Beachdiving Stingray Injury

Beach entries can be hazardous from several points of view. Not only is the entry difficult due to water action but there is another danger that is difficult to prevent, particularly if you back into the surf in a proper fashion. That is a stingray injury.

It is not too difficult to recognize what has happened to you as the pain of a stingray is quite severe and unrelenting. Immediate recognition of the situation helps as pressure, heat and immobilization are appropriate while the diver is being transported to an emergency facility.

This brings up several thoughts. First-just what first aid measures would be helpful with a stingray or other dangerous marine animal injury; and second- concerning what other harmful things could happen at the beach and near shore.

First, we need to know that any wounds that occur in sea water should be treated as contaminated wounds-sea water contains marine bacteria that are resistant to antibiotics, and all wounds should be washed out with soap and fresh water. All wounds, no matter how received, should be watched carefully for infection, dressed with sterile material and treated with antibiotic ointment for at least ten days. Sutures should be avoided because of the high chance of infection and butterfly closures should be applied.

Most of the hazards related to the beach fall into two groups: 1). Puncture wounds and 2). Marine toxins. Injuries from predators (sharks, barracuda, morays, large grouper) are so rare at the beach as to be newsworthy–but when they occur they need to be treated as noted. Barnacle cuts and sea urchin punctures are particularly painful and difficult to heal.

Marine toxins occur in just about every creature in the ocean as a protective mechanism. At the beach and around piers and jetties we need to be concerned mainly with jellyfish, fire corals and anemones. All of these produce a tiny “nematocyst” inside of which is a toxic barb which, if ruptured, fires off into the skin causing intense pain, burning, redness and swelling. Flush with sea water, vinegar or alcohol but not with fresh water and certainly don’t rub it! Meat tenderizer is also said to be helpful. Most people don’t realize that “sea lice” are also nematocysts of the thimble jellyfish floating around in water that get under your clothing.

Other frequent injuries that are seen at the beach are puncture wounds from sting rays, sea urchins , scorpion fish and fins or spines from dead fish in the sand (particularly cat fish). Stingray wounds usually occur when the buried animal is stepped upon and he instinctively fires his stinger located at the base of the tail. Most injuries are to the foot and lower leg, but occasionally to the head and neck in snorkelers. Rapid treatment should consist of removal of the stinger, immersion in hot water (45 degrees centigrade, or as hot as one can stand it) for 30-90 minutes, give adequate pain relief, watch for heart irregularities, treat for shock and infection and give tetanus prophylaxis. Spines from sea urchins break off under the skin and sometimes require surgical excision. Vinegar soaks are said to help.

AUTHOR

Ernest S. Campbell, M.D., FACS

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