands of venomous animals in the world’s oceans, but the majority fall into several classes. These include corals (mostly fire coral in North America), jelly fish and sea nettles, sea urchins and star fish, sting rays, and fish including lion fish, scorpion fish, and stone fish. Most cause envenomation by a sting or by a puncture wound from a spine. Envenomations range from uncomfortable irritations of the skin to potentially life-threatening conditions. You may come in contact with these animals during skin or scuba diving, wading or swimming in shallow waters, or through contact with animals washed up on the beach.

Living With Your Diagnosis
Signs of mild envenomations from fire coral, jellyfish, or sea anemones usually include variable stinging, itching, or pain at the site of contact. This will frequently have a very rapid onset. Especially with jellyfish, there may be tentacles attached to the skin that must be removed carefully to avoid further stings to the victim or the rescuer. Blistering, welts, or swelling (which may last 1–2 weeks) may follow the sting. More severe cases can result in allergic reactions, muscle cramps and spasms, and convulsions. Headache, paralysis, and unconsciousness can occur. Heart irregularities, difficulty breathing, nausea and vomiting, and destruction of tissue with scarring at the site of the sting can also occur. Puncture wounds from sea urchins, sting rays, and the venomous fishes result in a distinct puncture wound that may contain broken off spines. Most result in rapid pain that is frequently burning. This may spread to include the whole limb. Prolonged bleeding and discoloration around the wound can occur. Severe muscle spasms and cramps, and paralysis of the limb may be seen. Nausea and vomiting, fainting or unconsciousness, difficulty breathing, and delirium are present in severe cases. Infection in the wound is a frequent delayed problem, especially if there are spine fragments in the wound.

Treatment falls into two broad categories. For fire coral, anemones, and jellyfish, initial treatment is to flush the area vigorously with vinegar. This will help neutralize the venom and prevent further stings from any stingers left on the skin. You should not use fresh water to rinse. Rubbing alcohol, although suggested in the past, may actually increase stings. Scrape any visible tentacles off with a knife or a razor. Be careful not to touch them with bare skin because you may be stung. After initial treatment, steroids applied either as a cream or given internally may be helpful for severe envenomations. If stung by a sea nettle, a baking powder solution may be better for the initial flushing, but vinegar is best when you are not completely sure what stung you. For the puncture type of stings, the best initial treatment is to flush the wound with sea water. This is followed by soaking the wound in nonscalding hot water (at around 110°F) for 30–90 minutes or until the pain decreases. You should add hot water as needed to maintain the temperature. If pain recurs, you should soak the wound in hot water again. It is very important to make sure that the water is as warm as can be comfortably tolerated, but not hot enough to scald. Your doctor should examine the wound for any retained spines that need to be removed. Your doctor may need to order x-ray examinations to find spines that are not visible in the wound. Antibiotics may help prevent infection.

The DOs
You should take any medicines as prescribed; these may include antibiotics or steroids. You should decrease activity involving the injured limb until it has recovered. This will decrease swelling and slow spread of any venom present in the wound. The best prevention is to avoid the animals that cause envenomation. If you are going to be diving, swimming, or wading in waters with which you are not familiar, it is wise to consult local experts. These include beach lifeguards or dive shop personnel. Ask them what the local venomous animals are and what to do if you come in contact with them. Especially in Australia and Asia, you may run across animals such as the box jelly fish that can cause rapidly fatal envenomations. Also in Asia, there are such things as sea shells that are venemous.

The DON’Ts
Many sea animals can cause envenomations. Therefore, it is wise not to handle any unknown animals, including sponges, corals, sea worms, jellyfish, sea urchins, and spiny starfish. You should avoid handling sting rays or venomous fishes such as scorpion fish, lion fish, or stone fish. These latter fish are popular in the “underground” tropical aquarium business, and there are many reports of envenomations from aquarium fish. If you are going to keep these fish, you must know the risks involved and take appropriate precautions to avoid injury. Many fish envenomations affect individuals wading in water in which they can not see the bottom. It is best to avoid this activity but if you must wade, you should shuffle along so as to scare any stingrays or fish out from under your feet before you step on them. You may encounter sea urchins when wading and they can not move, so you have to watch out for them.

When to Call Your Doctor
Because any of these envenomations can have delayed adverse effects, it is prudent to seek medical attention for any envenomation. If you have any signs of infection (such as fever, increasing pain, and increasing swelling, or pus is present in the wound), you should call your doctor.