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Bites, Barbs, & Stings in the Marine Environment - by Paul D. Hart, M.D.

I can't tell you how many times I have been poked, bitten or stung while fishing. Over the summer I was finned by catfish six times in two hours while taking a boat load of kids night fishing. I think they found it more fun to sling the flopping catfish into my shin than they did catching it in the first place. The fact is you, or someone with you, will get stung, bitten, or finned sooner or later. Being prepared helps.

Stingrays and Catfish
Stingrays and catfish are similar in the fact that both cause local trauma and lead to envenomation. Medically, the major problem with these two fish is that they can leave their barbs behind in your skin or deep tissues and lead to infection. Some times this can be quite serious. I have had a few patients that have required surgery to remove barbs that have gone undetected for quite some time. One of these unfortunate individuals swore to me the fin of the catfish that stuck him came out completely intact.

Initially, after being finned by a catfish or a stingray, submersing the wound in hot water (not scalding!) for 30 to 90 minutes will provide quick and dramatic relief. This denatures or destroys the molecular structure of the venom and can be repeated if the pain starts to return. If the wound appears to be deep or continues to hurt or bleed this may be an indication that part of the barb is still within the wound and requires an x-ray or MRI. If there is any suspicion of the fin being broken off in the wound or that a joint is involved (like the knee or ankle) you need to be evaluated by a physician.

Jellyfish
We all know what these are. In our costal waters we have several types with the scariest being the Portuguese Man-O-War. A good rule of thumb is that they all sting, with some being worse than others. The venom is produced from cells called cnidocytes. The venom itself is made up mostly of proteins and carbohydrates.

When someone is stung by a jellyfish, typically there is only a local yet painful burning or stinging sensation. However, sometimes an individual can have a severe systemic reaction (body wide, multiple organs) that can be very dangerous leading to shock and even possibly death. Thankfully, the vast majority of jellyfish stings are not this severe. Never the less, you should watch those individuals who are stung closely for signs of impending shock, which includes: anxiety, pale clammy skin, or even an altered level of consciousness.

For treatment of jellyfish stings, first remove any tentacles while remembering to protect yourself from being stung. Second, apply plain old vinegar to help inactivate the venom. Diluted rubbing alcohol, baking soda, lime juice and meat tenderizer can also be applied to neutralize the venom of our local jellyfish. Meat tenderizer is much easier to keep handy in your first aid kit for obvious reasons.

Moray eel
Lately, I seem to be catching more and larger moray eels. Few fish that I have ever boated seem to want to bite you more than these gnarly things. After I narrowly missed being bitten by the first two that I put in the boat I decided I would just start cutting the leader. The bites from these things can be very nasty. Bacteria such as Pseudomonas and Vibrio* have been cultured from even minor infected bite wounds from the critters.

If you ever get bitten by a moray eel, you can forget all about vinegar, meat tenderizer, hot water and what-not. These just won't help. You need to see a physician and get some antibiotics as soon as possible.

And a note to readers: Some things I find very interesting may bore you to death. If there is something you would like for me to write about in future issues, I would appreciate your input. Please e-mail me at: Feedback@gaffmag.net

Stingray Injury Treatment - Self-Care at Home
Care of the injured person begins at the scene and is first directed at safe rescue and removal of the victim from the water. A stingray injury that does not need to be checked by a doctor is rare.

Home first aid measures should be started, but a medical evaluation is also warranted.
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.
If there is no pain, then treat as a puncture wound or laceration by cleaning and disinfecting with soap and water.
If there is pain, bleeding, or more than a minor wound, and symptoms such as faintness or sweating (which indicate that venom has been absorbed into the body) arrange for transportation to a medical facility.
If in a remote area, treat the pain by immersing the injured area in water as hot (but not burning) as the person is able to tolerate (113°F or 45°C) for 30-90 minutes. This neutralizes the painful effects of the venom because the venom is inactivated by heat.
Oral pain medication such as acetaminophen (Tylenol) or ibuprofen (Advil) can be given if the person is not vomiting and not allergic to it.

Jellyfish Stings Treatment - Self-Care at Home
Care of the injured person begins immediately:

Protect rescuers from contact with the jellyfish or jellyfish tentacles. All rescuers should consider protective clothing and gloves in order to protect themselves so they can better rescue and treat the victim.
Remove the victim from the water.
Rinse the affected area with salt water or don't rinse it at all. Do not rinse the involved area of skin with fresh water, because it will further activate nematocysts and worsen the reaction.
Using protective gloves or forceps, remove any tentacles still in contact with the victim.
Apply acetic acid 5% (white vinegar). This will inactivate undischarged nematocysts and the toxin and will help to decrease symptoms.
Use over-the-counter pain medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to control pain symptoms. Immobilize the area that was poisoned to prevent further spread. For example, if a foot was stung, encourage the victim to keep the area still with as little movement as possible.

Marine Bites Treatment

All bite wounds require immediate copious cleansing with fresh tap water. Gently scrub the wound with soap and water to remove foreign material. If a syringe is available, it should be used to provide high-pressure irrigation. Remove dead tissue with a sterile scissors or scalpel.
After cleansing, apply a topical Bacitracin ointment 3 times per day.
Wounded extremities should be immobilized and elevated.
Puncture wounds and bites are usually not sutured (stitched) unless they involve the face.
Oral antibiotics are usually recommended to prevent infection. If infection develops, continue antibiotics for at least 5 days after all signs of infection have cleared. Check for drug allergy prior to starting any antibiotic. Your doctor will recommend the right antibiotic. Some can cause sensitivity to the sun, so use a sunscreen (at least SPF 15).
Relieve pain with 1-2 tablets of acetaminophen 325-500 mg (Tylenol) pain relievers every 4 hours and/or 1-2 tablets of ibuprofen 200 mg (Advil, Motrin) every 6-8 hours.

Sea Urchin Puncture Treatment

Immerse the affected area in water as hot as the victim can tolerate for 30-90 minutes. Repeat as necessary to control pain.
Use tweezers to remove any spines in the wound.
Apply shaving cream and gently scrap with a razor to remove pedicellaria (see Jellyfish Stings).
Another method is to apply melted wax to your injury (use caution), allow the wax to set, and then peel it off to remove the tiny spines.
Scrub the wound with soap and water followed by extensive flushing with fresh water.
Do not close the wound with tape.
If signs of infection, such as pus, redness, or heat occur, apply topical antibiotic ointment.
Oral antibiotics are usually recommended for infection. If infection develops, continue antibiotics for at least 5 days after all signs of infection have cleared. Check for drug allergy prior to starting any antibiotic. Your doctor will recommend the right antibiotic. Some can cause sensitivity to the sun, so use a sunscreen (at least SPF 15).
Relieve pain with 1-2 tablets of acetaminophen (Tylenol) pain relievers every 4 hours and/or 1-2 ibuprofen (Advil, Motrin) every 6-8 hours.
CPR may be required.

Catfish Sting Treatment

Immediately immerse the affected area in water as hot as you can stand until pain is relieved.
Remove spines with tweezers.
Scrub the wound and irrigate with fresh water.
Do not tape or sew the wound together.
Oral antibiotics are usually recommended for stings that become infected. If infection develops, continue antibiotics for at least 5 days after all signs of infection have cleared. Check for drug allergy prior to starting any antibiotic. Your doctor will recommend the right antibiotic. Some can cause sensitivity to the sun, so use a sunscreen (at least SPF 15).
Pain may be relieved with 1-2 acetaminophen (Tylenol) every 4 hours and/or 1-2 ibuprofen (Motrin, Advil) every 6-8 hours.