Page 229 - ATP-P 11th Ed

Marine Envenomations Protocol

SPECIAL CONSIDERATIONS
1. Envenomation results from stings by jellyfish, fire corals, sting rays, sea urchins,
bristle worms, fish spines, sea snakes, etc.
2. Jellyfish account for the vast majority of envenomations, which occur with con-
tact to stinging cells on tentacles.
3. Stingrays are the most common cause of envenomation by marine vertebrates.
4. Sea snake venom is 2–10 times more potent than cobra venom, but only about SECTION 2
25% of those bitten develop symptoms (due to an inefficient delivery system and
small mouth).
5. All of these envenomations are more likely to occur in intratidal regions, reefs,
and surf zones.

Signs and Symptoms
1. Envenomation by jellyfish:
a. Contact with jellyfish tentacles causes immediate, intense sharp and burning pain,
followed by local, linear erythematous eruption.
b. Severe stings can cause anaphylactic reaction, hematuria, vomiting, syncope, hypo-
tension, or paralysis.
2. Envenomation by fire coral is similar to jellyfish, but less severe and rarely causes
complications. Pain symptoms usually resolve within 12 hours.
3. Envenomation by stingray:
a. Spine on tail contains retro-serrated teeth, with a venom gland along the groove.
b. Envenomation causes immediate, intense pain at site of injury out of proportion to
what it looks like, edema.
c. Pain tends to peak 30–60min after puncture and can last for several days.
d. Rare systemic symptoms include limb paralysis, hypotension, and bradycardia.
4. Envenomation by sea urchin:
a. Frequently cause multiple deep puncture wounds when stepped on.
b. Puncture and envenomation causes immediate, intense pain, erythema and local
swelling.
c. If more than 15–20 punctures are present then severe systemic symptoms can occur.
5. Envenomation by bristleworms:
a. Is caused by contact with bristle-like setae on feet of animal.
b. Contact is like brushing against a cactus plant and may result in many fine bristles
embedded in the skin.
c. Causes painful inflammation, which is almost never serious.

218 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 219