HAZARDOUS MARINE CREATURE IN OMAN

DR.Salim AL-Jabri

R1

INTRODUCTION

2000 species are venomous or poisoning to human

Many can produce sever illness and fatilties Number of victims increase Most marine injure human with defence and

food –procuring devices

VENOUMS MARINE ANIMALS

Three main classes according to mechanism of venom delivery;

1- Nematocysts2- Bites3- Stings

1- NEMATOCYSTS large numbers ,,, so

grestest numbers of envenomation

E.g ; - Portuguese man-of-

war - True jellyfish - fire corals - stinging hydroids - sew wasp,,,

boxjellyfish - sea nettle &

anemones

NEMATOCYSTS

Many different types

Basic mechanism is

‘spring –loaded’ venom

gland

mechanical or chemical

stimulation

suddenly evert and

discharge structure that

penetrates the prey and

deliver venom through

connecting tube

NEMATOCYSTS

Animal’s tentacles Tentacles can be up to

100 feet in som egaint species

Can still function even after animale is dead or tentacles are seprated

stinging cell can remain active for weeks

may discharge later during attempted rescue and treatmnet

TOXICITY

o nematocysts continue; - various peptides, phospholipase A,

proteolytic enzymes, hemolytic enzymes, quaternary ammonium compounds, serotonin

o Severity of venomation related to sveral factors;

1- number of nematocysts 2- varies form species to species 3- victims autopharmacologic response to

the venom

SYMPTOMS

Stinging sensation immediately on contact.

Intensity increasing over 10 minutes. Erythema. Pruritus. Papules, vesicles, pustules & Necrotic

ulcers. Increase oral secretions. Gastrointestinal disturbance. Muscle spasm. Respiratory distress; and Cardiovascular

failure.

BOX JELLYFISH

is the most venomous creature to live under the sea

It has caused 5,567 recorded deaths since 1954,,,,, ? Unrecorded

toxins which instantly attach the heart, nervous system, and the skin cells.

SYMPTOMS

tentacles which inject the poison become sticky and adhere tightly to the skin

venom of box jellyfish has cardiotoxic, neurotoxic and highly dermatonecrotic components

IN OMAN

Batinah coast and far east like Sur Jun , July and August 75 cases were reported in koula hospital

between 1991-1992 mild – moderate cases , no death

FIRST AID

remove the victim from the sea Immobilize the limbs Apply generous amounts of vinegar( acetic

acid) which will disables the box jelly's nematocysts that have not yet discharged into the bloodstream

Remove additional tentacles by a towel or gloved hand

FIRST AID

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

Pressure bandages or methylated spirits should Never be used

FIRST AID

Until the vinegar or acetic acid is available, a seawater

rinse may be useful in an attempt to wash away any

remaining nematocysts.

Ensure that the seawater is free of jellyfish or even

fragments of tentacles because they remain toxic for

months.

Nematocysts that remain adherent to the skin should

not be rubbed with sand, scrubbed with a cloth, or

vigorously washed.

MEDICAL TREATMENT

Topical steroid creams and anesthetic creams may

help relieve the pain and swelling.

Oral antihistamines and narcotics for pain control

are occasionally warranted.

Antibiotics should be considered for vesicular

lesions to prevent secondary infection.

Muscle spasms can be treated with 10 mL of

calcium gluconate of a 10% solution intravenously .

Immediate medical attention may be required for

severe reactions.

MANAGEMENT

cardiac arrest occurs quickly, (CPR) can be life saving and takes priority over all other treatment options

PREVENTION

BITES

Sharks Octopi

SHARKS

SHARKS

About 350 species of sharks, only 30 species could potentially be dangerous to humans and only 12 are reported potentially aggressive and dangerous

Most dangerous to human; - Great white -Tiger shark -Bull shark

SYMPTOMS & SIGNS

Severe bleeding, injury to or excision of muscle & bone

TREATMENT

Control any visible bleeding by applying direct pressure. Keep the victim calm.

Provide warmth, since the victim may be chilled from the water and may be suffering from hypothermia

Transfer the pt. To the hospital

OCTOPUS

- blue –ringed - bitten in upper

extremities - modified salivary

gland - venom into the

wound - vasodilator and

inhibitor of neuromuscular transmission

SYMPTOMS

initial bite is not painful weakness and numbness nausea and vomiting. Severe envenomations may progress rapidly

to generalised flaccid paralysis and respiratory failure

Death may occur in as little as thirty minutes.

TREATMNET

Reassure the patient and encourage them to remain calm .

Pressure-immobilisation first aid is recommended

No antivenin supportive respiratory support is most important

lifesaving intervention

3- STING

Puncture victim’s skin and introduce venom sea urchins cone shells bristal warm sea snakes stingrays scorpion fish Catfish

SEA URCHINS

Long, extremely brittle spines.

SEA URCHINS

Throbbing pain.

Purplish discoloration.

Edema and swelling.

Partial paralysis of a limb.

Facial swelling.

Muscle spasm.

Dyspnea.

Weakness.

Cardiac arrhythmias &

Collapse.

TREATMENT

For simple punctures, gently pull out any protruding spines.

Be careful,,,, almost always break off in the wound.

Neither urine nor vinegar dissolves such embedded spines

In most cases, the body either absorbs spine fragments in 24 hours to 3 weeks, or they work themselves out through the skin

TREATMENT

Most wounds heal in about one month. spines have penetrated a joint or nerve, see a

doctor wound shows any sign of infection, such as

redness, warmth, or pus formation. Victims with generalized weakness, shortness

of breath, and/or nausea and vomiting after a puncture should go directly to an emergency facility

CONE SHELLS

Much more toxic than sea urchins

Tubular gland connect to several teeth at the retractable proboscis

venom conetine sevral protiens ;

- 3-indolyl derivatives which act on skeletal muscle & cause variably spastic and flaccid paralysis

CONE SHELLS

Symptoms pain Nausea and general purities diplopia slurred speech numbness weakness Paralysis respiratory arrest

MANAGEMENT

Pressure immobilisation -The extremity should be wrapped with a

bandage Avoid movement. CPR may be necessary. Artificial respiration

may save the person's life Do not cut into the wound, apply suction no antivenom available A tetanus and antibiotics injection

STINGRAY

Shallow, sandy areas to deep oceans

Tail with poisonous barb near base of body.

Sting are often broken or left in the wound

SYMPTOMS

Lacerations & severe pain.

Punctures in abdomen or chest are very

serious.

Anorexia, Nausea and vomiting.

Diarrhea, increase micturition & salivation.

Muscle cramping, tremor & tonic paralysis.

Convulsions.

Cardiac abnormalities to include asystole.

Hypotension.

Respiratory depression.

Ulceration and necrosis & Infection.

FIRST AID

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.

FIRST AID

If there is no pain, then treat as a puncture wound or laceration by cleaning and disinfecting with soap and water.

faintness or sweating (which indicate that venom has been absorbed into the body), arrange for transportation to a medical facility

MEDICAL TREATMENT

Vital signs Pain- placing the injured area in water as hot as

the person can tolerate (113°F or 45°C) for 30-90 minutes

- Pain medication, such as narcotics- Local anaesthesia

TREATMENT Wound care;

- cleans the wound, removes foreign matter, and looks for injuries to tendons, nerves, blood vessels, and other body structures

- Tetanus- Antibiotics are usually given because the

wound is contaminated with bacteria from the stinger and from the seawater

- wound is left open, then closed with stitches a few days later if it has not become infected

- , such as nerves, tendons, or arteries, are damaged, then a surgeon

F/U

cleaning on a daily basis 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.

PREVANTION

When wading in shallow waters where stingrays may be, wear foot protection and shuffle your feet to scare away any resting rays

SEA SNAKES

SYMPTOMS

Mild Euphoria. Anxiety. Restlessness. Thirst. Swelling of tongue. Nausea & vomiting. Weakness. Stiffness & Muscle ache

Severe

Paralysis (ascending or spreading from bite).

Trismus. Ptosis. Facial & ocular palsies. Speech & swallowing

pathology. Respiratory distress. Cardiac failure. Convulsions. Coma.

MANGMNEGT

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.

Immobilize the limb.

Local excisions and suction should be avoided.

Monitor for any cardiac, pulmonary, renal, fluid, and

electrolyte abnormalities.

If possible, the snake should be killed & obtained for

identification.

TREATMNET

Upon arrival to the treatment facility, the pressure

dressing should be removed prior to administering

antivenom.

Sea snake venom should be used cautiously &

administered in strict accordance to guidelines.

Preparation for anaphylaxic shock should be

immediately available.

If land snake antivenom is to be used, then the tiger

snake type is preferred.

Victims should be hospitalized for 24 hours

BONY FISH

Spines located in their fine Venom ;; severl classes of proteins most of

which are heat labile Three Groups - Zebra fish - Scorpion fish - Stonefish

STONEFISH

STONEFISH

Glands at the base of their needle-like dorsal fin spines

Most venomous fish known Exactly like an encrusted rock Severity of the symptoms depends on the

depth of penetration and the number of spines involved

STONEFISH

pain Tremendous swelling rapidly develops with

death of tissues Muscle weakness Temporary paralysis Shock

FIRST AID

Remove pieces of spines encouraging bleeding might remove some

venom wash with water. Rest and elevate immerse wound in hot water (45 C or 113 F)

for 30-90 minutes or until pain decreases elevate and dress with something clean.

MANGMENT

Local analgsia IV narcotic analgesia, local anaesthetic

infiltration or regional block may be required antivenom ;1-the victim suffers from severe pain 2-systematic symptoms like weakness and

paralysis are observed 3-there are multiple punctures, which indicate

the discharge of several spines. This means that larger amount of venom has been injected.

IMPORTANT POINTS

Three important Things in the management Remove the cause. Treat the effects. Prevent further complications.

IMPORTANT POINTS

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

Be prepared for anaphylactic reactions.

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.

IMPORTANT POINTS

consider antibiotics Tetanus injuction

THANKS