Dangers of the dark side
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    Dangers of the dark side

    Off the back of Nobles nasty reaction to something, i have been reading a bit about marine medicine. Most of the pointers have come via one internet forum or other, however, it still can't harm to have a simple resource to have easy access to;-

    The following is from an online Journal accessed via Pubmed and medscape, both medical databases.

    It has a multitude of information about "Diagnosis and management of injuries from dangerous marine life". Here is some of the more relevant bits ....

    Some of the words are a bit random and wierd, so if you don't understand i'd be happy to help (so will google define: )



    ----------------------------------
    Diagnosis and management of injuries from dangerous marine life.
    Brown TP.
    Contract Physician, Naval Hospital, Pensacola, Florida

    Dangerous Marine Life
    With the ease of travel, the world is becoming a smaller place. Reefs that were once considered remote are now easily accessible. As humans enter this aquatic environment, the possibility of coming into contact with dangerous marine life significantly increases.

    Most venomous marine life resides in the warm waters of the tropics and subtropics, especially around reefs. Because of their beauty and marine inhabitants, these same reefs are frequently used for diving and snorkeling.

    Fortunately, most of the injuries that occur will result in nothing more than an uncomfortable sting or pruritic lesion, although on occasion, the injury will be significant and may even prove to be fatal.

    This article discusses various types of venomous marine life and the treatments for the injuries that they inflict. There have been almost as many remedies for each of these injuries as there are species of venomous marine life. Many came about because the substances used to treat the injuries were the only options available.

    An important rule to remember when treating these injuries involves 3 steps:

    Arrest the envenomation by inactivation of the venom;
    Treat the local reaction or injury; and
    Treat the systemic reactions.
    The following are important points to remember during the treatment phase:

    Be prepared for cardiopulmonary collapse even in what appears to be a minor envenomation.

    Be prepared for anaphylactic reactions.

    When culturing wounds, it is important to inform the laboratory that the injury was in a marine environment. Factors, such as salt concentration of the media, incubation temperatures, and time, need to be adjusted.

    Cover for infectious pathogens, including Vibrio vulnificus, Aeromonas hydrophila, Edwardsiella tarda, Erysipelothrix rhusiopathiae, Mycobacterium marinum, Streptococcus iniae, and Vibrio damsela.[1]

    Check tetanus status and treat accordingly.

    Sea Urchins
    There are 6000 species of sea urchins. Of these, 80 species are thought to be venomous to humans.[3] There are 2 mechanisms of injury from the sea urchin. The first includes the mechanical effects of embedded broken spines and injected venom along with an inflammatory reaction.[3,4] The second mechanism is due to pedicellariae. These organs are found on the surface of the urchin and spines and act as jaws to clamp onto prey.[4,8] Even when separated from the spine, they continue to function. After the injury occurs, there is immediate onset of pain that is out of proportion to the trauma.[4] The duration of the pain is several hours.

    Symptoms:

    Pain;
    Edema and swelling;
    Partial paralysis of a limb;
    Facial swelling;
    Muscle spasm;
    Dyspnea;
    Weakness;
    Cardiac arrhythmias; and
    Collapse.[3,4]
    The symptoms of pedicellariae are usually more severe than the spines, including aphonia, respiratory distress, and possibly death.[3]

    Treatment:

    Soak the wound in hot water (43.3°C to 45.0°C).

    Protruding spines should be removed carefully without bending because they are easily broken. The use of a local anesthetic may be required.

    Purple or black dye from the surface of a spine may tattoo the skin and lead to a false assumption that a spine is imbedded in the skin. The dye will be absorbed in 48-72 hours. If the mark remains visible after 72 hours, then a spine fragment is likely imbedded.

    Analgesics.
    If the species possesses pedicellariae (pincer system), apply shaving cream and carefully shave the area.

    Secondary infection may occur requiring antibiotics and the possible need for debridement or drainage.

    Surgical treatment will be required if the spine is imbedded in a joint space, nerve, or tendon.[2-4,8]

    Coral
    While admiring coral, divers and snorklers are often washed against it by the undersea current. The surface of coral is covered by living material, which is easily removed from the hard architecture beneath. This outer surface can then enter cuts and scrapes caused by the abrasive undersurface. At the time of injury, there may be little discomfort and the wound may go unnoticed. A few hours later, an inflammatory reaction may occur, which increases over the following 24-48 hours.[3] The damage caused by coral may take weeks or months to heal.[4]

    Symptoms:

    Swelling;
    Discoloration;
    Pruritus;
    Tenderness;
    Ulceration; and
    Abscess.[3,4]
    Treatment:

    Scrub the wound with soap and water;
    Flush with large amounts of water;
    Then flush the wound with half-strength hydrogen peroxide and water;
    Rinse again with water;
    Apply antibiotic ointment, such as neomycin/bacitracin/polymyxin (Neosporin) or mupirocin;
    Cover with a nonadherent sterile dressing;
    Dress twice daily; and
    Monitor for signs of infection.[3,8]

    Swimmer's Itch
    Swimmer's itch is caused by skin contact with free swimming organisms called cercariae, which are the larval form of parasitic schistosomes.[2,8] Symptoms occur when cercariae-infested water dries on exposed skin.[8] The cercariae penetrate the skin, resulting in an erythematous bumpy, highly pruritic rash that occurs within minutes. Blister formation may develop over the following 24-48 hours.[8] Occasionally, the lesions may become infected secondary to scratching.

    Treatment:

    Immediately after leaving the water, briskly rub the skin with a towel in an attempt to prevent the cercariae from penetrating the skin;

    If cercariae have penetrated the skin and a reaction has occurred, the skin should be lightly rinsed with isopropyl alcohol and then coated with calamine, cortisone, or diphenhydramine hydrochloride (Benadryl) creams;

    Oatmeal or baking soda baths may also be helpful;

    Significant reactions may require oral prednisone; and

    Monitor for secondary infection from scratching.[8]

    Sea Bathers Eruption
    Sea bathers eruption is caused by the larval forms of thimble jellyfish.[2,8] The condition is common along the coasts of Florida and Cuba and the Caribbean. These organisms are very small -- about the size of flakes of black pepper. They become trapped in bathing suits or attach to hair and rarely affect noncovered skin.[2] Stinging occurs in the same manner as mature jellyfish (nematocysts) in areas that are covered.[2,8]

    Symptoms:

    Rash;
    Pruritus (which may become severe);
    Headache;
    Fever;
    Chills;
    Weakness;
    Vomiting; and
    Burning of eyes and urethra.[2,8]
    Treatment:

    Remove the bathing suit or wet suit;
    Rinse in freshwater shower;
    Apply vinegar to neutralize the nematocysts if no shower is available;
    Apply hydrocortisone cream 1% twice daily to rash;
    Systemic reactions should be treated with oral prednisone; and
    Machine wash the bathing suit or thoroughly rinse in alcohol

    Fish
    There are over 200 species of venomous fish.[3] They commonly inhabit shallow waters, especially around reefs. Common offenders include lionfish (zebra fish), scorpion fish, stonefish, catfish, and stingrays. Popular additions to marine aquariums include scorpion fish and lionfish (zebra fish).

    Venomous fish possess spines and a venom delivery system that are used for both protection and for incapacitating prey.[2,3] The venom is composed of proteins and polysaccharides of various sizes. The venom is unstable and is rapidly destroyed by heat.[8] After penetration by the venomous spine, there is immediate and intense pain that radiates along the course of the lymphatics. The puncture site is often anesthetic, but surrounding tissue becomes swollen, discolored, and even gangrenous.[2,3] The pain may last for 16-24 hours.[2]

    Of the venomous fish, stonefish are perhaps the most dangerous because their venom has been compared to that of the cobra.[5] They are found in the Indo-Pacific regions.

    Stonefish may grow to 30 cm in length and possess 13 dorsal spines that are extremely strong and covered by loose skin. When pressure is applied over the spines, 2 venom glands discharge through ducts. The venom causes intense vasoconstriction and thus remains localized. The venom is heat-labile and is destroyed at 50°C in 2 minutes or by alkalis or acids (pH greater than 9 or less than 4). The venom is a myotoxin that acts on skeletal, involuntary, and cardiac muscle by blocking conduction, which may result in cardiorespiratory collapse and paralysis. The venom can be neutralized by antivenom from the Australian CSL.[3]

    Symptoms:

    Nausea and vomiting;
    Diarrhea;
    Hypotension;
    Delirium;
    Diaphoresis;
    Fever;
    Leukocytosis;
    Respiratory distress;
    Cardiovascular collapse;
    Convulsions; and
    Death.[3]
    Treatment:

    Elevate the limb;

    Immerse in hot water (45°C) for 30-90 minutes;

    Thoroughly wash and irrigate the wound;

    Local anesthesia or regional block may be warranted prior to exploring the wound for broken spines;

    Systemic analgesics;

    Topical antibiotics;

    Tetanus prophylaxis; and

    Healing make take weeks to months.[3]

    Treatment for Stonefish:

    Use the above protocol. Topical application of a weak solution of potassium permanganate.

    Local injection of hyoscine N-butylbromide may provide relief if infiltrated in the first 15 minutes.

    Two milliliters of stonefish antivenom are given intramuscularly (1 mL neutralizes 10 mg of venom, which is the amount released from each spine). The antivenom can be administered IV in severe cases.

    Culture both aerobes and anaerobes for any signs of infection.

    Convalescence from a stonefish sting may take months.[3,4,5,8]
    --------------------------------------------------------------

    Reference = here >> http://www.medscape.com/viewarticle/512590_1
    Last edited by Claude; 27-12-2005 at 10:11 PM.

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    Exclamation Mycobacterium marinum

    For those who aren't aware that we can catch TB from our fish, it is caused by a strain of mycobacterium, Mycobacteria marinum and is a nasty zoonose

    Link to a reefkeeper article here >> http://www.reefkeeping.com/issues/20...ture/index.php

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    Good article!

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    - http://www.vetclick.com/safavet-dire...ubSubCatId=292 - gloves, armlength, disposable, pack of 100, saving of 17.99% (apparently)
    - Arm Length Gloves pack of 100 = £7.18 http://www.daleheadvetgroup.co.uk/farm/lambinglist.htm

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    With Ellie **O B 1**'s Avatar
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    good post claude nicely investigated maybe someone could consider this a stickie so it doesnt get lost as time goes by

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    Registered User Noble's Avatar
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    Great post Claude... Lots of useful information and a real eye opener as to just how careful you have too be...

    Im not any better (5 days now) and still have stinging nettle type rashes all up my arms so im hoping to see my doc tomorrow.. Im of the opinion that my severe reaction has a lot to do with my recent operation and the fact due to other medical problems i was dosed up with heavy duty antibiotics. I think these may have striped me of something that would have normally given me some sort of natural skin protection.
    The only reason ive mentioned this is because i wouldn't want anyone who is thinking of getting into marines to be put off... I think what has happened to me is very rare and may well not happen to anyone else.

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    Registered User dejavu's Avatar
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    Thanks for the good reading Claude. I have this little book on poisonous and dangerous marine creatures that I have always found facinating reading and re-reading.

    By the way, TB is caused by Mycobacterium tuberculosis, M. marinum is a nontuberculous, atypical mycobacterium, which is found on plants, soil, and fish in freshwater and saltwater worldwide (Palenque E, Skin disease and nontuberculous atypical mycobacteria. Int J Dermatol 2000; 39:659.).
    Louis Tsai

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    the fact due to other medical problems i was dosed up with heavy duty antibiotics. I think these may have striped me of something that would have normally given me some sort of natural skin protection.
    Yea, broad spectrum antibiotics will kill off commensal bacteria. You might be having allergic reactions to the antibiotics too? Strong antibiotics almost ALL have nasty side effects. Which antibiotics where they giving you if you don't mind me asking? If you do mind me asking, then do a online search for the active ingredients and find out their modes of action and possible side effects. Medline Plus is an excellent online drug info database.

    http://www.nlm.nih.gov/medlineplus/druginformation.html
    Louis Tsai

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    Hot,Cold & Wet ER richt's Avatar
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    Nigel is it hives? (Urticaria) You get nettle like stings on the skin and they sort of develop and move over a few hours, a bit like rings or raised bumps. Mostly arms, legs and upper body, but seems to be in zones. They feel prickly and it isn't pleasant to have. Anti-histamines stop the problem, but not all together.

    I had this out of the blue about a year ago. It seemed I may have had a liver infection, or something else unknown. It just went away and hasn't been back. Consultants were saying that I wasn't normal as I should have had them for at least 5 years! I have had urticaria reactions in the past to odd things like new clothes. It lasted over a month.

    Worst thing was I was told to give up alcohol. Mmmm I drink about 2 units a week on average, but I "gave up" anyway!

    HTH

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    Quote Originally Posted by dejavu
    Thanks for the good reading Claude. I have this little book on poisonous and dangerous marine creatures that I have always found facinating reading and re-reading.

    By the way, TB is caused by Mycobacterium tuberculosis, M. marinum is a nontuberculous, atypical mycobacterium, which is found on plants, soil, and fish in freshwater and saltwater worldwide (Palenque E, Skin disease and nontuberculous atypical mycobacteria. Int J Dermatol 2000; 39:659.).
    'lo, i know that, but fish TB is caused by M marinum, which does all the wonderfully similar things that M tuberculosis does to us (granulomas with central caseous necrosis) and can cause granulomas in us humans if innoculated subcut. Granted its not tuberculous (because its not caused by the tubercule bacillus) but is indeed a very similar variant AFB (sequence homology of 99.4%) to the TB we all know and love.



    i know as a bug man you will be annoyed that i have put the latin names in italics, sorry but i cba
    Last edited by Claude; 28-12-2005 at 12:00 AM.

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    Got fish? Guybirch's Avatar
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    Estimated annual incidence is 0.27 cases per 100,000 adult patients

    Which means you have a 0.00027% chance of contracting it.

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    Estimated annual incidence is 0.27 cases per 100,000 adult patients

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    tell that to Don Tuttle
    Last edited by Claude; 28-12-2005 at 02:18 PM.

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    Hot,Cold & Wet ER richt's Avatar
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    Trust in Allah, but tie your camel

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    Registered User Noble's Avatar
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    Right my GP just rang me up and said that its defiantly Urticaria (Hives) (thanks Rich) and that it may well have been caused by the coral or the water or in fact just about anything from heat to cold or even stress.
    So she prescribed some more antihistamines, told me to stay away from the tank until i have some arm length gloves and hopefully it will clear up in a few more days.

    Thanks for everyone's input.

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