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treatment of poisoning of venomous fishes
(english) In all cases qualified medical attention should be sought immediately. The following suggestions give some basic assistance and indicate severity of poisoning and are taken from Halstead (1970):- 1) sting rays including Dasyatidae, Gymnuridae, Mobulidae, Myliobatidae, Potamotrygonidae, Rhinopteridae, and Urolophidae - irrigate wound with cold seawater, explore wound and remove all pieces of integumentory sheath, after thorough cleansing soak injured part in water as hot as can be borne without damage for 30-90 minutes. Magnesium sulphate may be added to the water as a mild anaesthetic. Following soaking the wound may be debrided, cleansed and closed with dermal sutures. Anti-tetanus agents are recommended, antibiotic agents may be required. Intramuscular or intravenous demerol has been found effective in controlling pain. Primary shock can be treated with the usual measures. Secondary shock from action of venom on the cardiovascular system may require immediate and vigorous therapy - maintaining cardiovascular tone and preventing complications. Elevation of the injured member is advisable. Do not use potassium permanganate, ammonia or cryotherapy. Stingrays can be avoided by shuffling one's feet along the bottom. 2) catfish stings including Ariidae, Bagridae, Clariidae, Doradidae, Heteropneustidae, Ictaluridae, Pimelodidae, Plotosidae, Siluridae - treatment is similar to that for stingray stings, see above. 3) weaverfish stings, Trachinidae - treatment is similar to that for stingray stings, see above. In addition calcium gluconate alleviates pain; procaine injections may be used for less severe cases; and intravenous meperidine helps relieve severe pain which continues beyond the first hour after injury. 4) scorpionfish stings, Scorpaenidae - punctures should be thoroughly cleansed to remove venom. Bleeding should be encouraged. Soak injured part in water as hot as can be borne without damage to the tissues for 30-90 minutes. Magnesium sulphate may be used in the water as a mild anaesthetic. Surgical closure of the wound is not usually required. Anti-tetanus agents are recommended, antibiotic agents may be required. Intramuscular or intravenous demerol may or may not help control pain. Secondary shock from the venom may require vigorous therapy to maintain cardiovascular tone and avoid complications. 5) stonefish (Synanceja) stings - this envenomation is very dangerous. Prompt immersion in hot water is recommended. Injection of emetine hydrochloride into the wound has been found of value (0.5-1.0 ml of solution of 1 g of emetine hydrochloride per ml), apparently having an antagonistic action against the venom and relieving the pain. Injections of 0.1 to 0.5 ml of 5% potassium permanganate and congo red have also been recommended. 2 ml of the Australian anti-venom is recommended. Initially intramuscularly, but if the case is severe the intravenous route may be used. If symptoms persist another 2 ml may be used. This anti-venom has been used with encouraging results with Scorpaena stings and is recommended for serious types of scorpionfish stings that do not otherwise respond to treatment. Anti-venom is available from the Commonwealth Serum Laboratories, Melbourne, Australia 6) toadfish stings, Batrachoididae - treatment as for scorpionfish stings, see above. 7) rabbitfish, Siganidae, and surgeonfish, Acanthuridae, stings - treatment is similar to scorpionfish stings, see above.

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