Lionfish Stings: Treatment and Prevention Derek B. Covington, M.D. Resident Physician – PGY2 Department of Anesthesiology Technical Diving International - Instructor Candidate
Dec 25, 2015
Lionfish Stings: Treatment and Prevention
Derek B. Covington, M.D.
Resident Physician – PGY2
Department of Anesthesiology
Technical Diving International - Instructor Candidate
Why should I Care?
Painful
Why Should I Care?
Deadly
Why Should I Care?
Tasty
Objectives and Outline
• To properly identify lionfish
• To recognize symptoms of an envenomation
• To treat an envenomation in the field
• To prevent an envenomation
Lionfish• Belong to family of fish called
Scorpaenidae– 3 genus: categorized based on venom organ
structure and toxicity• Pterois
– Long, slender spines w/ least potent sting– Lionfish
• Scorpaena– Shorter, thicker spines w/ more potent sting– Scorpionfish
• Synanceia– Stout, powerful spines w/ most potent sting– Stonefish
Scorpaenidae
Pterois SynanceiaScorpaena
www.stinapa.org, http://www.scubatravel.co.uk/e_Scorpion_fish_26_06.html, http://www.jamesfreeanimals.com/2012/04/stone-fish-what-do-you-know-about-this.html,
Scorpaenidae• Spines
– Number and location• 12-13 dorsal spines• 2 pelvic spines• 3 anal spines• Pectoral spines vary in number and are innocuous
– Each spine associated with pair of venom glands– Integumentary sheath surrounds spine and is
pushed downwards onto venom glands to stimulate venom during a sting
Lionfish
http://rollingharbour.com/tag/pterois-miles/
Venom
• Toxicity secondary to proteins– Proteins
• Antigenic stimulate the immune system• Large high molecular weight• Heat labile denatures at high temperatures
Lionfish
• Scientific name: Pterois volitans
• Venomous marine fish native to Indo-Pacific
• Characterized by red, white, and black bands with extravagant pectoral fins and dorsal spines
• Measure 6 to 4cm in length
• Weigh up to 500 grams
Lionfish
• Lifespan: 5 – 15 years
• Prey: small fish, invertebrates, and mollusks
• Predators: few natural predators include moray eels, large fish (Tiger groupers), and sharks.
Epidemiology
• Number of envenomations unknown– >100 in medical literature from aquarists– Typically involve divers, fisherman, and others
involved in marine activies
Mortality and Morbidity
• Severity of envenomations increase from Pterois to Scorpaena to Synanceia
• Lionfish– Typically local wound– May progress to tissue necrosis– Rare case reports of death
Symptoms• Immediate, excruciating to incapacitating,
local wound pain– Pain may spread to involved entire limb
• Peaks at 60-90 minutes and lasts up to 12 hours• Mild subsequent pain may last up to weeks
• Edema, erythema, tissue necrosis• Systemic symptoms
– Hypotension, pyrexia, chills, nausea, muscle twitching, dyspnea, convulsions, dizziness, diaphoresis, and anaphylaxis
Signs
• Single or multiple puncture wounds– Surrounding ring of blue-cyanotic tissue– Subsequent edema, erythema, and warmth
may involved entire limb– Vesicle formation (often in hands) may
progress to rapid tissue sloughing, cellulitis, and surrounding hyperesthesia.
Prehospital Care
• Gentle removal of visible spines
• Direct pressure to control bleeding
• Administration of analgesia
• Immerse wound in hot water (<114F/45C)
• Transport for definitive medical evaluation
Hospital Care
• Tetanus prophylaxis
• Removal of retained spines
• Resusitation with IV fluids
• IV analgesia
• Antibiotic prophylaxis
• Antivenom available, but rarely indicated
Prevention
• Avoidance
• If not avoidance, use proper precautions:– Kevlar gloves– Shears to trim spines– Knife to remove fish from spear– Properly lined catch bag
Quiz!
• An open water diver comes back to the boat complaining of being attacked by a “frilly” striped fish. As you examine the wound, you notice a single puncture wound on the dorsum of his hand with surrounding erythema. He is complaining of substantial pain.
• What do you do next?
What did we learn today?
Summary
• Lionfish stings are increasing due to increased interaction with people in the Atlantic and Carribean oceans
• Wounds appears as
• Field treatment should include immediate removal of spines, analgesia, and immersion in hot water
Summary
• Best prevention is avoidance. However, those wishing to get close should utilize proper equipment (kevlar gloves, knifes, and appropriate catch bag).
• Lionfish can be tasty!
Continuing Education
• Divers Alert Network– www.DAN.org
• Undersea and Hyperbaric Medicine Society– http://membership.uhms.org
• Annals of Emergency Medicine• Emedicine/Medscape
– http://emedicine.medscape.com/article/770764-overview
Additional Information
Lionfish Cookbook
Any Questions ?