HAZARDOUS MARINE CREATURE IN OMAN DR.Salim AL-Jabri R1
Jan 17, 2015
HAZARDOUS MARINE CREATURE IN OMAN
DR.Salim AL-Jabri
R1
INTRODUCTION
2000 species are venomous or poisoning to human
Many can produce sever illness and fatilties Number of victims increase Most marine injure human with defence and
food –procuring devices
VENOUMS MARINE ANIMALS
Three main classes according to mechanism of venom delivery;
1- Nematocysts2- Bites3- Stings
1- NEMATOCYSTS large numbers ,,, so
grestest numbers of envenomation
E.g ; - Portuguese man-of-
war - True jellyfish - fire corals - stinging hydroids - sew wasp,,,
boxjellyfish - sea nettle &
anemones
NEMATOCYSTS
Many different types
Basic mechanism is
‘spring –loaded’ venom
gland
mechanical or chemical
stimulation
suddenly evert and
discharge structure that
penetrates the prey and
deliver venom through
connecting tube
NEMATOCYSTS
Animal’s tentacles Tentacles can be up to
100 feet in som egaint species
Can still function even after animale is dead or tentacles are seprated
stinging cell can remain active for weeks
may discharge later during attempted rescue and treatmnet
TOXICITY
o nematocysts continue; - various peptides, phospholipase A,
proteolytic enzymes, hemolytic enzymes, quaternary ammonium compounds, serotonin
o Severity of venomation related to sveral factors;
1- number of nematocysts 2- varies form species to species 3- victims autopharmacologic response to
the venom
SYMPTOMS
Stinging sensation immediately on contact.
Intensity increasing over 10 minutes. Erythema. Pruritus. Papules, vesicles, pustules & Necrotic
ulcers. Increase oral secretions. Gastrointestinal disturbance. Muscle spasm. Respiratory distress; and Cardiovascular
failure.
BOX JELLYFISH
is the most venomous creature to live under the sea
It has caused 5,567 recorded deaths since 1954,,,,, ? Unrecorded
toxins which instantly attach the heart, nervous system, and the skin cells.
SYMPTOMS
tentacles which inject the poison become sticky and adhere tightly to the skin
venom of box jellyfish has cardiotoxic, neurotoxic and highly dermatonecrotic components
IN OMAN
Batinah coast and far east like Sur Jun , July and August 75 cases were reported in koula hospital
between 1991-1992 mild – moderate cases , no death
FIRST AID
remove the victim from the sea Immobilize the limbs Apply generous amounts of vinegar( acetic
acid) which will disables the box jelly's nematocysts that have not yet discharged into the bloodstream
Remove additional tentacles by a towel or gloved hand
FIRST AID
No scientific evidence that urine, ammonia, meat tenderizer, sodium bicarbonate, boric acid, lemon juice, freshwater, alcohol, cold packs, papaya, or hydrogen peroxide will disable further stinging
Pressure bandages or methylated spirits should Never be used
FIRST AID
Until the vinegar or acetic acid is available, a seawater
rinse may be useful in an attempt to wash away any
remaining nematocysts.
Ensure that the seawater is free of jellyfish or even
fragments of tentacles because they remain toxic for
months.
Nematocysts that remain adherent to the skin should
not be rubbed with sand, scrubbed with a cloth, or
vigorously washed.
MEDICAL TREATMENT
Topical steroid creams and anesthetic creams may
help relieve the pain and swelling.
Oral antihistamines and narcotics for pain control
are occasionally warranted.
Antibiotics should be considered for vesicular
lesions to prevent secondary infection.
Muscle spasms can be treated with 10 mL of
calcium gluconate of a 10% solution intravenously .
Immediate medical attention may be required for
severe reactions.
MANAGEMENT
cardiac arrest occurs quickly, (CPR) can be life saving and takes priority over all other treatment options
PREVENTION
BITES
Sharks Octopi
SHARKS
SHARKS
About 350 species of sharks, only 30 species could potentially be dangerous to humans and only 12 are reported potentially aggressive and dangerous
Most dangerous to human; - Great white -Tiger shark -Bull shark
SYMPTOMS & SIGNS
Severe bleeding, injury to or excision of muscle & bone
TREATMENT
Control any visible bleeding by applying direct pressure. Keep the victim calm.
Provide warmth, since the victim may be chilled from the water and may be suffering from hypothermia
Transfer the pt. To the hospital
OCTOPUS
- blue –ringed - bitten in upper
extremities - modified salivary
gland - venom into the
wound - vasodilator and
inhibitor of neuromuscular transmission
SYMPTOMS
initial bite is not painful weakness and numbness nausea and vomiting. Severe envenomations may progress rapidly
to generalised flaccid paralysis and respiratory failure
Death may occur in as little as thirty minutes.
TREATMNET
Reassure the patient and encourage them to remain calm .
Pressure-immobilisation first aid is recommended
No antivenin supportive respiratory support is most important
lifesaving intervention
3- STING
Puncture victim’s skin and introduce venom sea urchins cone shells bristal warm sea snakes stingrays scorpion fish Catfish
SEA URCHINS
Long, extremely brittle spines.
SEA URCHINS
Throbbing pain.
Purplish discoloration.
Edema and swelling.
Partial paralysis of a limb.
Facial swelling.
Muscle spasm.
Dyspnea.
Weakness.
Cardiac arrhythmias &
Collapse.
TREATMENT
For simple punctures, gently pull out any protruding spines.
Be careful,,,, almost always break off in the wound.
Neither urine nor vinegar dissolves such embedded spines
In most cases, the body either absorbs spine fragments in 24 hours to 3 weeks, or they work themselves out through the skin
TREATMENT
Most wounds heal in about one month. spines have penetrated a joint or nerve, see a
doctor wound shows any sign of infection, such as
redness, warmth, or pus formation. Victims with generalized weakness, shortness
of breath, and/or nausea and vomiting after a puncture should go directly to an emergency facility
CONE SHELLS
Much more toxic than sea urchins
Tubular gland connect to several teeth at the retractable proboscis
venom conetine sevral protiens ;
- 3-indolyl derivatives which act on skeletal muscle & cause variably spastic and flaccid paralysis
CONE SHELLS
Symptoms pain Nausea and general purities diplopia slurred speech numbness weakness Paralysis respiratory arrest
MANAGEMENT
Pressure immobilisation -The extremity should be wrapped with a
bandage Avoid movement. CPR may be necessary. Artificial respiration
may save the person's life Do not cut into the wound, apply suction no antivenom available A tetanus and antibiotics injection
STINGRAY
Shallow, sandy areas to deep oceans
Tail with poisonous barb near base of body.
Sting are often broken or left in the wound
SYMPTOMS
Lacerations & severe pain.
Punctures in abdomen or chest are very
serious.
Anorexia, Nausea and vomiting.
Diarrhea, increase micturition & salivation.
Muscle cramping, tremor & tonic paralysis.
Convulsions.
Cardiac abnormalities to include asystole.
Hypotension.
Respiratory depression.
Ulceration and necrosis & Infection.
FIRST AID
Lay the person down If the person is vomiting, position the person
on the side so they do not inhale vomit. Stop the bleeding by applying direct pressure
with a clean cloth or whatever is available such as a beach towel.
You may attempt to remove the stinger with tweezers to decrease toxin exposure if doing so will not cause further injury. Be careful not to injure yourself with the stinger.
FIRST AID
If there is no pain, then treat as a puncture wound or laceration by cleaning and disinfecting with soap and water.
faintness or sweating (which indicate that venom has been absorbed into the body), arrange for transportation to a medical facility
MEDICAL TREATMENT
Vital signs Pain- placing the injured area in water as hot as
the person can tolerate (113°F or 45°C) for 30-90 minutes
- Pain medication, such as narcotics- Local anaesthesia
TREATMENT Wound care;
- cleans the wound, removes foreign matter, and looks for injuries to tendons, nerves, blood vessels, and other body structures
- Tetanus- Antibiotics are usually given because the
wound is contaminated with bacteria from the stinger and from the seawater
- wound is left open, then closed with stitches a few days later if it has not become infected
- , such as nerves, tendons, or arteries, are damaged, then a surgeon
F/U
cleaning on a daily basis and then application of an antibiotic ointment and dressing.
If antibiotics are prescribed, take them as directed.
If your wound becomes infected, have it rechecked.
Keep any follow-up appointments that have been scheduled.
PREVANTION
When wading in shallow waters where stingrays may be, wear foot protection and shuffle your feet to scare away any resting rays
SEA SNAKES
SYMPTOMS
Mild Euphoria. Anxiety. Restlessness. Thirst. Swelling of tongue. Nausea & vomiting. Weakness. Stiffness & Muscle ache
Severe
Paralysis (ascending or spreading from bite).
Trismus. Ptosis. Facial & ocular palsies. Speech & swallowing
pathology. Respiratory distress. Cardiac failure. Convulsions. Coma.
MANGMNEGT
Place a wide - pressure dressing over the bite,
applying the same pressure as used for treating a
sprain. The dressing should then extend proximally to
distally.
Immobilize the limb.
Local excisions and suction should be avoided.
Monitor for any cardiac, pulmonary, renal, fluid, and
electrolyte abnormalities.
If possible, the snake should be killed & obtained for
identification.
TREATMNET
Upon arrival to the treatment facility, the pressure
dressing should be removed prior to administering
antivenom.
Sea snake venom should be used cautiously &
administered in strict accordance to guidelines.
Preparation for anaphylaxic shock should be
immediately available.
If land snake antivenom is to be used, then the tiger
snake type is preferred.
Victims should be hospitalized for 24 hours
BONY FISH
Spines located in their fine Venom ;; severl classes of proteins most of
which are heat labile Three Groups - Zebra fish - Scorpion fish - Stonefish
STONEFISH
STONEFISH
Glands at the base of their needle-like dorsal fin spines
Most venomous fish known Exactly like an encrusted rock Severity of the symptoms depends on the
depth of penetration and the number of spines involved
STONEFISH
pain Tremendous swelling rapidly develops with
death of tissues Muscle weakness Temporary paralysis Shock
FIRST AID
Remove pieces of spines encouraging bleeding might remove some
venom wash with water. Rest and elevate immerse wound in hot water (45 C or 113 F)
for 30-90 minutes or until pain decreases elevate and dress with something clean.
MANGMENT
Local analgsia IV narcotic analgesia, local anaesthetic
infiltration or regional block may be required antivenom ;1-the victim suffers from severe pain 2-systematic symptoms like weakness and
paralysis are observed 3-there are multiple punctures, which indicate
the discharge of several spines. This means that larger amount of venom has been injected.
IMPORTANT POINTS
Three important Things in the management Remove the cause. Treat the effects. Prevent further complications.
IMPORTANT POINTS
Be prepared for cardiopulmonary collapse even in what appears to be a minor envenomation.
Be prepared for anaphylactic reactions.
When culturing wounds, inform the laboratory that the injury was in a marine environment. Factors, such as salt concentration of the media, incubation temperatures, and time, need to be adjusted.
IMPORTANT POINTS
consider antibiotics Tetanus injuction
THANKS