Stingrays and skates
Marine envenomations in the United States and worldwide include those from stingrays and skates. Calls have come into the Philadelphia PCC during the summer months involving injuries inflicted from people accidentally stepping on the stingray or being slashed by the tail. The three most common stingrays are the round stingray, Urolophus halleri, found along the Pacific coast from California to Panama; the blunt-nosed stingray, Dasyatis sayi, found along the eastern Atlantic coast of North, Central, and South America and the spotted eagle ray, Aetobatus narinari, found throughout the tropical waters from the Atlantic to the Pacific.4
When stepped on, the ray strikes upward and drives the spine deeply into foot or leg. As the stinger enters the flesh, the integumentary sheath surrounding the spine is ruptured and the venom escapes into the victim's tissues.5 Stingray venom is one of the most powerful vasoconstrictors found among the natural toxins. It is primarily made up of protein and the extracts contain serotonin and enzymes such as 5’-neucleotidase and phosphodiesterase.4
The venom from a stingray can cause severe pain from six to 48 hours, with the greatest intensity of the pain within 30 to 60 minutes. Systemic effects of the venom can cause cardiovascular effects such as coronary artery spasm, hypotension, syncope and peripheral vasoconstriction.4, 5 It can also cause arrhythmia, respiratory distress, sweating, nausea, vomiting, weakness and abdominal pain.5 Treatment includes care of the wound, relief of pain, hot water immersion, observation and hospitalization in severe cases. Continuous hot water immersion of the wound for 60 minutes is recommended for relief of pain and is considered the standard of care. Tetanus prophylaxis and antibiotic coverage is usually required because these wounds are prone to infection.4