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Marine InjuryAka: Marine Envenomation, Marine Trauma, Marine Animal Bite

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  1. Causes of Marine Injury
    1. Marine envenomation
      1. See Neurotoxin
      2. Cnidaria
        1. Jellyfish
        2. Portuguese Man-Of-War
        3. Hard Coral
        4. Fire Coral
        5. Anemone
      3. Echinoderms
        1. Sea Urchins
        2. Starfish
      4. Stingrays (Chondrichthyes)
      5. Cottonmouth, water moccasin (Agkistrodon piscivorus)
      6. Sea Snake (Southeast Asia, Persian gulf, Malaysia)
      7. Octopus (Blue-ringed and spotted)
      8. Cone Shell (Australia, New Guinea, California)
      9. Scorpion Fish
      10. Sea Sponges (Touch-me-not and Fire sponge)
      11. Bristle worms (Fire Worms)
    2. Marine Animal Bites
      1. See Animal Bite
      2. Moray eel
      3. Barracudas
      4. Sharks
    3. Other trauma
      1. Abrasions or Lacerations from coral or sharp rocks
        1. Most common cause of marine injury
        2. High risk of infection
    4. Pruritus after water exposure
      1. See Aquagenic Pruritus
      2. Swimmer's Itch (Fresh water exposure)
      3. Seabather's Eruption (Salt water exposure)
        1. Type of Cnidaria envenomation
  2. Management: General Injury
    1. See specific marine organism for management
    2. Remove patient from water (do not remove wet suit)
    3. ABC Management with control of bleeding sites
    4. Identify cause of injury if possible
    5. Wound management
      1. Standard wound care
        1. See Wound
        2. See Wound Repair
        3. Copious irrigation
      2. Consider primary closure only if absolutely necessary
        1. Sutures should be loose enough to allow drainage
        2. Contraindication to suturing or closure
          1. Puncture Wound
          2. Crush injury
          3. Wound involving distal hands or feet
    6. Observe for signs of infection
      1. Most common bacterial organisms
        1. See Cellulitis
        2. Vibrio vulnificus (high risk of rapid progression)
      2. Treat Cellulitis early if observed
        1. Select antibiotics to cover Vibrio Cellulitis
      3. Prophylaxis is usually not indicated
  3. References
    1. Habif (1996) Dermatology, p. 491
    2. Jain (2003) Emerg Med Clin North Am 21(4):1117
    3. Perkins (2004) Am Fam Physician 69(4):885

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