Question 3 of 15

You are marooned on a large desert island with several other people after the grounding and wreck of your tour boat. Fortunately you have a good store of supplies and agree to provide the correct medical services to your compatriots as long as they can bring you food. Which of the following remedies is correctly paired with the injuries?

A 23-year-old actress was stung on the thigh by a Portuguese man-of-war and tentacles are still present → tentacle removal using surgical gloves and irrigation with fresh water.

A 42-year-old college professor with rash on his arms from handling sponges → apply dilute baking soda soaks tid.

An obese 50-year-old captain with a wound to his calf from a stingray tail → remove retained fragments and soak leg in 46.1°C (115°F) water for 90 minutes.

A 62-year-old millionaire and his slightly younger wife who have puncture wounds to their hands and arms from sea urchin spines → remove foreign bodies and inject 2% lidocaine with epinephrine at the puncture sites, avoiding use in the fingers.

A 21-year-old first mate with a puncture wound of the arm from a catfish spine → apply ice packs to the area tid and remove foreign body.

Direct identification of the organism may not be possible, so it is acceptable to treat wounds by unidentified marine organisms in a similar fashion. The toxins found in many spines, including the tail of the stingray, catfish, and stone fish, are heat labile; therefore, the affected part should be immersed in water as hot as the patient can comfortably withstand (not over 45°C [113°F]) for 30–90 minutes depending on the size of the wound and the organism, if known. Ice treatment for these acute puncture wounds should not be used. Local anesthetics without epinephrine and systemic analgesics may be needed. The stings of the Portuguese man-of-war in particular can cause severe systemic reactions. The tentacles should be picked off with forceps and not with gloved hands. A weak vinegar solution may be used to inactivate the nematocysts, or salt water used to wash off the skin. In general, most coelenterate (some coral, anemones, and jellyfish) stings should not be treated with basic solutions or exposed to fresh water as this causes the nematocysts to discharge. The same applies to acute stings from handling sponges. General measures include antihistamines for itching, topical steroids for dermatitis, debridement and wound treatment, and tetanus prophylaxis. Certain envenomations (sea snake, sea wasp) may require antitoxin treatment.