July 6, 2013

Personal Experience of Accidental Sea Urchin Sting to the Bilateral Foot

Diadema setosum, original image from this [link]
It was a hot sunny afternoon in Bohey dulang Island Sempoarna and the sweats wetting my whole body after finished climbing the Bohey dulang's hill in a mission to enjoy and capture the mesmerizing scenery. I rushed to the sea and without hesitancy, jumping into the sea water without realizing that it was full of long spine black urchin or Diadema setosum.


The only thing that I can recall was the intense pain at the bilateral foot. Immediately came out from the water, I Inspect my foot and found that both of my plantar surface of the foot was penetrated by multiple length of sea urchin spines.

After removing the visible protruding spines, the broken part remain inside the foot.


Without having an emergency kit, I just removed the visible spine using a bare hand and put back my legs into the water to help with the pain.


Four hours later, I reached my home and soaked my foot inside the hot water to alleviate the pain and self extracting the buried spine. The problem with the spine was that, it was too brittle and easily broken with manipulation and I just left it in situ. For the first two days, I need NSAIDs to cope with the pain.


Few days later, there was a blackish discoloration at the punctured site and  small pustules started to develop. In view of that, I covered myself with Cloxacillin for 1 week duration. After two weeks, the lesion heals completely and the appearance of the foots were back to normal.



Discussions


Sea urchins belongs to the class Echinoidea with globe to flattened shaped bodies. The body is covered by spines made of non poisonous calcium carbonate that will produced a puncture wound injury. Meanwhile the pedicellaria which is the small, delicate seizing organs lies between the spines contains histamine, serotonin, glycosides, steroids, cholinergic substances and bradykinin like substance (William J. Dahl). Living in a shallow coastal water, this animal is harmless and most of the injuries occurs after incidentally stepping on it, direct contact to the skin or upon holding it with hand.


The injuries causing by Sea urchin puncture wounds are usually minimal with the most common one would be inflammation manifested by swelling and redness, progressing to severe pain. After a while, it may trigger to infection. Rarely, generalize malaise, severe muscle pain, paralysis, respiratory failure and anaphylactic shock may occurs following multiple deep puncture wound


Even rarely, untreated sea urchin stings may lead to joint stiffness, tenosynovitis, arthritis and granuloma formation. (William J. Dahl).


Immediate response following accidental sea urchin sting injury would be application of the vinegar to the injured part as it will dissolve the spine. Large spine can be manually removed by using a tweezers while the small pedicellaria can be removed by applying shaving cream to the affected area and scrape it with a razor. To reduce the pain, you may immerse the injured part to the hot water as the patient may tolerate. If by immersing the injured part into the hot water does not alleviate the pain, you may use simple analgesic like paracetamol or NSAIDs. Severe pain warrants a visit to the healthcare practitioner.


Myths of using urine to neutralize the poison should not be followed and the wound should not be closed with tape or glue skin. When there is present of infection, you may seek  medical practitioner's consultation and antibiotic prescription may be needed. However, immunocompromised patient or patient with diabetes may require prophylactic antibiotic treatment even without the evidence of infection.  A large and long Spine near to the joint possibly needs surgical removal and you should consult the nearest medical personnel.

Reference:

1) Barbara J Drobina, "Dive Medicine: Sea Urchin Puncture Wound", eMedicinehealth
 
2) W. J. Dahl, P. Jebson, and D. S. Louis, Sea urchin injuries to the hand: A case report and review of the literature",The Iowa Orthopaedic Journal, vol 30

8 comments:

  1. normally wat antibiotic is used?

    ReplyDelete
  2. cloxacillin is enough... can consider beta lctamase group as well

    ReplyDelete
  3. Salam alaik. Salam Ramadhan! :)
    Im a silent reader of your blog.
    As a medical student..I find your blog very interesting and motivating I might say. Pls do continue writing.
    May Allah repay all your good deeds in the afterlife.amin amin.

    ReplyDelete
  4. wsalam wbt.. ramadhan el mubarak.. thanks for the support. hope you will gain some benefit.... pray for me that i will achieve my dream to become an emergency physician.

    best of luck in your study.. who knows we might working together someday

    ReplyDelete
  5. good information about PERSONAL EXPERIENCE OF ACCIDENTAL SEA URCHIN STING TO THE BILATERAL FOOT thanks for share with us.
    http://www.footcentersofnc.com/common-foot-problems/athletes-foot.html

    ReplyDelete
  6. good information about PERSONAL EXPERIENCE OF ACCIDENTAL SEA URCHIN STING TO THE BILATERAL FOOT thanks for share with us.
    http://www.footcentersofnc.com/common-foot-problems/athletes-foot.html

    ReplyDelete
  7. are you sure you had the spines were inside? i had the same accident, but the dark thing you see under your skyn is ink and i leaves some days later.

    ReplyDelete
  8. i personally remove the spine by making small incision and remove it with tweezers... and the ink last for weeks

    ReplyDelete

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