Pediatric emergency medicine trisk 1996 1996

ability of stony corals is minor; coral cuts can be severe due to a combination of
lacerations, nematocyst venom, foreign debris in the wound, and secondary
bacterial infection. The clinical picture is one of stinging sensation followed by
wheal formation and itching. If the wound is untreated, an ulcer with an
erythematous base may form within a few days. Cellulitis, lymphangitis, fever,
and malaise may occur.
Treatment consists of cleaning the wound and irrigation with copious amounts
of saline, removal of foreign particles, and debridement. Marine bacteria that can
inoculate wounds are generally heterotrophic, motile, and facultatively anaerobic,
gram-negative rods. Organisms include Vibrio species, Erysipelothrix
rhusiopathiae, and Mycobacterium marinum. Wounds should be left open. Broadspectrum antibiotic therapy, particularly tetracycline, at a dosage of 40 mg/kg/day
in four divided doses, has been advocated but should not be used routinely in
children younger than 8 years. For children younger than 8 years, cephalexin (50
mg/kg/day in four divided doses) or trimethoprim-sulfamethoxazole (10 mg
TMP/kg/day divided in two doses) should be used.

Phylum Echinodermata
Phylum Echinodermata includes starfish, sea urchins, and sea cucumbers. Of the
three classes, only the Echinoidea (sea urchins) have clinical relevance for U.S.
children. The long-spined urchins (e.g., Diadema) are dangerous to handle. They
do not appear to possess venom like tropical urchins, but the spines, composed of
calcium carbonate, easily pierce the skin, wet suits, and sneakers and can lodge
deep into flesh. Most injuries occur during wading in shallow water.
Penetration of skin by spines is accompanied by intense pain followed by
redness, swelling, and aching. The venom has hemolytic, myonecrotic,
hepatotoxic, and anticoagulant properties. Complications include tattooing of the
skin, joint arthritis, secondary infection, and granuloma formation.
Management. All spines should be removed as completely as possible using
local anesthetic if needed. Radiography and ultrasound may be used for spine
localization and removal. Any spines not reachable will be absorbed in time, but
granulomas from retained spine fragments may require excision. Soaking in

warm water may be helpful for pain. Systemic antistaphylococcal antibiotics
should be used if signs of infection develop. In case of reactive neuropathy,
systemic corticosteroids are recommended.

MARINE VERTEBRATES
Stingrays