GUIDELINE 9.4.7 ENVENOMATION - FISH STINGS

INTRODUCTION

Many fish have spines with attached venom glands. When trodden upon, the spines of the marine Stonefish (Synanceia spp) and the freshwater Bullrout (Notesthes robusta) penetrate deeply and deposit venom causing excruciating pain. General cardiovascular toxic effects can occur but are rare. Handling these or similar fish is also potentially dangerous.

The barbed spines on the tails of stingrays can inflict a serious gash or penetrating stab injury with subsequent venom-induced tissue death. Organs and blood vessels may be damaged and fragments of spine may remain in the wound requiring surgical removal. Injuries usually occur when the victim stands on an unseen fish, pulls a captured fish into a boat or swims too closely over a fish on the sea-floor.

RECOGNITION

Symptoms and signs may include:

intense pain, leading to irrational behaviour
swelling
sometimes a local grey/blue discolouration
an open wound
bleeding

MANAGEMENT

Call an ambulance
If the sting is to the trunk (chest, abdomen), assess the victim for signs of bleeding and treat as per ARC Guideline 9.1.1 Principles of Control of Bleeding for First Aiders
If there is an embedded object (eg. a barb from a stingray sting), do not remove it as it may be plugging the wound and restricting bleeding. Place padding around or above and below the object and apply pressure over the pads.
If the sting is to a limb, place the victim’s stung hand or foot in hot water (no hotter than the rescuer can comfortably tolerate)1-8 (Class A, LOE IV).
Transport the victim to a medical facility.

If the victim is unresponsive and not breathing normally, follow ANZCOR Guideline 8: Cardiopulmonary Resuscitation.

Note: DO NOT use the Pressure Immobilisation Technique. Antivenom is available for stonefish envenomation. (LOE IV, CLASS A)

AUSTRALIAN VENOM RESEARCH UNIT

For urgent advice concerning any marine envenomation you can call the Australian Venom Research Unit 24 hour advisory line 1300 760 451

RATIONALE

Whilst the mechanism is not understood, the local application of heat decreases pain in the majority of cases. The Pressure Immobilisation Technique is not used for fish stings because the venom remains localized at the wound

REFERENCES

Clark RF, Girard RH, Rao D, Ly BT, Davis DP. Stingray envenomations: a retrospective review of clinical presentation and treatment in 119 cases. J Emerg Med 2007; 33: 33-37.
Atkinson PR, Boyle A, Hartin D, McAuley D. Is hot water immersion an effective treatment for marine envenomation? Emerg Med J 2006; 23: 503-508.
Isbister GK. Venomous fish stings in tropical northern Australia. Am J Emerg Med 2001; 19: 561-565.
Aldred B, Erickson T, Lipscomb J. Lionfish envenomations in an urban wilderness. Wilderness Environ Med 1996; 7: 291-296.
Kizer KW, McKinney HE, Auerbach PS. Scorpaenidae envenomation. A five-year poison center experience. JAMA 1985; 253: 807-810.
Ngo SY, Ong SH, Ponampalam R. Stonefish envenomation presenting to a Singapore hospital. Singapore Mewd J 2009; 50: 506-9.
Satora L, Kuciel M, Gawlikowski T. Catfish stings and the venom apparatus of the African catfish Clarias gariepinus (Burchell, 1822), and stinging catfish Heteropneustes fossilis (Bloch, 1794). Ann Agric Environ Med 2008; 15: 163-8.
Grandcolas N, Galéa J, Ananda R. et al. Stonefish stings : difficult analgesia and notable risk of complications. [Article in French] Presse Med 2008; 37: 395-400.

ANZCOR 9.4.7: Fish Stings