====== Penetrating marine envenomation ======

The major causes of penetrating marine envenoming or injuries are:\\
1. Venomous fish: stone fish, catfish, scorpion fish, weever fish\\
2. Sting rays\\
3. Echinoderms: sea urchins

There are a huge variety of different venomous fish and stingrays throughout the world which are summarised in tables 1 to 3.

**Table 1.** List of important groups of venomous fish that have been implicated in envenomation.

|**Group** |**Distribution** |**Examples** |
|Stonefish (//Synanceia// spp.)|Tropical and warm temperate oceans, including central Pacific, Indo-Pacific and east to the African coast|Australian estuarine stonefish (//S. trachynis//), the Indian stonefish (//S. horrida//) and the reef stonefish (//S. verrucosa//)|
|Scorpionfish (Scorpaenidae)|Worldwide mainly in tropical and temperate oceans|Lionfish (//Pterois volitans//), soldierfish or cobbler (//Gymnapistes marmoratus//), sculpin (Scorpaena guttata), red rock cod(//S. ergastulorum//), bullrout (//Notesthes robusta//), Fortesque (//Centropogon australis//)|
|Weever fish (Trachinidae)|Mediterranean, European coastal areas, Black Sea, Pacific Ocean of the coast of Chile|Greater weever fish (//Trachinus draco//) and the lesser weever fish (//Echiichtis vipera//)|
|Scats (Scatophagidae)|Indo-Pacific Ocean|Silver scat, striped butterfish or spadefish (//Selenotoca multifasciata//)|
|Rabbitfish or happy moments (Siganidae)|Tropical Indo-Pacific region|//Siganus// spp.|
|Enoplosidae|Australia (temperate waters)|Old wife //(Enoplosus armatus)// |

**Table 2.** List of the families of catfish that have been implicated in envenomation.

|**Family** |**Distribution** |**Examples** |
|Ariidae|Worldwide|//Arius// spp.|
|Bagridae|Asia, Africa, Japan|//Pseudobagrus, Liobagrus reini// |
|Clariidae|Indo-Pacific and India|//Clarias batrachus// |
|Doradidae|Fresh waters of South America|//Pterodoras granulosus//, //Centrochir crocodili// |
|Heteropheustidae|India|//Heteropneustes fossilis// |
|Ictaluridae|America,|//Ictalurus// and //Noturus// |
|Pimelodidae|South America to Mexico|//Pimelodus clarias// |
|Plotosidae|Indo-Pacific region including Australia|//Plotosus lineatus//, //Cnidoglanis megastoma//, //Tandanus bostocki// |
|Siluridae|Africa and Asia| |

**Table 3.** Important families of stingrays and their distributions

|**Family** |**Common Name** |**Examples** |**Distribution** |
|Urolophidae|Round stingrays or stingarees|//Urolophus// |Worldwide|
|Dasyatidae|Stingrays or whip rays|//Dasyatis//, //Taeniura//, //Urogymnus// |Worldwide|
|Potamotrygonidae|River rays|//Potamotrygon// |South America|
|Gymnuridae|Butterfly rays|//Gymnura// |America|
|Myliobatidae|Bat or devil rays|//Aetobatus narinari//, //Myliobati// |Worldwide|
|Rhinopteridae|Cow-nosed rays|//Rhinoptera// |Europe and America|

===== TREATMENT =====

The treatment of marine injuries is similar with minor modifications depending on the size of the wound and the presence of broken off spines.

==== First aid ====

  * Wound site: wash with water
  * Bleeding: local pressure
  * Pain: immerse in hot water (45ºC) for a maximum duration of 90 minutes

==== Hospital treatment ====

  * local irrigation of the wound and removal of foreign material/spines
  * radiography or ultrasound to identify retained spines or foreign bodies
  * oral or titrated parenteral analgesia and/or local or regional anaesthesia; the latter may assist with exploration of the wound
  * stonefish antivenom is available for stonefish stings with severe pain or systemic effects
  * surgical consultation is required for deep injuries, involvement of joints or bones or retained foreign material
  * thoracic or abdominal stingray injuries should be treated as major trauma with appropriate resuscitation and surgical intervention
  * prophylactic antibiotics should be considered for large wounds with foreign material or delayed presentation
  * all penetrating marine injuries must be reviewed every 24 to 48 hours for the first week

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