Pediatric emergency medicine trisk 1999 1999
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pain can persist for hours or even days and the emergency provider should
provide adequate analgesia.
Treatment involves irrigating the wound with sterile saline. The injured
extremity is then immersed in very hot water (40° to 45°C [104° to 113°F]) for 30
to 60 minutes or until the agonizing pain is completely relieved. Pain relief is best
achieved with morphine 0.1 mg/kg IV, IM, or SC. The patient should be
monitored carefully for cardiotoxic effects and respiratory depression. Antivenin
is available only for the stings of the stonefish of Australia.
Catfish
The catfish is a popular food and sport fish found in many lakes and rivers
throughout the United States. The venom apparatus consists of a number of
spines located in the dorsal and pectoral fins. The integumentary sheaths covering
the spines contain venom glands. The venoms are unstable, heat-labile
compounds.
Injuries can be a combination of puncture wounds and lacerations, foreignbody reactions, and the effects of venom. The spines may become imbedded in
flesh, causing soft tissue swelling, infection, or foreign-body reaction. The venom
produces a local inflammatory response with local intense pain, edema,
hemorrhage, and tissue necrosis.
Treatment involves irrigating the wound with sterile saline. The injured
extremity is then immersed in hot water (40° to 45°C [104° to 113°F]) for 30 to
60 minutes or until pain is relieved. Pain relief is best achieved with morphine.
The wound should be explored, spines removed and debrided if needed. Systemic
antibiotics to cover gram-negative organisms are recommended. Wounds may be
closed by using a delayed primary closure.
TERRESTRIAL INVERTEBRATES
Phylum Arthropoda
The arthropods make up the largest phylum in the animal kingdom. All
arthropods have an exoskeleton with jointed appendages. The phylum is divided
into two subphyla: the Chelicerata, which includes scorpions, spiders, ticks, and
mites, and the Mandibulata, which includes insects.
Scorpions
There are 650 known scorpion species (class Arachnida), but only a limited
number are dangerous to humans. In the southwest United States, Centruroides
sculpturatus is the potentially lethal inhabitant. Although C. sculpturatus and
