Envenomation by Trachinus draco in the eastern Mediterranean

Envenomation by Trachinus draco and Pain Management

We report a case of a 42-y-old female patient who sustained a sting to the neck from a Trachinus draco fish. She subsequently developed complications including arytenoid membrane edema secondary to either the local anesthetic agent administered to the wound or the dracotoxin itself. The patient was examined in the emergency department after the sting. Local anesthesia with lidocaine was administered to the areas of injury at another hospital before presenting to our hospital emergency department. The patient reported that her pain partially decreased but hoarseness developed and she had difficulty breathing after the local anesthetic was administered. Laryngeal examination by our hospital's otolaryngologist revealed edema of the patient's right arytenoid membrane without evidence of vocal cord swelling. Computed tomography of the neck revealed edema in the right arytenoid membrane on the side of the neck where the local anesthetic had been injected. The patient, who was given supplementary treatment, was discharged without any complications on the seventh day of hospitalization. The principle treatment for these types of stings includes immersion in hot water, analgesic therapy, and observation for signs of local and systemic envenomation. We recommend using caution when injecting local anesthetic agents in the neck because of underlying vital structures.

The venoms of the lesser (Echiichthys vipera) and greater (Trachinus draco) weever fish- A review

In comparison with other animal venoms, fish venoms remain relatively understudied. This is especially true for that of the lesser Echiichthys vipera and greater weever fish Trachinus draco which, apart from the isolation of their unique venom cytolysins, trachinine and dracotoxin, respectively, remain relatively uncharacterised. Envenomation reports mainly include mild symptoms consisting of nociception and inflammation. However, like most fish venoms, if the venom becomes systemic it causes cardiorespiratory and blood pressure changes. Although T. draco venom has not been studied since the 1990's, recent studies on E. vipera venom have discovered novel cytotoxic components on human cancer cells, but due to the scarcity of research on the molecular make-up of the venom, the molecule(s) causing this cytotoxicity remains unknown. This review analyses past studies on E. vipera and T. draco venom, the methods used in the , the venom constituents characterised, the reported symptoms of envenomation and compares these findings with those from other venomous Scorpaeniformes.

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Research on the weever fish venoms Echiichthys vipera and Trachinus draco has

been scarce.

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E. vipera and T. draco venoms elicit cardiorespiratory symptoms in victims.

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E. vipera and T. draco contain unique cytolysins – Trachinine and Dracotoxin.

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Dracotoxin is haemolytic and contains membrane depolarising activities.

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E. vipera venom triggers apoptosis in human colon carcinoma cells.

Hot Water Immersion Therapy with a Thermal Isolator in Patient with Marine Envenomation

Objective

Hot water immersion (HWI) has been proven to be effective for the treatment of pain due to marine envenomation. Our preliminary study by simply measuring the temperature change over time on the hot water in our conventional metal tray method revealed a too rapid fall in water temperature that happened in minutes. The aim of this study was to review the current practice of HWI for patients with marine envenomation in the emergency departments in Hong Kong, and to look for the optimal equipment in performing HWI.

Method

We first conducted a phone survey to 16 registered nurses or nursing officers from 16 emergency departments of public hospitals in Hong Kong for the current practice of hot water immersion. The second part of our study was an in-vitro experiment done in observation room that a healthy subject immersed a hand into the water bath in metallic tray, sharp box and thermal isolator with and without covering of aluminum foil or plastic foil. The temperature change of the water bath in these containers was serially monitored.

Results

In our phone survey, 14 respondents used plastic tray or sharp box for hot water immersion. Nine of them claimed that they commonly encountered inadequate wound pain relief and early cooling of the hot water bath. The experiment showed that the water temperature dropped out of optimal range for 5 minutes and 15 minutes in metallic tray and sharp box respectively. The thermal isolator kept the optimal temperature throughout 30 minutes of the study time.

Conclusion

Our purposed thermal isolator is a safe, practical and effective device for HWI therapy.

Stonefish envenomation of hand with impending compartment syndrome

Background

Marine stings and envenomation are fairly common in Malaysia. Possible contact to various marine life occurs during diving, fishing and food handling. Even though majority of fish stings are benign, there are several venomous species such as puffer fish, scorpion fish, lionfish, stingray and stonefish that require urgent medical treatment. Stonefish is one of the most venomous fish in the world with potential fatal local and systemic toxicity effects to human.

Case Presentation

We reported a case of stonefish sting complicated with impending compartment syndrome.

Conclusions

Medical staff should be alert about the possibility of this potential emergency in standard management of stonefish stings.

The effect of supportive emergency department nursing care on pain reduction of patients with Red Sea marine wildlife injuries

INTRODUCTION

The emergency department at Yoseftal hospital in Eilat is on the shore of the Red Sea, and it is visited by patients with marine wildlife injuries. The purpose of this study was to examine the effects of supportive nursing care on the pain level of patients with Red Sea marine wildlife injuries.

METHOD

A prospective quantitative study including 102 patients admitted to the emergency department. The study included a study group (N = 50) and a control group (N = 52). Both groups rated their pain level on the VAS before and after receiving treatment. The control group received the usual treatment, and the study group received the usual nursing treatment along with structured patient guidance and support.

RESULTS

There was a significant difference in the level of pain after the intervention between the control and the study group. In the study group, the level of pain was significantly reduced compared with the control group (p < 0.001).

DISCUSSION

Nursing training and patient guidance contributed to increasing cooperation with patients and pain reduction. Therefore, training interventions should be structured and assimilated as an integral part of nursing practice.

Is hot water immersion an effective treatment for marine envenomation?

Envenomation by marine creatures is common. As more people dive and snorkel for leisure, the incidence of envenomation injuries presenting to emergency departments has increased. Although most serious envenomations occur in the temperate or tropical waters of the Indo-Pacific region, North American and European waters also provide a habitat for many stinging creatures. Marine envenomations can be classified as either surface stings or puncture wounds. Antivenom is available for a limited number of specific marine creatures. Various other treatments such as vinegar, fig juice, boiled cactus, heated stones, hot urine, hot water, and ice have been proposed, although many have little scientific basis. The use of heat therapies, previously reserved for penetrating fish spine injuries, has been suggested as treatment for an increasing variety of marine envenomation. This paper reviews the evidence for the effectiveness of hot water immersion (HWI) and other heat therapies in the management of patients presenting with pain due to marine envenomation.