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Sources of emergency information

Diving Medicine Online maintained by Dr. Ernest Campbell, MD, FACS provides "Comprehensive updated information about diving and undersea medicine for the non-medical diver, the non-diving medical professional and an excellent reference source for the diving medical specialist". Information is available about all kinds of Hazardous Marine Life including Cone Shells and other species employing injected toxins. See also brief description of cone shells and venom apparatus.

First-aid for Cone Shell envenomation (from AVRU)
Brian Fry's advice (Australian Venom Research Unit, AVRU) for those stung by cone shells. 
Includes link to a list of dangerous Australian species and other information about Cone Shells and conotoxins

Safety Procedures for dealing with envenomation by Conidae
Authored by Suzanne Sheherd, Residency Director, Associate Professor of Emergency Medicine, University of Pennsylvania, and James Martin M.D., Emergency Medicine, Hospital of the university of Pennsylvania.

CONTENTS

  • INTRODUCTION
    • Background
    • Pathophysiology
    • Frequency
    • Mortality/Morbidity
  • CLINICAL
    • History
    • Physical
    • Causes
  • WORKUP
    • Lab Studies
    • Imaging Studies
    • Procedures
  • TREATMENT
    • Emergency Department Care
  • FOLLOWUP
    • Further Inpatient Care
    • Patient Education
References
  • Brown, C.K., Shepherd, S.M. (1992) Marine Trauma, Envenomations and Intoxications. Emergency Medicine Clinics of North America 10: 385-408.
  • Auerbach, P.S. (1991) Marine Envenomations. The New England Journal of Medicine 7: 486-493.
  • Auerbach, P.S. (1995) In: Wilderness Medicine: Management of Wilderness and Environmental Emergencies. Chicago: Mosby: pp. 1327-1374.

The Diver's First Aid Reference to Potentially Hazardous Marine Life

The Diver's First Aid Reference to Potentially Hazardous Marine Life is a four page laminated guide that was designed to be kept with a diver's log book. Produced by Jeffrey Howe, Senior Research Associate at Auburn University, this reference guide covers a wide range of potentially hazardous marine life including bristle worms, coelenterates (jellyfish, sea anemones, etc.), echinoderms (sea cucumbers, sea urchins, starfish), bite wounds, sting rays, venomous fishes, hard corals, mollusks (cone shells, octopus), sea snakes, and sponges. For each group of marine life covered, the etiology, symptoms, treatment, and preventative measures are covered in detail. In addition, there is a first aid kit check list and an area for important telephone numbers (e.g., chamber, hospital, relative, U.S. Coast Guard, etc.). The Diver's First Aid Reference to Potentially Hazardous Marine Life is not only essential for divers, it should be one of the first items a marine aquarist should obtain, read, and keep for emergency situations. 

For a laminated copy, please send $1.50 to Auburn University Marine Extension and Research Center, 4170 Commanders Drive, Mobile, AL 36615-1413. Up to five unlaminated copies are available free of charge. 


Venomous Bites and Stings - Active First Aid Online v2.5

  • includes Signs and Symptoms
  • Care and Treatment

Australian Venom Database
Maintained by Bryan Grieg Fry, Peptide Laboratory, Centre for Drug Design and Development, University of Queensland, St. Lucia, Qld., 4072, Australia. 

"The purpose of this page is to provide an online guide to Australian venomous snakes and other venomous animals. The focus is primarily on the venom and the clinical effects of the venom. Publications for each genera are linked to provide a service to people who may not have access to either of these databases. Publication lists will be updated quarterly." 

The Molluscs link provides detailed information about the biochemistry and biology of venoms and toxins of individual species of Cone shells including: 

  • Conus geographus (Geographer's Cone)
  • Conus magus (Cone of Magi)
  • Conus marmoreus (Marbled Cone)
  • Conus pennaceus
  • Conus purpurascens (Purple Cone)
  • Conus striatus (Striated Cone)
  • Conus textile (Textile Cone : Cloth-of-Gold Cone)
  • Conus tulipa

"Neurotoxin - Cone Shell" by Don R Revis, Jr, MD
eMedicine Journal, December 6, 2000, Volume 1, Number 12
- Topics include:

Introduction
Background to Cone Shells and envenomations
Pathophysiology
Frequency
Mortality / Morbidity

Clinical
History
Physical
Causes

Differentials Workup
Lab Studies and Other Tests

Treatment Medical Care
Surgical Care

Follow Up Further Inpatient Care
Further Outpatient Care
Prognosis
Patient education

Miscellaneous Medical-Legal Pitfalls

Bibliography


Marine-medic.com
This site by Dr Peter Fenner, current Honorary National Medical Officer for Surf Life Saving Australia, provides information about Cone Shells under the following headings :
Distribution
Appearance
Envenomation
"Pain at the site of envenomation, occasionally mild, occasionally severe and excruciating. The envenomated area may blanch, or develop a bluish tinge, and is followed by numbness and local swelling.
In serious envenomations incoordination and muscular weakness may develop rapidly, and swallowing, speech, vision and hearing may be affected. Nausea, generalised pruritus and respiratory paralysis may develop."
Fatalities
Medical treatment
There is no specific treatment, and symptoms and signs should be treated under the usual guidelines.1 As with any envenomation, marine or otherwise tetanus immunisation is advised and follow-up to exclude secondary infection may be necessary.

FIRST AID FOR HOLIDAY NASTIES
This Australian site from myDr.com.au provides visitor advice on treatment for envenomation from a number of marine and terrestrial nasties, including the following advice for cone snails. Cone shell/snail: "Living in shallow reef waters, these conical shells contain a snail which kills its prey with venom. The venom of the cone snail is injected by small teeth which look like harpoons. The venom causes prolonged weakness of muscles, including the muscles of respiration and disturbance of vision, speech and hearing. Pain, numbness and swelling occur commonly. If untreated, high levels of venom could cause death in a short time. 
Pressure immobilisation, using a firm crepe bandage to the limb, particularly over the site, is recommended. Prolonged artificial respiration, even mechanical ventilation, may be required. At this stage, there is no antivenom available for cone shell stings. A tetanus injection may also be needed in case the wound is contaminated". 
 
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