1. Hazardous marine creature in Oman <br />DR.Salim AL-Jabri<br /> R1<br />
2. Introduction <br /> 2000 species are venomous or poisoning to human<br />Many can produce sever illness and fatilties<br />Number of victims increase<br /> Most marine injure human with defence and food –procuring devices <br />
3. VenoumsMarine Animals<br />Three main classes according to mechanism of venom delivery;<br />1- Nematocysts<br />2- Bites<br />3- Stings<br />
4. 1- Nematocysts <br /><ul><li> large numbers ,,, so grestest numbers of envenomation
7. Basic mechanism is ‘spring –loaded’ venom gland
8. mechanical or chemical stimulation
9. suddenly evert and discharge structure that penetrates the prey and deliver venom through connecting tube </li></li></ul><li>Nematocysts<br /><ul><li> Animal’s tentacles
10. Tentacles can be up to 100 feet in somegaint species
11. Can still function even after animale is dead or tentacles are seprated
12. stinging cell can remain active for weeks
13. may discharge later during attempted rescue and treatmnet</li></li></ul><li>Toxicity<br /><ul><li> nematocysts continue;</li></ul> - various peptides, phospholipase A, proteolytic enzymes, hemolytic enzymes, quaternary ammonium compounds, serotonin <br /><ul><li> Severity of venomation related to sveral factors;</li></ul> 1- number of nematocysts<br /> 2- varies form species to species <br /> 3- victims autopharmacologic response to the venom<br />
14. Symptoms<br /><ul><li> Stinging sensation immediately on contact.
22. Respiratory distress; and Cardiovascular failure. </li></li></ul><li>Box Jellyfish<br />is the most venomous creature to live under the sea<br />It has caused 5,567 recorded deaths since 1954,,,,, ? Unrecorded<br /> toxins which instantly attach the heart, nervous system, and the skin cells.<br />
23. Symptoms<br />tentacles which inject the poison become sticky and adhere tightly to the skin<br />venom of box jellyfish has cardiotoxic, neurotoxic and highly dermatonecrotic components <br />
24. In oman<br />Batinah coast and far east like Sur<br /> Jun , July and August<br /> 75 cases were reported in koula hospital between 1991-1992<br /> mild – moderate cases , no death<br />
25. First aid<br /><ul><li> remove the victim from the sea
26. Immobilize the limbs
27. Apply generous amounts of vinegar( acetic acid) which will disables the box jelly's nematocysts that have not yet discharged into the bloodstream
28. Remove additional tentacles by a towel or gloved hand</li></li></ul><li>First aid<br /><ul><li> No scientific evidence that urine, ammonia, meat tenderizer, sodium bicarbonate, boric acid, lemon juice, freshwater, alcohol, cold packs, papaya, or hydrogen peroxide will disable further stinging
29. Pressure bandages or methylated spirits should Never be used</li></li></ul><li>First aid<br /><ul><li>Until the vinegar or acetic acid is available, a seawater rinse may be useful in an attempt to wash away any remaining nematocysts.
30. Ensure that the seawater is free of jellyfish or even fragments of tentacles because they remain toxic for months.
31. Nematocysts that remain adherent to the skin should not be rubbed with sand, scrubbed with a cloth, or vigorously washed.</li></li></ul><li>Medical treatment<br /><ul><li>Topical steroid creams and anesthetic creams may help relieve the pain and swelling.
32. Oral antihistamines and narcotics for pain control are occasionally warranted.
33. Antibiotics should be considered for vesicular lesions to prevent secondary infection.
34. Muscle spasms can be treated with 10 mL of calcium gluconate of a 10% solution intravenously .
35. Immediate medical attention may be required for severe reactions.</li></li></ul><li>Management<br /><ul><li> cardiac arrest occurs quickly, (CPR) can be life saving and takes priority over all other treatment options</li></li></ul><li>Prevention<br />
36. Bites<br />Sharks <br />Octopi<br />
37. Sharks<br />
38. Sharks<br />About 350 species of sharks, only 30 species could potentially be dangerous to humans and only 12 are reported potentially aggressive and dangerous<br />Most dangerous to human;<br /> - Great white <br /> -Tiger shark <br /> -Bull shark <br />
39. Symptoms & signs<br />Severe bleeding, injury to or excision of muscle & bone <br />
40. Treatment<br />Control any visible bleeding by applying direct pressure. Keep the victim calm.<br />Provide warmth, since the victim may be chilled from the water and may be suffering from hypothermia<br /> Transfer the pt. To the hospital<br />
42. Octopus<br /> - blue –ringed <br /> - bitten in upper extremities <br /> - modified salivary gland <br /> - venom into the wound <br /> - vasodilator and inhibitor of neuromuscular transmission <br />
43. Symptoms<br />initial bite is not painful<br /> weakness and numbness <br /> nausea and vomiting. <br />Severe envenomations may progress rapidly to generalised flaccid paralysis and respiratory failure<br />Death may occur in as little as thirty minutes.<br />
44. Treatmnet<br />Reassure the patient and encourage them to remain calm .<br />Pressure-immobilisation first aid is recommended <br />No antivenin<br />supportive <br />respiratory support is most important lifesaving intervention <br />
60. Cardiac arrhythmias & Collapse.</li></li></ul><li>treatment<br />For simple punctures, gently pull out any protruding spines.<br />Be careful,,,, almost always break off in the wound.<br />Neither urine nor vinegar dissolves such embedded spines<br />In most cases, the body either absorbs spine fragments in 24 hours to 3 weeks, or they work themselves out through the skin<br />
61. treatment<br />Most wounds heal in about one month.<br />spines have penetrated a joint or nerve, see a doctor<br />wound shows any sign of infection, such as redness, warmth, or pus formation.<br />Victims with generalized weakness, shortness of breath, and/or nausea and vomiting after a puncture should go directly to an emergency facility<br />
62. Cone shells<br /> Much more toxic than sea urchins<br /> Tubular gland connect to several teeth at the retractable proboscis<br /> venom conetinesevralprotiens ; <br /> - 3-indolyl derivatives which act on skeletal muscle & cause variably spastic and flaccid paralysis<br />
63. Cone shells<br /><ul><li>Symptoms
65. Nausea and general purities
67. slurred speech
71. respiratory arrest</li></li></ul><li>management<br />Pressure immobilisation<br /> -The extremity should be wrapped with a bandage<br /> Avoid movement.<br />CPR may be necessary. Artificial respiration may save the person's life<br />Do not cut into the wound, apply suction<br />no antivenom available<br />A tetanus and antibiotics injection <br />
72. Stingray<br />
73. Shallow, sandy areas to deep oceans<br />Tail with poisonous barb near base of body.<br />Sting are often broken or left in the wound<br />
74. Symptoms<br /> Lacerations & severe pain.<br /> Punctures in abdomen or chest are very serious.<br /> Anorexia, Nausea and vomiting.<br /> Diarrhea, increase micturition & salivation.<br /> Muscle cramping, tremor & tonic paralysis.<br /> Convulsions.<br /> Cardiac abnormalities to include asystole.<br /> Hypotension.<br /> Respiratory depression.<br /> Ulceration and necrosis & Infection.<br />
76. First aid<br />Lay the person down<br />If the person is vomiting, position the person on the side so they do not inhale vomit.<br />Stop the bleeding by applying direct pressure with a clean cloth or whatever is available such as a beach towel.<br />You may attempt to remove the stinger with tweezers to decrease toxinexposure if doing so will not cause further injury. Be careful not to injure yourself with the stinger.<br />
77. First aid<br />If there is no pain, then treat as a puncture wound or laceration by cleaning and disinfecting with soap and water. <br /> faintness or sweating (which indicate that venom has been absorbed into the body), arrange for transportation to a medical facility <br />
78. Medical treatment<br />Vital signs<br />Pain<br /><ul><li>placing the injured area in water as hot as the person can tolerate (113°F or 45°C) for 30-90 minutes
79. Pain medication, such as narcotics
80. Local anaesthesia </li></li></ul><li>treatment<br />Wound care;<br /><ul><li>cleans the wound, removes foreign matter, and looks for injuries to tendons, nerves, blood vessels, and other body structures
82. Antibiotics are usually given because the wound is contaminated with bacteria from the stinger and from the seawater
83. wound is left open, then closed with stitches a few days later if it has not become infected
84. , such as nerves, tendons, or arteries, are damaged, then a surgeon</li></li></ul><li>F/U<br />cleaning on a daily basis and then application of an antibiotic ointment and dressing. <br />If antibiotics are prescribed, take them as directed.<br />If your wound becomes infected, have it rechecked.<br />Keep any follow-up appointments that have been scheduled.<br />
85. Prevantion<br />When wading in shallow waters where stingrays may be, wear foot protection and shuffle your feet to scare away any resting rays<br />
89. Mangmnegt<br /><ul><li>Place a wide - pressure dressing over the bite, applying the same pressure as used for treating a sprain. The dressing should then extend proximally to distally.
90. Immobilize the limb.
91. Local excisions and suction should be avoided.
92. Monitor for any cardiac, pulmonary, renal, fluid, and electrolyte abnormalities.
93. If possible, the snake should be killed & obtained for identification.</li></li></ul><li>Treatmnet<br /><ul><li>Upon arrival to the treatment facility, the pressure dressing should be removed prior to administering antivenom.
94. Sea snake venom should be used cautiously & administered in strict accordance to guidelines.
95. Preparation for anaphylaxic shock should be immediately available.
96. If land snake antivenom is to be used, then the tiger snake type is preferred.
97. Victims should be hospitalized for 24 hours</li></li></ul><li>Bony fish<br /> Spines located in their fine<br /> Venom ;; severl classes of proteins most of which are heat labile<br /> Three Groups <br /> - Zebra fish<br /> - Scorpion fish <br /> - Stonefish<br />
98. Stonefish<br />
99. Stonefish<br />Glands at the base of their needle-like dorsal fin spines<br />Most venomous fish known<br />Exactly like an encrusted rock<br />Severity of the symptoms depends on the depth of penetration and the number of spines involved<br />
100. Stonefish<br />pain <br />Tremendous swelling rapidly develops with death of tissues<br />Muscle weakness<br /> Temporary paralysis <br /> Shock<br />
102. First AId<br />Remove pieces of spines<br /> encouraging bleeding might remove some venom<br />wash with water. Rest and elevate<br /> immerse wound in hot water (45 C or 113 F) for 30-90 minutes or until pain decreases<br />elevate and dress with something clean.<br />
103. Mangment<br />Local analgsia<br /> IV narcotic analgesia, local anaesthetic infiltration or regional block may be required<br />antivenom ;<br />1-the victim suffers from severe pain <br />2-systematic symptoms like weakness and paralysis are observed <br />3-there are multiple punctures, which indicate the discharge of several spines. This means that larger amount of venom has been injected.<br />
104. Important points<br /><ul><li> Three important Things in the management</li></ul>Remove the cause. <br /> Treat the effects. <br /> Prevent further complications. <br />
105. Important points <br /> Be prepared for cardiopulmonary collapse even in what appears to be a minor envenomation.<br /> Be prepared for anaphylactic reactions.<br /> When culturing wounds, 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.<br />
106. Important points<br /> consider antibiotics<br /> Tetanus injuction<br />