Dr Danika Jurat1, Dr Douglas Copson1, Professor Fiona Wood1
1Fiona Stanley Hospital, Murdoch, Australia
Synanceia genus (stonefish) stings are infamous for the excruciating nature of the pain inflicted¹,². The most effective form of first aid is immersion in hot water¹,².
A 35 year old male was admitted to the State Burns Unit post immersion of his right foot in hot water after a Synanceia (stone fish) sting during a triathlon. First aid was administered onsite by a trained provider and at a regional hospital. It comprised of immersion in hot water of unknown temperature and pouring of hot water directly onto the site of envenomation. His burn was of deep partial thickness that required skin grafting whilst an inpatient.
Current guidelines for the first aid of fish sting envenomation include those by the Australian Resuscitation Council¹ (ARC) and St John Ambulance Australia² (SJAA). Both rely on the first aid provider dipping their periphery into the hot water briefly as a test of suitability for application to the injured patient¹,². ARC is non-time specific and SJAA is non-mechanism specific, suggesting either shower, immersion or a pour technique¹,².
This case and subsequent application of first aid raised several issues:
- Time and temperature of hot water required to deactivate the venom of the stonefish.
- Appropriate guidelines and subsequent application of first aid. The nature of a water scald burn injury requires a combination of time and temperature, with the recipient likely to be exposed to the hot water longer than the provider who self-tests the temperature.
Addressing these issues:
- A recent study published in Diving and Hyperbaric Medicine covered the varying nature of time and temperature required for deactivation; recommending 42.1°C for 20 minutes in cardiomyocytes post Synanceia horrida sting³. At 49°C it takes 10 minutes to cause full thickness burns of adult skin⁴. This leaves a small range for first aid management.
- Non specificity of the aforementioned guidelines highlights the need for further research on the issue and development of more clearly defined aids.
Danika Jurat is a resident medical officer working in the State Burns Unit of Western Australia at Fiona Stanley Hospital with a keen interest in Plastic Surgery, particularly burns.