An interesting case report is published in the latest Wilderness & Environmental Medicine. Suzuki et al describe a patient with missed traumatic pneumothorax due to penetrating neck injury that was presumably caused by a stingray while diving. The barb can result in significant injuries to deep structures and organs despite a deceptively small entrance wound. This case underscores the importance of performing a thorough examination and having a high suspicion of distant injury in patients with penetrating neck injuries. The full case report can be read here.

The Stingray is found in tropical and subtropical waters worldwide. They will usually only attack as defense mechanism. During an attack, the barbed tail sticks into the victim and injects venom.

Clinical signs of are:

• Severe pain.
• Laceration.
• Wound can become ischemic and necrotic. The surrounding tissue will show signs of edema and inflammation.

Prehospital (wilderness) treatment includes:

• Primary survey using MARCH.
• The wound should be soaked in hot water (temperature as hot as can be tolerated, with a maximum of 45C) for at least 30 minutes. This will decrease the pain. If the pain returns, the soak can be repeated.
• The wound needs to be irrigated with warm saline.
• Narcotics and local anesthesia can be used for pain control.
• Evacuation.

Interested in Dive medicine? We organise a Dive and Marine Life Support Course. Read more on our webpage.

References

Suzuki T, Takada T, Fudoji J. Traumatic Pneumothorax Associated With Penetrating Neck Injury Caused by a Stingray: A Case Report. Wilderness Environ Med. 2017;28(2):119-121.

Auerbach PS, Della-Giustina D, Ingebretsen R. Advanced wilderness life support. 8th ed. AdventureMed LLC, 2013.