RT Book, Section
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
SR Print(0)
ID 1181051065
T1 Stingray Envenomation
T2 The Atlas of Emergency Medicine, 5e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260134940
LK accessmedicine.mhmedical.com/content.aspx?aid=1181051065
RD 2024/04/19
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.