TY - CHAP M1 - Book, Section TI - Stingray Envenomation A1 - Zafren, Ken A1 - Thurman, R. Jason A1 - Jones, Ian D. A2 - Knoop, Kevin J. A2 - Stack, Lawrence B. A2 - Storrow, Alan B. A2 - Thurman, R. Jason Y1 - 2021 N1 - T2 - The Atlas of Emergency Medicine, 5e AB - Stingrays are found throughout the oceans of the world. Stingrays are not typically aggressive, and the majority of envenomations are defensive in nature. Injuries typically involve a lower extremity if the animal is stepped on or an upper extremity if the animal is handled. Fatal injuries have been reported from chest trauma, which may result in perforation of the myocardium. Stingray envenomation occurs when a reflexive and forceful forward thrust of the caudal spine or spines of the animal impacts the victim, producing a puncture wound or laceration. The force of injection causes the integumentary sheath covering the spine to be driven into the wound, fragmenting and potentially releasing venom, mucus, pieces of the sheath, and spine fragments deep within the wound. Envenomation typically produces immediate and intense pain, edema, and bleeding. The initially dusky or cyanotic wound may progress to erythema, with rapid fat and muscle hemorrhage. Systemic symptoms may include nausea, vomiting, diarrhea, diaphoresis, muscle cramps, fasciculations, weakness, headache, vertigo, paralysis, seizures, hypotension, and syncope. SN - PB - McGraw-Hill CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1181051065 ER -