Vertebrates

Etiology: Many marine vertebrates, including stingrays, scorpionfish (e.g., lionfish and stonefish), marine catfish, and horned venomous sharks are capable of envenomating humans.
Clinical features: depend on the offending fish
- - Stingrays: represent both an envenomation and a traumatic wound. The venom causes immediate, intense pain that may last up to 48 h. The wound often becomes ischemic and heals poorly. Systemic effects can include weakness, dysrhythmias, hypotension, paralysis, and rare deaths.
- - Stonefish: Because of the neuromuscular toxicity of the venom, stings may be life-threatening, and death may occur within 6-8 h. Local pain is immediate and intense and may last for days. Systemic effects are similar to those of stingray envenomations.

Treatment: Marine Vertebrate Envenomations

Immerse the affected part immediately in nonscalding hot water (113°F/45°C) for 30-90 min or until there is significant pain relief. Repeated hot-water therapy may help with recurrent pain.
Explore, debride, and vigorously irrigate the wound after local/regional anesthetics are given.
Antivenom is available for stonefish and serious scorpionfish envenomations. In the United States, contact the nearest regional poison control center for assistance.
Leave wounds to heal by secondary intention or to be treated by delayed primary closure.
Update tetanus immunization.
Consider empirical antibiotics to cover Staphylococcus and Streptococcus species for serious wounds or envenomations in immunocompromised hosts. Coverage should be broadened to include Vibrio species if the wound is primarily closed.