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Sea Urchins, Stonefishes, Stingrays

Their Weapons:

Porcupines of the sea, urchin spines are like hypodermic needles that break off once deep inside you, injecting their venom. The venom from stonefish spines is delivered deep into the wound and produces excruciating pain that may last several days. Stingrays use one or more large spines or stings on their tails as defensive weapons. When you step on one, the ray thrusts its tail forward and upward, lacerating or puncturing your foot, ankle or leg.

Effects:

Mind-numbing, eye-watering pain, redness, swelling and bleeding. Multiple punctures can cause weakness, paralysis, breathing difficulty, even death.

Rx:

• If possible, elevate the affected area and apply a pressure bandage. Both techniques will help slow the absorption of any venom in the wound. Do not apply a tourniquet. This will generally result in more damage than it will prevent.
• Immerse the wound in 45C/115F water, or as hot as you can tolerate, for 30 to 90 minutes. Many marine toxins are proteins which are destroyed by heat, much like what happens to an egg when it's hard-boiled. A hot soak can dramatically reduce the pain, and amount of damage, caused by a sting.
• Control the pain. The pain from marine stings can be excruciating and lead to shock, making pain control an important early step in wound care. This can generally be done with local anesthetics, and very rarely will require the use of systemic pain relievers or narcotics.
• Cleanse the wound with an antiseptic solution. Washing out remaining venom and pieces of spine will help minimize damage, speed healing and prevent infection. Leave an inaccessible spine alone only if it hasn't penetrated a joint, nerve or blood vessel.
• Seek appropriate medical care. Despite doing all of the above, some wounds will require surgical cleansing and repair, antibiotics for infection control, as well as antivenins and life support for severe stings. It is not always immediately obvious which stings will need more intensive medical care, so if at all possible, get care for all stings.

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Coelenterates

Their Weapons:

Don't let the coy name fool you; these are nasty guys - stinging hydroids, fire coral (not a true coral) and jellyfish. Their weapons are nematocysts, stinging cells filled with venom and a coiled thread adorned with a barb at its business end. When triggered, the nematocyst fires and harpoons you with enough force to penetrate your skin and inject venom.

Effects:

Hydroids such as fire coral produce an immediate burning sensation followed within 30 minutes by an itchy rash that takes several days to heal. Jellyfish stings cause burning and leave a trail of bumps and welts. Serious jelly encounters can result in a severe burning sensastion, muscle spasms, vomiting, shock, even collapse.

Rx:

• Remove tentacles with a gloved hand or tweezers to keep from getting stung and then rinse thoroughly with salt water. Fresh water or rubbing will trigger unfired nematocysts.
• Deactivate remaining nematocysts with a 5 percent vinegar solution until the stinging stops. Use isopropyl alcohol if you don't have vinegar. Meat tenderizer also neutralizes venom - add some to the solution if you have it.
• Apply shaving cream and scrape skin with a razor to remove nematocysts. A paste of mud, flour or talc scraped with a dive knife or credit card also works.
• Dry the skin and apply hydrocortisone ointment and take a diphenhydramine preparation (like Benadryl) for mild allergic reactions.
• Keep the victim still to prevent venom from spreading, with the injured part elevated above the heart.
• Serious stings that result in life-threatening reactions like spasms, breathing difficulty and shock require emergency medical attention.

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Corals

Their Weapons:

Shame on you. Brushing against coral removes its protective mucous coating. Although the nematocysts of coral polyps can't do much damage to humans, they have other ways of paying you back: cuts and abrasions from the sharp points and razor edges of stony corals.

Effects:

Burning pain and itchy welts. This "reef rash" (a form of coral poisoning) can take up to six weeks to heal completely.

Rx:

• Scrub area with soap and water. Rinse stinging wounds with 5 percent vinegar solution or isopropyl alcohol.
• Apply hydrocortisone ointment.
• Get buoyant!

How to Keep From Getting Poked

Wetsuits provide only limited protection against one of the most dangerous classes of marine creatures - the "stickers." Spines of urchins and stonefish, for example, are capable of easily penetrating 6mm neoprene or a hard soled bootie.

Divers and snorkelers need to take several measures to minimize the risk of getting punctured.

Maintain proper buoyancy:

Buoyancy is a skill that has been increasingly stressed to divers in recent years, helping minimize damage to the reef, reducing air consumption, and dramatically lowering the risk of accidentally bumping into, or landing on, a creature that exacts its revenge. If you find it necessary to place a finger down to stabilize yourself for a picture, then make sure to look carefully first to ensure that it is clear of residents. Reef hooks are increasingly being used in areas with swift currents, such as Palau's Blue Corner, where they may serve to limit damage to both reef and diver.

Watch your step:

Approximately 1,500 people a year are injured by stingrays, while stonefish are the most poisonous of fishes. Contact with both of these bottom dwellers can be avoided with a little care. Divers should either avoid settling down on the bottom or fan their landing site gently with a fin to encourage any concealed critters to move elsewhere. People walking in shallow water where these fish are known to live should shuffle their feet as they walk. The vibrations will alert bottom dwellers ahead they should move away.

Don't handle marine life:

This may sound obvious, but a significant number of stings occur while trying to coax, entrap, play with or otherwise manipulate creatures with spines. Marine animals have evolved spines almost exclusively as a defensive measure. If you are a careful and considerate guest in their home, they can be observed without risk to you or them.

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Questions for Dr. Shelanski should be addressed to RSD, Dive Medicine, 6600 Abercorn St., Suite 208, Savannah, GA 31405; e-mail: RSDmgzn@aol.com.