Page 230 - ATP-P 11th Ed

6. Envenomation by fish spines:
a. First symptom is usually immediate localized pain out of proportion to clinical man-
ifestations, lasting minutes to hours.
b. Puncture wound is usually cyanotic, with surrounding erythema and edema
c. Pain is often noted in proximal lymph nodes.
d. Symptoms can progress to delirium, malaise, nausea, vomiting, and ele vated
temperature.
e. Infrequently leads to shock and death
7. Envenomation by sea snake bites:
SECTION 2 a. Fang and teeth marks consist of small puncture wounds and may number from 1–20.
b. Latent period of 10 minutes to several hours between bite and onset of symptoms.
c. May initially present with mental status changes, including euphoria, anxiety or
restlessness.
d. Progresses to dry throat, nausea, vomiting, generalized weakness and paralysis,
leading to respiratory distress/failure.
8. Envenomation by blue-ringed octopus bite:
a. Bite is painless and may go unnoticed.
b. Patient may become paralyzed with respiratory distress.
c. Symptoms are usually rapid in onset and extremely variable in severity.
Management
1. Stings (Jellyfish, Sea Wasp)
a. Remove stinger, tentacles, etc. if possible with gloved hand, forceps or tape.
b. Immediately flush with dilute acetic acid (vinegar). Alternative flush is isopropyl
alcohol and seawater. Do not use fresh water.
c. Topical lidocaine
d. Topical steroids
e. Follow Pain Management Protocol.
2. Bites (Sea snakes, blue ringed octopus) – See Envenomation Protocol.
3. Punctures (Sea urchin, stingray, fish spines, bristleworms)
a. Remove all penetrating foreign bodies with gloved hand, forceps or tape.
b. Irrigation with cold seawater.
c. Soak the affected area in nonscalding water (110–115° F [43.3–46.1° C]) for 30–90
minutes to inactivate toxins.
d. Ultrasound or x-ray (if available for retained foreign body)
e. Antibiotics for deep puncture wounds: moxifloxacin (Avelox )
®
f. Follow Pain Management Protocol.

220 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 221