Stingray Injury Treatment

[SpearMax]

We are all shocked and saddened by the loss of Steve Irwin - aka Crocodile Hunter from a stingray puncture wound to his heart on the Great Barrier Reef in Australia.

Waterbug and I researched the injury and offer the following information for the Spearboard community.

A great text on the subject of stingray and other injuries is "Dangerous Marine Creatures," by Carl Edmonds, M.D. which states: "Damage from the spine may cause death from either physical trauma, such as penetration of the body cavities or from the venom of the spine, or both. In Australia the deaths tend to be from the penetration of body cavities, whereas in the US the deaths are more likely from the venom effects. There are said to be 1500 injuries per year from stingrays in the US."

[SpearMax]

Here are some Stingray photos from the excellent book provided by Waterbug titled "Dangerous Marine Creatures," by Carl Edmonds, M.D.

[SpearMax]

A very good item to have on your boat or in your dive box is this waterproof small booklet available from DAN Divers Alert Network.

[SpearMax]

The following is from the website http://www.emedicinehealth.com/stingray_injury/article_em.htm

Stingray Injury Overview

Stingrays do not actually attack. Injuries from these sharklike creatures are usually defensive actions. Once disturbed, their venomous stinger (spine) near the base of their tails lashes out and can cause punctures or lacerations (cuts). Their mouth parts do not cause injury, but a hickey can occur if they try to suck you.

Stingrays are aquatic, cartilaginous vertebrates who are members of the shark family. They have flat bodies and winglike fins. Stingrays are nonassertive and can be found lying in the sand in shallow water at the beach or swimming free in open waters. Most are saltwater creatures, but a few live in fresh water.

• In 1608, Captain John Smith, the explorer who founded the Jamestown settlement, was injured by a stingray in the Chesapeake Bay.

• Annually, about 1,500 stingray-induced injuries occur in the United States.

Stingray Injury Causes

Most stingray injuries typically occur when a person accidentally steps on a ray as it lies on the shallow, sandy bottom of a beach area. Rays often cover themselves with sand for camouflage while resting or hiding from predators, so they can be hard to see. When stepped upon or harassed, they swing or arch their tail in the direction of the intruder as a defensive maneuver to protect themselves. This drives their spine into the unwanted intruder. The ray’s tail can reach all the way to the front of its head for protection.

• People who step on a stingray most frequently are injured on their feet and lower legs. Hands and arms can be injured if a person tries to touch or catch one.

o A fisherman, for example, can be injured removing a stingray from a net or fishing line.

o In rare cases, the stingray's powerful spine has penetrated a person's abdomen or chest causing severe injury.

• Rays found in home aquariums can cause injuries.

• You can prevent injury by shuffling your feet while walking or wading through water to startle and shoo them away. Wearing footwear such as sneakers or dive booties may not help because the spine can penetrate them.

• Don't try to chase or ride a stingray.

• If you have hooked one, cut the line and release it. A seemingly dead ray can whip its tail in defense and cause an injury.

• Certain rays, such as skates and manta rays, do not have a stinger at the base of their tails and are harmless.

• Some rays in marine parks are friendly because they have become used to humans, and you can touch them. These rays are more likely to give you a hickey from the suction action created by their mouths when trying to feed on your hands. Venom is only located in the tail spine.

[SpearMax]

Stingray Injury Symptoms

The stinger, or spine near the base of the tail, is hard and sharp with backward pointing barbs (retroserrations) that can cause a jagged cut. It can be difficult to remove from a wound because of the back-facing barbs. There can be 1-4 spines at the base of the ray’s tail depending on the species.

A skinlike covering, the sheath, over the stinger encloses the venom glands. The spine lies in a groove along the tail. Injury from a stingray can damage a person's muscles or tendons in addition to the cut or puncture wound. Part of the sheath and spine can be left in the wound. The venom is composed of many different substances that cause tissue to break down and die as well as cause severe pain.

• The toxins contained in the sheath can cause the following symptoms:

o Immediate and severe pain radiating up the limb and lasting up to 48 hours

o Swelling in the wounded area

o Bleeding from the wound

o Color change in the area of injury—first dusky blue, then red

o Sweating

o Low blood pressure

o Faintness, weakness, dizziness

o Salivation, nausea, vomiting, diarrhea

o Headache

o Shortness of breath

o Seizure

o Muscle cramps and pain, paralysis

o Heart rhythm irregularities

o Death, though rare, has been reported from a puncture of the heart or abdomen and from loss of blood.

When to Seek Medical Care

Because stingray injuries usually hurt so much, medical attention is definitely needed. Pain management, wound care, a tetanus vaccine update, and antibiotics are the most likely treatments.

• Seek medical care if generalized symptoms, such as faintness or sweating, are felt. These symptoms indicate that venom has been absorbed.

• If the injury does not hurt, but you need a tetanus booster, then medical attention should be sought.

• If you have redness, swelling, infection, or delayed healing, seek medical attention.
In most cases, a stingray injury should be handled in a hospital's emergency department. If the injured person is in severe distress with pain, bleeding, vomiting, and faintness, then 911 should be called for ambulance transport to a medical facility.

• Transport by ambulance, if available, is the best choice so treatment can be started en route. If an ambulance is not available, go by car. If a boat ride is needed to shore, call ahead to arrange an ambulance or car for transportation to a medical facility.

• A tetanus booster is needed if it has been more than 5 years since the last tetanus booster. Tetanus prevention is needed if the person has never had a tetanus vaccination.

Exams and Tests

Rapid evaluation and entry into the treatment area of the emergency department may be needed, especially if the stinger penetrated the person's head, chest, or abdomen.

Typical steps in diagnosing the extent of the stingray injury are as follows:

• Blood pressure and pulse are checked.

• The doctor performs an initial examination to see if resuscitation (help in breathing) is needed.

• The doctor treats the pain and takes care of the wound.

• Once the injured person is stable, x-rays may be taken if the doctor thinks foreign matter or parts of the stingray's sheath and spine remain in the wound.

• Blood tests are usually not needed.

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.

o 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.

o Oral pain medication such as acetaminophen (Tylenol) or ibuprofen (Advil) can be given if the person is not vomiting and not allergic to it.

• If you belong to Divers Alert Network (DAN), call their emergency number to obtain medical evacuation assistance and arrange for referral to a medical care facility. Your DAN membership card has details.

Medical Treatment

Stingray injury care is mainly directed at monitoring the injured person's vital signs, providing pain relief, and treating the wound.

• Vital signs: Treatment for abnormal vital signs is the first step.

o If blood pressure is low, fluids are given through an IV.

o Additional medications may be needed to maintain a proper blood pressure.

o Sometimes, hospitalization is required if the person is very ill.

• Pain: There is no antivenom (antidote) to stingray toxin. The venom is a protein and is broken down by heat, so placing the injured area in water as hot as the person can tolerate (113°F or 45°C) for 30-90 minutes can dramatically relieve the pain. A word of caution: Once the area is numb, care must be taken to prevent a burn injury from the hot water.

o Pain medication, such as narcotics, given through an IV may be needed until the heat has neutralized the toxin.

o Numbing medications injected into the injured area help to relieve the pain and allow the doctor to explore the wound to look for injuries to structures below without causing further pain.

• Wound care: The doctor cleans the wound, removes foreign matter, and looks for injuries to tendons, nerves, blood vessels, and other body structures. If it has been more than 5 years since the last tetanus booster, one should be given.

o Antibiotics are usually given because the wound is contaminated with bacteria from the stinger and from the seawater. The doctor needs to consider the specific types of marine organisms that caused the injury when choosing the antibiotics used to treat this wound.

o The wound is left open, then closed with stitches a few days later if it has not become infected. If the wound is repaired on the initial visit, it is usually closed loosely to allow any infection to easily drain.

o If important structures, such as nerves, tendons, or arteries, are damaged, then a surgeon (such as a hand specialist) needs to be consulted to assist in the management of the wound. Cleaning and repair in the operating room may be needed.

Next Steps
Follow-up

Stingray injury wounds usually require recleaning on a daily basis with soap and water and then application of an antibiotic ointment and dressing.

• If antibiotics are prescribed, take them as directed.

• If your wound becomes infected, have it rechecked.

• Keep any follow-up appointments that have been scheduled.

Outlook

With early medical care, serious symptoms and pain can be relieved. Follow-up is required to check for additional complications. The wound will probably require more than one visit to treat depending on how severe it is.
Referral for reevaluation or to perform a delayed repair may be advised for the following reasons:

• Wounds are often slow to heal.

• Pieces of the spine’s integument (coating) may remain in the wound.

• Additional tissue damage can happen from tissue break down.

• Delayed infections can occur.

• Patience, time, and proper medical care help limit the damage from this injury.

[westpalmspearo]

thanks tony

[ROBERTO REYES]

Ouch!

[intowin]

I stepped on a sting ray once. It was the most severe pain I have ever been in. It went on for four hours. I was about to go to the hospital and we looked up a cure on the net.

VERY hot water took the pain away immeditaley. It was crazy that such a simple thing can neutralize the pain.

The sore however took months to heal.

[Seth]

good info, im with intowin on this, once a guy i know stepped on one, comfortably hot water gave him almost immediate relief, then the docs treated him for the infection, he was off of his feet for ages.

[SpearMax]

That's right intowin. I have heard the pain is excruciating. The above emedicine article says this:

o 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.

[bgbill]

I would think drinking a bunch of beer would be a good thing to do also, it may not relieve the pain, but after a bunch of beers, you just won't care that much. :D

[inletsurf]

Staff infection or blood poisoning is usually the most dangerous factor of any stingray injury. Death like Steve Darwin is very unlikely in any case.

[Nsearch]

I stepped on a sting ray once. It was the most severe pain I have ever been in. It went on for four hours. I was about to go to the hospital and we looked up a cure on the net.

VERY hot water took the pain away immeditaley. It was crazy that such a simple thing can neutralize the pain.

The sore however took months to heal.

Been there, done that and have to agree 100%. The pain almost caused me to pass out and it was one of the worst things I've even been subjected to. Still have the puncture scar on my ankle to this day. If one could "bottle" the venom and manufacture into like a stun gun it would bring any man to his knees faster than bgbill in a gay bar. :D ;)

[chasintail]

I stepped on one wade fishing about 5 years ago.Went to shore and pulled the barb from my right calf.I took a sharp knife and cut the hole open and let it bleed.Later that day the emergency room Dr said that was probably the best thing I could have done.

[Charlestondivin]

Hot water is defiitely the ticket for stingray stings. Worst pain I have ever felt but as soon as i put my hand in hot water the pain instantly went away.

[inletsurf]

Since there seems to be a lot of stingray mishaps on this thread and elsewhere (I also know people who don't dive who have had them also), I'm just curious as to how most of you were inflicted. Was it the typical wading in shallow murky bay waters scenario? From what I've heard, that seems to be the most common.

[inletsurf]

Hey check this out, in this picture you can see the image of a skull in the gash. Far left side of the gash. Creepy, huh?

http://www.spearboard.com/attachment.php?attachmentid=37634&stc=1

[waterbug]

inlet surf, I think you have way too much free time on your hands!!

[spine shot]

i got spined taking my hook out of one when i was fishing. It stuck in my rist and the ray was hanging from my arm. my friend that i was with had to grab the ray and yank as hard as he could to get it out, the spine has barbs on it facing inwards so it is very difficult to pull out!! The worst pain i have ever had in my life!!!!!! hot water is the only thing that helps. 3 shots of morphine did not help. allot of antibiotics had to be taken

[f94gator]

Glad I've never been stung by one, but it's good to hear the hot water advice, I never realized that that was a way to treat it.

Back to the Croc Hunter, based on what I've read, the only treatment for a sting to the chest is a quick Hail Mary and prepare to meet your maker. As soon as that barb hit Irwin, he was as good as gone.

[inletsurf]

Back to the Croc Hunter, based on what I've read, the only treatment for a sting to the chest is a quick Hail Mary and prepare to meet your maker. As soon as that barb hit Irwin, he was as good as gone.

Wow, thats crazy. Does anyone know the worldwide stats on any documented deaths from stingrays...out of curiosity?

[bgbill]

Wow, thats crazy. Does anyone know the worldwide stats on any documented deaths from stingrays...out of curiosity?

Earlier someone posted that there have been 17 documented stingray deaths, I guess it is 18 now, the chances are greater that you will killed on the way to the ramp, than by a stingray.

I still wouldn't try to go for a ride on one, I think he was probably ****ing with the stingray either that or it felt trapped between him and the camera man, and just wanted to get away.

[Don B]

The hot water treatment also works on "hard head catfish" wounds.

[snowstopsspears]

Solid solution:


Hot water = hot tub

Pain medication = your favorite cocktail


First, you need to remove the barb. This requires a sharp knife and a steady pair of hands (and a sober friend). Second, you'll need to locate a hottub. Local hotel tubs work wonders. Third, you'll need to secure liquid refreshments. Follow those three steps and you should be alright. Now, if you take a shot in the trunk, you should probably see somebody. But, in my experience, most of these wounds occur on extremities. Really, it works. The most amusing part of this solution is that I put it all together on a vacation on the west coast at the tender age of 11 or 12 in response to a wound my dad received while wading with his castnet. At any rate, keep it in mind.


Regards,

Andrew

[f94gator]

Earlier someone posted that there have been 17 documented stingray deaths, I guess it is 18 now, the chances are greater that you will killed on the way to the ramp, than by a stingray.




I heard a quote from Jim Hanna that put it well. He is very surprised that a ray is what ended up killing Irwin, considering all the creatures he *****ed with. Hanna compared it to himself getting killed by a poodle. :)

Anyway, Irwin had admitted in the past that he wasn't as comfortable with the ocean as crocs and snakes and such. I'm guessing he didn't know what the ray could do and got way too cozy with it. It's one thing to grab its tail or feed it at arms length, but swimming on top of it is just asking for problems.

[Grin]

I used to know someone(got rid of her :D ) whos freind stepped on a stingray and got jabbed in the arch of the foot while we were at the redneck beach. It was a small wound, and it was a holiday weekend, so no hospital visit was immediatly sought. She went a few days later and they gave her instructions to stay off it etc... She didn't take it 100% seriously and it got worse and worse. Finally she went back to the doc and they told her it was borderline amputation time. She now took everything serious and it took forever to heal up.

[ascotgregory]

Did Steve die from the venom or was it a puncture wound to the heart ? I guess both probably played a part . I think he died very fast ?

[waterbug]

Although the venom is known to be cardiotoxic, my understanding is that he pulled the barb from his chest just prior to collapsing. It could have been either or both the venom or the barb, but most likely it was from the puncture wound. If he had left the barb in place it may have protected him for awhile, but it's all speculation at this point.

[junior]

I doubt he even knew the barb was in his heart. I would imagine it was not really evident how extensive an injury he had received.

[Bottomcrawler]

Most recent news is that there is a video of the incident. The producer said that after the hit, Steve pulled the barb out and was dead inside of a minute. They attempted resuscitation, but as we now know...No Luck. The barb is predicted to have been 10 inches long. So I don't think the venom even played a part. OUCH My best suggestion, be careful and "live like you were dyin!"

[inletsurf]

My best suggestion, be careful and "live like you were dyin!"

Steve would have rode a bull named "fu manchu". In fact, he'd wrestled it mud and hog tied it just to thump it in the balls and let it go. All in 3.7 seconds.

[JAW]

I have stepped on a couple back when I was a kid growing up on the Indian River and always running around in the mud terrorizing the wildlife. Worst one was in about 6inches of water as I was tearing down a barbed wire cattle fence. The barb went through my foot in between the tendons of the little toe and the next to little toe.

[Straight Hook]

Stingray Hell……………..and Farewell to Brother Steve

I’ve been hit twice by stingrays.

Both times were my fault…………………..I got hit in the ankle once when I accidentally pinned one down by stepping on it in shallow water (he was totally buried up)………………the other time I had one in the boat taking a hook out of his mouth………telling everyone on the boat how dangerous it was and got hit in the thigh…………he sprung out of the boat off of my leg like a pogo stick.

The time when I was in the shallow water…………….I had been wading in very warm bay water and the warm water really helped clean out the wound and minimize the pain

The second time (the one in the boat)……………I took a good hit about 4 inches above the knee (he jumped off the gunell as I was removing the hook)…………….I did everything wrong……………..I put ice on it which prolonged the pain and allowed the venom to continue doing it’s thing.……………soon a large lump the size of a golf ball raised on my leg…………….all of my leg muscles began to wiggle and twitch like a frog leg in a frying pan…………and my leg got covered by goose bumps…………..very strange.


We were off shore a good distance and I had to run back to the ramp ………..load my boat and drive my 5 speed manual transmission SUV to the Hospital.

At the hospital they probed and dug around in the wound to make sure all the barb was gone.

They also gave me a tetanus shot in the wound and left the wound open to drain………………it healed up in a few weeks.

I still have a pretty good puncture scar with some tissue damage……..and every once in a while a little pimple type thing rises and extrudes some liquid out of the area.

It was extremely excruciating pain………………….my wife asked what it felt like……………

I described it as this:

Take a thin dagger and insert it into your flesh deeply…………remove the dagger………open the wound and pour in rock salt……………..insert an electric curling iron (the one with the little projectiles all over it) that is plugged in and set on the highest heat and insert it in the salted wound…………..then begin slowly twisting the curling iron.

That’s the best way I could describe it.

Back to the original story about Steve Irwin.

He was extremely passionate about his love and excitement for Animal Kind……………….one of the greatest things he did was educating people about how beautiful and cool reptiles really are.

I too (as I’m sure many of you) have a great respect and love for reptiles and appreciate all his work and efforts getting people to understand them and learning not to harm them.

Steve will be missed by everyone who cares about wildlife, conservation and our surrounding environment.

Cheers to Steve Irwin

We will all miss you Aussie Brother

[rbp 4 135]

^ amen.

fortunately i have never been hit my a sting ray but down in costsrica one did stick it's barb in to the side of our wooden panga. Story goes like this... We were fishing around the reef down there forwhat ever was biting i put on a big ol chunk of cut bait following the tradition of bigger bait = bigger fish. dropped it to the bottom, around 40 feet, mabey a little less. About 10 minutes later fish on! when i finally drug that bastard up, and belive me they fight pretty well, it turned out to be a stingray, probably close to 4-5 feet wide. the guide/local grabbed the line and thats when it stuck the boat. not sure if it left the whole spine or not, but what was left was nearly 6 inches and stuck in the wood about 1/2 of an inch.

[sawfish]

The hot water cure works great, if you have a hot teakettle handy. Emergency heat packs like those used for sports injuries will work well in a pinch, and are more portable (keep a couple in your pack or tackle box). I imagine that you could catch the warm exhaust water from an outboard, but it might not be hot enough. The older Mercs had a weep hole in the water pump that put out a stream of pretty warm water.

I even heard of one guy that got hit while beach diving. He made it back to his car, and used the hot air from the car heater to relieve the pain. There seems to be a fairly narrow between where the heat will be effective to break down the poison. Obviously, it has to be hotter than body temp., but not too hot to stand. I heard that 105 degrees was the minimum, but cannot document that statistic. Maybe someone on the board knows.