Jessica Kierath 1, Suzanne Rea 2, Fiona Wood 3
1 Burns Service of Western Australia, Fiona Stanley Hospital, 12 Australind Street, Swanbourne, WA 6010, firstname.lastname@example.org
2 Burns Service of Western Australia, Fiona Stanley Hospital, Murdoch, WA Fiona.Wood@heath.wa.gov.au
3 Burns Service of Western Australia, Fiona Stanley Hospital, Murdoch, WA Suzanne.Rea@health.wa.gov.au
Puncture injury and subsequent envenomation from a stingray barb results in extreme pain1,2. The venom is made up of enzymes, proteins, serotonergic and cholinergic substances and is heat labile2. The most common and effective treatment for the pain is hot water immersion therapy between 43.3° and 46.1°C2.
When administered correctly this treatment should not result in thermal injury.
3 case studies of individual patients who sustained burns to their lower limbs when receiving hot water immersion treatment of envenomation injury after a stingray puncture wound
Prolonged immersion of the injured area was reported with the relief of the pain by the immersion in hot water overwhelming the pain associated with burn injury.
No attention was given to regular testing the temperature with a non injured site.
All injuries were partial thickness injury which healed conservatively.
These cases highlight the need for caution when treating envenomation with hot water immersion. Strict continuous temperature measurement of the hot water bath must be maintained throughout the duration of the treatment. We would recommend that this treatment is done in a medical setting rather than administered by the patient at home.
Geoffrey K. Isbister. Venomous Fish Stings in Tropical Northern Australia. American Journal of Emergency Medicine. 2001. Volume 19, Number 7.
Clark, R et al. Stingray Envenomation: A Retrospective Review of Clinical Presentation and Treatment in 119 Cases. 2007. The Journal of Emergency Medicine, Vol. 33, No. 1, pp. 33–37
Jessica Kierath is a service registrar in plastic surgery at Royal Perth Hospital. She has burns experience as a registrar in Princess Margaret Hospital, Royal Perth Hospital and Fiona Stanley Hospital. She is also an instructor for the EMSB course.