Synanceia First Aid: The New Burn’s Risk?

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.

Case description:

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:

  1. Time and temperature of hot water required to deactivate the venom of the stonefish.
  2. 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:

  1. 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.
  2. 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.

Lithium battery explosions – A statewide NSW review 

Dr Jason Diab1, Dr Andrea Issler-Fisher1, Dr Justine O’Hara1 Dr Erik La Hei2, Dr Robert Gates3, Prof Peter Maitz1

1Concord Hospital, Concord, Australia, 2Westmead Children’s Hospital, Westmead, Australia, 3Royal North Shore Hospital, St Leonards, Australia



Since the increase of lithium battery devices such as electronic cigarettes and battery power banks, there has been a steady increase of reporting for burn injuries secondary to device malfunction. The nature of these devices result in partial thickness to full thickness injuries from chemical or flame burns. Our aim is to identify and classify epidemiological trends of explosions from lithium battery devices across New South Wales from all three major burn units.


A comprehensive literature review was conducted initially to understand the nature of these incidents followed by a review of the data across Westmead Children’s Hospital, Royal North Shore Hospital and Concord Hospital. A search was conducted using keywords such as lithium, e-cigarettes, battery and vaping to encapsulate the cohort. All patients whom suffered a burn secondary from a lithium battery device were included and data was extracted on mechanism of injury, severity of injury and management. A statistical analysis using SPSS assessed the relationship between linear data and correlation based on a level of significance set at p value of 0.05.


There were 26 patients whom presented to the burn units across New South Wales. The patients injuries ranged from partial thickness to full thickness injuries with flame burn being the most common type of injury. The majority of cases were males with most cases involving spontaneous explosions.


Lithium battery device explosions can result in chemical and flame burns that require a comprehensive assessment to exclude secondary injuries such as inhalation injury. The increasing global trend of e-cigarettes and battery power banks raises the importance of consumer awareness on safety regulation and potential risks associated with use. Nursing care and medical education on hazards associated with these devices and the risk for serious injury, particularly amongst the youth, should be considered early in assessment and care for patients.


Jason is a SRMO at Concord Burns Unit with an interest in public health epidemiology and prevention in burns.


ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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