title: Stingray envenomation: a retrospective review of clinical presentation and treatment in 119 cases.
abstract: Stingray stings are common along coastal regions of this country and the world. The tail of the stingray contains a barbed stinger attached to a venom gland and contained within an integumentary sheath. During a sting, the stinger and sheath can become embedded in the soft tissue of the victim, and venom is injected into the wound. Stingray venom most often causes severe pain on contact, although the exact mechanism of toxicity is not certain. Hot water immersion of the stung extremity has been reported to be effective in relieving pain associated with the envenomation, but large studies of this therapy have not been performed. We retrospectively reviewed stingray stings presenting to our Emergency Department (ED) over an 8-year period. Cases were divided into acute (group 1, within 24 h of the sting) and subacute (group 2, 24 h or more after the sting) presentations. Charts were abstracted for information concerning the victim's history, physical examination, treatment, diagnostic imaging, and outcome, including the effectiveness of hot water immersion as analgesia, and use of antimicrobials. A total of 119 cases were identified and abstracted, 100 in group 1 and 19 in group 2. Of the group 1 patients initially treated with hot water immersion alone, 88% had complete relief of pain within 30 min without administration of any other analgesic. In the patients who initially received a dose of analgesic along with hot water immersion, none required a second dose of analgesics and all had complete pain relief before discharge. There were no adverse effects (such as thermal burns) with this therapy. Analysis of infectious complications in group 1 patients demonstrated a significant number of patients returning to the ED with wound infections when prophylactic antibiotics were not administered at initial presentation. Our findings suggest that hot water immersion was effective in decreasing or eliminating the pain associated with stingray envenomation in our series. Due to the high potential for bacterial contamination in these puncture wounds, standard antibiotic prophylaxis may be prudent. Although stingray barbs can be radio-opaque, radiography in our series failed to detect barbs or other foreign bodies in stung extremities, although no barbs or other stinger material were found on inspection of wounds.
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California, USA.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Clark
authors.forename: Robyn Heister
authors.initials: RH
authors.lastname: Girard
authors.forename: Daniel
authors.initials: D
authors.lastname: Rao
authors.forename: Binh T
authors.initials: BT
authors.lastname: Ly
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001733:Bites and Stings / Q000628:therapy*; D002648:Child; D004638:Emergency Treatment; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D006875:Hydrotherapy / Q000379:methods*; D007101:Immersion; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D012860:Skates, Fish