Situations during which humans may become envenomated:
(1) accidentally stepping on a camouflaged stingray lying on the sea floor
(2) cornering or provoking a stingray
(3) during commercial fishing
Most injuries occur in the lower extremity but may occur in the upper extremity, thorax or abdomen.
Local findings at the site of the wound:
(1) The spine may make a puncture wound, a laceration or may break off and become embedded.
(2) The initial sting may cause local pain and edema. Severe pain develops within 30-90 minutes of the injury and may last 24-48 hours.
(3) The wound is discolored and may be erythematous, dusky, cyanotic or hemorrhagic.
(4) Hemorrhage may occur if a major artery is lacerated. Lacerations may also transect nerves and tendons.
(5) Usually there is extensive tissue necrosis in the wound and surrounding tissues.
(6) The affected limb may or may not become edematous.
(7) The wound may become infected with risk of cellulitis, abscess and/or osteomyelitis.
Systemic symptoms may include:
(1) nausea and vomiting
(2) syncope
(3) generalized weakness
(4) salivation or diaphoresis
(5) muscle cramps and/or fasciculations
(6) diarrhea
(7) seizures
(8) vertigo
(9) bradycardia or tachycardia
(10) headache
(11) hypotension
(12) cardiac arrhythmias
(13) respiratory depression
(14) circulatory collapse
Death may occur if:
(1) Tetanus develops in the unvaccinated patient.
(2) The wound is not properly cared for, becomes infected and is followed by sepsis.
(3) The spine penetrates into the thoracic cavity, causing pneumothorax and punctures the heart.
(4) The spine penetrates the abdomen.
(5) There is massive exsanguination from a lacerated artery.
(6) Severe pain incapacitates a diver or swimmer.
