Bites
Reptiles
- A.
Snakes
- 1.
Overview: Snake venom often has both hemotoxic and neurotoxic properties, but one usually predominates over another according to the species. Of all snakebites, 25% to 50% are “dry bites” and cause no envenomation. , Children tend to have more severe envenomations because of the dose of venom relative to weight and body surface area. The antivenin dose is the same for children and adults. Be cognizant of the quantity of fluids used in administration of antivenin to children (typical initial pediatric fluid bolus is 20 mL/kg). ,
- a.
Universal care of bites:
- i.
Monitor airway, breathing, circulation (ABCs) and provide supportive care (i.e., pain control, fluids, anxiolytics, etc.).
- ii.
Assess for progression of swelling or symptoms (remove all restrictive clothing immediately).
- iii.
Do not suction wound, tourniquet, incise, place ice packs, or provide electric shock.
- iv.
Do limit activity such as walking to a minimum if possible and immobilize the affected area.
- v.
Evacuate to the nearest hospital as soon as possible (preferably one with antivenin).
- vi.
Do not risk further envenomation to identify snake species.
- vii.
Do not hesitate to consult Poison Control or a toxicologist for guidance.
Specific signs and symptoms and treatments based on species will be discussed below.
- i.
- a.
- 2.
Crotalidae (pit vipers, i.e., water moccasin, rattlesnake, copperhead, bushmaster, lanceheads, temple vipers, jumping vipers)
- a.
Found in parts of Europe and Asia and both North and South America
- b.
Identified by slit-like pupils, triangular head, and a “pit” located behind the nose
- c.
Hemotoxic effects, and swelling/localized pain is marked
- d.
Elevate extremity and monitor compartment pressures (fasciotomies in snake bites are controversial and should only be undertaken in extreme circumstances or in consultation with a surgeon)
- e.
ABCs, intravenous (IV) access, monitor
- f.
Severity of envenomation is graded based on six areas: respiratory, cardiovascular, local wound, hematologic, gastrointestinal, central nervous system. The severity and quantity of symptoms are a direct correlation with need for antivenin (i.e., a minimal score correlates with few symptoms and does not require treatment but a moderate to severe score correlates with significant symptoms and lab derangements and needs antivenin).
- g.
Laboratory tests (Complete blood count [CBC], Comprehensive metabolic panel [CMP], Creatine phosphokinase [CPK], coagulation studies, etc.)
- h.
Administer specific or polyvalent antivenin (Crotalidae Polyvalent Immune Fab or FabAV) as soon as possible preferably within 6 hours (FabAv is known in the US by the registered name CroFab )
- i.
FabAV administration is 4 to 6 vials in 250 mLs of normal saline IV over 1 hour.
- ii.
Monitor closely for allergic or anaphylaxis symptoms.
- iii.
Repeat 4 to 6 vials/dose IV until localized swelling halts progression and/or coagulation tests normalize.
- iv.
Patient may need 2 vials IV q 6 hours for 18+ hours.
- i.
- i.
Other antivenins exist and have specific administration instructions (follow instructions on the packaging insert).
- j.
There is a risk of immediate hypersensitivity (anaphylaxis occurs within minutes to hours) and delayed hypersensitivity (serum sickness occurs from 1 to 12 days; mean 7 days) with antivenin (total risk ∼15%).
- i.
Overall rare events and should not preclude lifesaving intervention
- ii.
Pretreatment with antihistamines or steroids has no benefit.
- iii.
Skin testing of antivenin is not recommended before administration.
- i.
- a.
- 3.
Elapidae (i.e., coral snakes, kraits, cobras, mambas, asps)
- a.
Found in most tropical and subtropical regions of the world except Europe
- b.
Typically identified by long/slender bodies with smooth scales, round pupils, and heads that seem indistinct from the rest of the body
- c.
Primarily neurotoxic effects with local necrosis
- d.
More insidious symptom onset than with the Crotalidae species
- e.
Paralysis is the most deadly feature and usually begins with ptosis and then progresses to eventually involve muscles of respiration leading to death if no intervention.
- f.
ABCs, IV access, monitor, and supportive care
- g.
Antivenin if available and signs of severe systemic symptoms (can survive with supportive care alone with adequate respiratory support)
- h.
Anticholinesterase drugs have been used successfully to aid treatment of elapids snake bites as neurotoxic symptoms closely resemble myasthenia gravis.
- i.
Pretreat with glycopyrrolate 0.1 mg IV or atropine 0.6 mg IV
- j.
Neostigmine 0.5–2.5 mg IV q 1 hour or as a continuous infusion (based on symptom severity)
- a.
- 4.
Hydrophilidae: sea snakes
- a.
Neurotoxic and myotoxic
- b.
Generalized myalgias: can be severe and last for months if untreated
- c.
Myotoxic effects include the release of myoglobin and potassium resulting in renal failure or life-threatening potassium levels.
- d.
May require ventilator support
- e.
ABCs, IV access, monitor, and supportive care
- f.
Antivenin if available and severe symptoms
Note that Antivenin has some risk of anaphylaxis or severe reactions. Weigh the risk versus benefit carefully in each patient. Anaphylaxis is not a reason to terminate treatment as the antivenin is the antidote needed for resolution. Slow the infusion and treat symptoms of anaphylaxis and shock appropriately.
- a.
- 1.
- B.
Lizards
Most lizards produce localized pain and swelling only. The Gila Monster Lizard and the closely related Mexican Beaded Lizard can cause systemic symptoms such as nausea, vomiting, sweating, fever, generalized weakness, and even some difficulty breathing but rarely death.
- 1.
Monitor lizards
- a.
Native to Africa, Asia, and the Indo-Pacific regions but can now be found all over the world as pets
- b.
Size ranges from 20 cm to 3 m (7.9 in to 10 ft)
- c.
Can be aggressive if provoked
- d.
No antivenin exists. Symptomatic care only. See later
- a.
- 2.
Komodo dragons
- a.
Native to Indonesia
- b.
Can grow to sizes of up to 3 m or 10 ft
- c.
Some reported fatalities but usually caused by injuries/trauma and not because of envenomations
- d.
No antivenin exists. Symptomatic care only.
- a.
- 3.
Gila Monster
- a.
Found in the Southwestern United States and Northern Mexico
- b.
Size approaches 60 cm or 2 ft
- c.
Does produce a potent neurotoxic venom but only small amounts are excreted during a bite and therefore very rarely fatal
- d.
Symptomatic care. No antivenin available.
- a.
- 4.
Mexican Beaded Lizard
- a.
Native to Mexico and Guatemala
- b.
Adults range from 57 to 91 cm (22–36 in)
- c.
Venom is hemotoxic in nature and therefore coagulation studies should be followed to resolution.
- d.
Symptomatic care only. No antivenin.
- a.
- 5.
Prehospital care
- a.
Many lizards are known for clamping onto the victim with great force and not letting go.
- b.
It is important to try to pry the animal away without causing more damage to the victim.
- c.
Techniques include using a stick or a metal bar to pry the animal’s mouth open and away from the victim.
- d.
After the lizard is removed, bandage the area if bleeding and monitor ABCs.
- e.
Do not tourniquet or try to suction the wound.
- a.
- 6.
Signs and symptoms
- a.
Mostly local pain and swelling
- b.
Can have systemic symptoms such as nausea, vomiting, lightheadedness, hypertension, and rarely breathing difficulty
- a.
- 7.
Treatment
- a.
No commercially available antivenin exists
- b.
Supportive care
- c.
IV, monitor, ABCs
- d.
Local wound care
- e.
Monitor for signs of infection
- f.
Antibiotics (amoxicillin/clavulanate 875 mg twice a day for 7–10 days or clindamycin 300 mg four times a day for 7–10 days or doxycycline 100 mg twice a day for 7–10 days) reserved for secondary infection or high-risk wounds (highly contaminated wounds, neurovascular compromise, deep penetrating wounds [especially in distal extremities], associated cellulitis, significant medical comorbidities such as diabetes, delayed presentation of >12 hours for extremity wounds or >24 hours on the face, or an immunocompromised state).
- g.
Remove foreign bodies; x-rays or ultrasound may aide in the identification of foreign bodies (i.e., teeth, dirt, and debris).
- a.
- 1.
- C.
Crocodiles and Alligators
- 1.
Technically classified in separate biological families but will be discussed together as the medical treatment remains the same
- 2.
Found in warm wet climates of the Americas, Africa, Asia, and Australia
- 3.
Can be aggressive and are responsible for many human deaths every year
- 4.
Bites can cause significant trauma and death is usually secondary to wounds or blood loss.
- 5.
Treatment should focus on the following:
- a.
Supportive care to include trauma resuscitation
- b.
IV, monitor, ABCs
- c.
Local wound care for minor bites or scratches
- d.
Remove foreign bodies; x-rays or ultrasound may aide in the identification of foreign bodies (i.e., teeth, dirt, and debris)
- e.
Routine antibiotics are not warranted but can be considered for secondary infection, someone who will not have follow-up care, or high-risk wounds (highly contaminated wounds, neurovascular compromise, deep penetrating wounds [especially in distal extremities], associated cellulitis, significant medical comorbidities such as diabetes, delayed presentation of >12 hours for extremity wounds or >24 hours on the face, or an immunocompromised state).
- f.
Antibiotics could include the following: amoxicillin/clavulanate 875 mg twice a day for 7–10 days or clindamycin 300 mg four times a day for 7–10 days or doxycycline 100 mg twice a day for 7-10 days.
- a.
- 1.
Spiders
- A.
Widow Spiders ( Lactrodectus species): most common is the black widow spider of North America but also includes the Australian red-back spider, the brown widow spider, and the “button” spider of South America
- 1.
Found in every continent except Antarctica and other areas prone to extreme hot or cold climates (high concentration in North America and Australia)
- 2.
Typically found in dark spaces close to the ground such as wood piles, sheds, and cluttered basements/garages
- 3.
Classic appearance of North American female black widow spider is a black spider with red “hourglass” on abdomen
- 4.
Venom can cause symptoms ranging from mild local pain to severe generalized muscle pain, abdominal cramping, vomiting, headache, and abnormal vital signs.
- 5.
Symptomatic care should include ABCs, monitor, updated tetanus, and pain control.
- 6.
There is an antivenin available, but given the risk of anaphylaxis or other adverse outcomes, the risk versus benefits should be weighed and discussed with patient before administration.
- 7.
Envenomation is rarely fatal and therefore antivenin is justified only for severe symptoms.
- 8.
Narcotic pain medications as well as benzodiazepines are helpful (i.e., morphine 0.1 mg/kg IV q 2 hours; hydrocodone/Tylenol 5/325 mg 1–2 tabs PO q 4–6 hours; diazepam 2–10 mg IV q 4 hours or diazepam 5 mg PO q 8 hours).
- 9.
Calcium gluconate is not beneficial.
- 10.
Antibiotics not necessary
- 1.
- B.
Brown Recluse ( Loxosceles reclusa )
- 1.
Small brown spider with dark brown “fiddle” or “violin” on back
- 2.
Typically found in the Central to Southeastern United States and discovered in undisturbed locations like sheds, wood piles, basement corners, closets, and so on.
- 3.
Bite causes minimal pain initially progressing to severe pain from about 2 to 8 hours after bite.
- 4.
Most bites require no treatment, but a small percentage can become necrotic.
- 5.
Necrosis leads to ulceration which can progress over several days.
- 6.
Eventually the lesion heals with secondary intention, with minimal to no scarring most of the time.
- 7.
Systemic effects include malaise, nausea, and fevers.
- 8.
Rarely do life-threatening conditions such as disseminated intravascular coagulopathy, renal failure, rhabdomyolysis, angioedema, or death occur.
- 9.
Supportive care to include monitor, pain medication, local wound care, and tetanus is usually sufficient. Antibiotics are usually reserved for superimposed bacterial infections only.
- 10.
Concern for systemic involvement should prompt laboratory studies to evaluate for renal function, hemolysis, and rhabdomyolysis.
- 11.
Various other treatments have been suggested with varying but limited success. These include such treatments as: steroids, dapsone, surgical debridement, antibiotics, nitroglycerin patches, and colchicine. Owing to lack of good evidence, these therapies are not routinely recommended outside of expert consultation.
- 1.
Mammals
- A.
Cautions/Special Considerations
- 1.
Bites on extremities (especially hands and feet) have a higher risk of infection.
- 2.
Wound cultures are not necessary for noninfected wounds.
- 3.
X-rays to assess for foreign bodies (ultrasound can also be helpful)
- 4.
Perform full range of motion of the injured area to assess for hidden injuries.
- 5.
Pasteurella multocida , Capnocytophaga , anaerobes, Staphylococcus species, and Streptococcus species are the most common bacteria isolated from mammalian bite wounds.
- 6.
Most common wounds are from dogs and cats. Dog bites tend to have crushed/macerated tissue, whereas cat bites can look inconspicuous but tend to have deep seed bacteria leading to higher rate of infection, complications, and delayed diagnosis.
- 7.
Rabies is nearly 100% fatal if contracted (most have saliva contact on broken skin or mucous membranes, scratches, or bites to transmit rabies).
- 8.
The wild animals typically associated with rabies are foxes, bats, raccoons, skunks, and coyotes.
- 9.
Bat contact or questionable exposure warrants rabies vaccination/rabies immunoglobulin.
- 10.
High-risk wounds include crush injuries, puncture wounds, bites of the hands and feet, cat and human bites, greater than 12 hours since bite (or 24 hours on the face).
- 1.
- B.
Management/Treatment
- 1.
Clean wounds with povidone iodine or benzalkonium solution along with pressure irrigation.
- 2.
Update tetanus as necessary.
- 3.
If patient has not completed the initial tetanus vaccine series (a three-shot series typically completed as a child in the form of the DTaP vaccination) then a tetanus vaccination and tetanus immunoglobulin (TIG; 500 units IM) should be given. The tetanus immunoglobulin should be partially administered at the wound site and the rest administered at a different site than the tetanus vaccination (TDAP or TD 0.5 mL IM).
- 4.
Prophylactic antibiotics (amoxicillin/clavulanate 875 mg twice a day for 7–10 days or clindamycin 300 mg four times a day for 7–10 days or doxycycline 100 mg twice a day for 7–10 days) are controversial and therefore should only be used for high-risk wounds such as highly contaminated wounds, neurovascular compromise, deep penetrating wounds (especially in distal extremities), associated cellulitis, significant medical comorbidities such as diabetes, delayed presentation of more than 12 hours for extremity wounds or more than 24 hours on the face, or an immunocompromised state.
- 5.
Most wounds will/should heal by secondary intention because of the risk of a deep seeded infection worsening in a closed wound. (Do not use tissue adhesives for this reason.)
- 6.
Rabies vaccine can be given prophylactically in a three-shot series before traveling to a high-risk area or in a four-shot series in conjunction with human rabies immune globulin (HRIG) after potential rabies exposure.
- a.
IM vaccination given on day of exposure (day 0) and then days 3, 7, and 14 after exposure (if immunocompromised then another vaccination is given on day 28 and preexposure prophylaxis series is day 0, 7, and 21 or 28. Booster doses based on rabies antibody titer level every 2 years.
- b.
If a previously vaccinated person is exposed to rabies then the postexposure prophylaxis is given on day 0 and 3.
- c.
Vaccine should be given as soon as possible after the incident and is still effective even if started several days after exposure.
- i.
HRIG is given for high-risk wounds or exposures (i.e., rabies endemic area, unprovoked animal attacks, bizarre animal behavior, unknown vaccination status of animal, etc.) to those who have not been previously vaccinated against rabies.
- ii.
Dose is 20 units/kg IM.
- iii.
Infiltrate as much as possible around the wound/bite.
- iv.
The rest of the HRIG is given at the most proximal site away from the wound.
- v.
Never give the rabies vaccine and HRIG in the same location.
- vi.
Previously vaccinated persons should not receive HRIG even if previous vaccination was some years ago.
- i.
- a.
- 1.
Stings
- A.
Insects
- 1.
Hymenoptera (bees, wasps, hornets, yellow jackets, ants, etc.)
- a.
ABCs, IV access, monitor
- b.
Remove stinger/venom sac if present (use a dull edge such as a credit card to scrape along the skin)
- c.
Supportive care to include: ice to the affected area, elevation to limit swelling, pain medication, antihistamine administration, and update tetanus
- d.
Severe cases (anaphylaxis) may include hives, tongue/lip swelling, wheezing, decreased level of consciousness, hypotension, throat swelling, and so on.
- i.
Epinephrine IM initially but may need IV doses/infusion (epinephrine 1:1000 0.01 mg/kg IM, maximum dose of 0.5 mg; IV infusion of 0.1–1 mcg/kg per minute titrated to effect)
- ii.
H1 and H2 blockers (i.e., diphenhydramine 25–50 mg IV; ranitidine 50 mg IV)
- iii.
Steroids (i.e., methylprednisolone 1–2 mg/kg per day IV)
- iv.
Monitor/manage airway (do not hesitate to intubate early in anaphylaxis to protect the airway)
- v.
Bronchodilators as needed for wheezing and respiratory distress (i.e., albuterol 2.5–5 mg nebulized or continuous nebulizer treatment if severe)
- i.
- a.
- 2.
Centipede, millipede, caterpillar
- a.
Rarely, if ever, fatal
- b.
Symptomatic care is usually sufficient (ice, pain medication, antihistamines, steroid creams, etc.).
- c.
Centipede bites can be as painful as a bee sting.
- d.
Millipede secretions can be irritating, especially if rubbed into eyes (flush eyes frequently if this occurs).
- e.
Caterpillars: irritating hairs usually with localized symptoms (can attempt to remove hairs with tape for symptom relief but not required)
- f.
Anaphylaxis is very rare but potentially fatal (treat appropriately; see Hymenoptera for explanation of anaphylaxis treatment).
- a.
- 1.
- B.
Scorpions: Deathstalker, Fat-tail, Emperor, Indian Red, and Blue Scorpions
- 1.
Found in every continent except Antarctica but typically prefer habitats between 68°F and 99°F (20°C–37°C)
- 2.
Nocturnal creatures that can be found using ultraviolet “black lights” owing to fluorescent chemicals within the cuticle portion of the exoskeleton
- 3.
Can be aggressive if provoked
- 4.
Signs and symptoms of envenomation
- a.
Neurotoxic venom
- b.
Can be fatal
- c.
Bites graded on a scale of I to IV
- i.
Grade I: local pain and paresthesias
- ii.
Grade II: local and remote pain and paresthesias
- iii.
Grade III: cranial nerve dysfunction (dysphagia, drooling, abnormal eye movements, slurred speech, etc.) or somatic skeletal muscular dysfunction (muscle fasciculations, jerking of extremities, restlessness, etc.)
- iv.
Grade IV: cranial nerve and skeletal muscle symptoms. Also can have hyperthermia, rhabdomyolysis, wheezing, bronchospasm, respiratory failure.
- i.
- d.
Children have more severe symptoms because of venom versus body surface area ratio (can see pathologic hypertension from adrenergic release).
- a.
- 5.
Management and treatment
- a.
ABCs, monitor, tetanus, labs generally reserved for grade III to IV envenomations, supportive care
- b.
Pain control: depending on severity of symptoms
- i.
Oral pain control for minor symptoms
- ii.
If using IV narcotics, use short-acting forms such as fentanyl (0.5–2 mcg/kg IV) owing to less histamine release.
- iii.
Severe extremity stings can be managed with a regional block.
- iv.
Benzodiazepines (i.e., diazepam 2–10 mg IV) for pain/muscle spasm (caution when using antivenin as the patient may become oversedated once the symptoms of envenomation are subsiding)
- i.
- c.
Antivenin
- i.
Only suggested for grade III or IV envenomations
- ii.
Several different types and manufacturers (check local resources)
- iii.
Give in conjunction with poison control if available (In the United States call 1(800) 222-1222.)
- iv.
Some risk of anaphylaxis: risk versus benefit and prepare for complications
- v.
Children require the same amount of antivenin as the envenomation is the same amount (caution with the amount of fluid used for children).
- vi.
Centruroides species antivenin most commonly used in the United States and Mexico
- vii.
Administer two to three vials in 50 mL of normal saline IV over 10 minutes.
- viii.
Continue to give single vials diluted in normal saline solution every 30 to 60 minutes for up to five doses or until resolution of symptoms. (Each dose is administered over 10 minutes.)
- i.
- a.
- 1.
Marine Envenomations
General treatments include tetanus, hot water bath (40°C–45°C), and removing all foreign bodies. Antibiotics are reserved for infection or high-risk wounds (i.e., ciprofloxacin, doxycycline, trimethoprim/sulfamethoxazole). Coverage should include Vibrio species as well as typical Staphylococcus and Streptococcus species.
- A.
Coelenterates (Portuguese Man-of-War, Jellyfish, Box-Jellyfish, Coral, and Anemones)
- 1.
Hot water bath (40°C–45°C) for 30 to 60 minutes to relieve pain
- 2.
Jellyfish stings should be rinsed with 5% acetic acid (vinegar) or isopropyl alcohol 40% to 70% (do not rub area or rinse with fresh water as this will cause nematocysts to discharge and worsen symptoms).
- 3.
Lacerations caused by coral are prone to infection.
- 4.
Only supportive care unless infected
- 5.
Update tetanus if necessary (tetanus toxoid TD 0.5 mL IM)
- 6.
The Box-Jellyfish or Sea Wasp ( Chironex fleckeri ) sting is deadly
- a.
Most deadly species found in the Indo-Pacific region but subspecies have been found in the Atlantic Ocean and Mediterranean Sea.
- b.
They are nearly transparent and have a characteristic box shape measuring up to 20 cm (7.9 in) each side and long tentacles measuring up to 3 m (9.8 ft).
- c.
Can cause respiratory paralysis, shock, muscle spasm, and death within 2 to 5 minutes in severe envenomations
- d.
Envenomation causes death by allowing large amounts of potassium to leak from cells leading to cardiovascular collapse.
- e.
ABCs, monitor, respiratory support, tetanus
- f.
Acetic acid 5% immediately to wound before removal of tentacles to neutralize nematocysts
- g.
An antivenin does exist and should be given rapidly to increase chance of survival.
- h.
Antivenin dose and administration is one ampule (20,000 units) diluted in 20 cc of normal saline given IV over 20 minutes or give three ampules IM once (at three different sites). Repeat IV doses until symptoms improve or maximum dose of 60,000 units achieved.
- a.
- 1.
- B.
Echinoderms (Starfish, Sea Urchins, and Sea Cucumbers)
- 1.
Hot water immersion provides good pain relief (40°C–45°C or 104°F–113°F).
- 2.
Local anesthetic or even regional nerve blocks may be needed in severe pain.
- 3.
Remove all retained foreign bodies (x-ray or ultrasound may help in diagnosis).
- 4.
Symptomatic care
- 5.
Local irritation can be treated with steroid creams or calamine lotion.
- 6.
Sea cucumber stings may benefit from acetic acid 5% or isopropyl alcohol 40% to 70%.
- 1.
- C.
Vertebrates (Stonefish, Catfish, Stingrays, Lionfish, Weever Fish, etc.)
- 1.
Hot water baths seem to help with pain (temperatures around 45°C or 113°F or as hot as can be reasonably tolerated by the patient).
- 2.
Remove all foreign bodies (the barbs of stingrays can be particularly difficult to remove and sometimes require surgical removal if indicated by location or predicted difficult of removal).
- 3.
There are some rare cases of death from penetrating stingray stings.
- 4.
Most vertebrates only cause local pain and swelling.
- 5.
Antibiotics are reserved for secondary infections or high-risk wounds such as a deep penetrating wound (especially on the distal extremities), immunocompromised host, very dirty wounds, and so on.
- 6.
Allow wounds to heal by secondary intention because of the risk of closing a wound in an area with potentially deep seeded bacteria.
- 7.
Antivenin only exists for stonefish envenomations and is only used in severe cases such as respiratory distress, severe pain, cardiovascular compromise, and so on.
- a.
Antivenin developed to specifically combat the neurotoxic effects
- b.
Dose is one ampule IM per two barbs puncture wounds with maximum administration of three ampules IM total.
- c.
No absolute contraindications for administration but monitor closely for signs and symptoms of anaphylaxis
- a.
- 1.
- D.
Mollusks (Blue-Ringed Octopus, Cone Snail)
- 1.
Cone snails
- a.
Typically found in the Indo-Pacific but have been identified off the coast of California, South Africa, and the Mediterranean region.
- b.
Snails inhabit beautifully decorated shells, which can be problematic as people try to collect the shells.
- c.
The snails inject a neurotoxic venom in defense or when hunting other sea creatures.
- d.
No antivenin exists.
- e.
Treatment revolves around symptomatic care and early ventilatory support. Even in severe envenomations, chances of survival are good with proper respiratory care.
- f.
The venom also has some anticoagulant properties and therefore coagulation studies should be checked and followed until resolution.
- a.
- 2.
Blue-ringed octopus
- a.
Typically found in the coral reefs and tidal pools of the Indo-Pacific region of the world
- b.
Only 12 to 20 cm (5–8 inches) in length and characterized by multiple blue rings on the body which flash as a warning to intruders when the octopus is provoked
- c.
Envenomations are extremely dangerous because of the activity of the deadly compound tetrodotoxin.
- d.
Tetrodotoxin is a powerful neurotoxin that causes sodium channel blockade leading to muscle paralysis.
- e.
Symptoms start rapidly and can lead to total body flaccid paralysis, respiratory arrest, and subsequent death within minutes.
- f.
Mainstay of treatment is symptomatic care and ventilatory support until the effects of the toxin subside and are excreted from the body.
- a.
- 1.
References
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