| Sıra | DOSYA ADI | Format | Bağlantı |
|---|---|---|---|
| 01. | Toxin Venomous Toxin Stonefish | pptx | Sunumu İndir |
Transkript
Marine BiotechnologyGeorge Schroeder MD., M.S., FACEP, FAAUCM Clinical Assistant Professor of Emergency Medicine University of Central Florida College of Medicine Orlando, Florida, USAAmerican Academy of Urgent Care MedicineChairman-International Urgent Care Medicine CommitteeExecutive Council & Senior Medical Editor – Journal of the American Academy of Urgent Care Medicine
Emergency Medical Management of Scorpionfish, Stonefish and Lionfish Envenomation
LIONFISH - (Pterosis Species)
Red Lionfish
Lionfish Distribution
Lionfish & Stonefish
Stonefish (Synanceia verrucosa)
StonefishFamily: SynanceiidaeGenus: SynanceiaSpecies: Synanceia alula, Synanceia horrid, Synanceia nana, Synanceia platyrhyncha, and Synanceia verrucosaLength: Up to 50 cmWeight: nearly 5 pounds or 2400 gramsDiet: Carnivorous, primarily small fishes and shrimpsLife Span: 5 to 10 yearsNature: Venomous, dangerous and even fatal to humansHabitat: Coral reef, near and about rocks, mud or sand in tidal inletsRange: Coastal regions of Indo-Pacific oceans and northern Australian waters
Stonefish Marine ToxinsThe venom of a stonefish is made of a mixture of proteins, like the haemolytic stonustoxin, the proteinaceous verrucotoxin and the cardioactive cardioleputin.Its glands have neurotoxins at the base of its needle-like dorsal fin spines, 13 of them. The stonefish emits toxins when it feels threatened or is disturbed.Depending on the depth of the penetration of its poisonous spines, the poison takes less than 1- 2 hours to kill a human being after driving him into severe pain, tissue death and paralysis.
Four Marine Toxins1. Primary Toxin = antigenic heat-labile protein2. Acetylcholine = a neurotransmitter3. Neuromuscular Toxins4. Low Molecular weight non-proteinaceous icthyotoxin
Scorpionfish (Scorpaena Species)
Scorpion Fish rank 2nd only to Stingrays in total number of estimated envenomations.50,000 cases annuallyClimate change Change in environmental Oceanic conditions Distribution of these venomous species of fish
California ScorpionfishAlso known as Sculpin, Scorpaena guttataRock fish shape – red in deeper water, brown in shallow water12 – 17 inches long, depth range 30m – 183mHabitat = shallow rocky areas, often in caves & crevicesHeat labile toxin delivered through dorsal spines
Brazilian ScorpionfishScorpaena plumieri, Scorpaena brasiliensisVenom is lethal (LD50) in mouse 0.28 mg/kg, i.v. Displays 3 activities – 1. Hemorrhagic 2. Hemolytic 3. ProteolyticEndothelial Barrier Dysfunction, microvascular hypermeability & CV effects = change in BP + HR
Scorpionfish Venom Potent hemolytic toxin (Sp-CTx-121 kDa) Scorpaena plumieri venom Isolated from an Atlantic ScorpionfishMass Spectrometry: AA sequences in Sp-CTx shared by other piscine hemolytic toxinsHemolytic activity of Sp-CTx on rabbit RBC’s attenuated by osmotic protectants (PEG Polymers), and molecules larger than 6 nm in diameter inhibited cell lysis = Sp-CTx maybe pore-forming protein
Scorpionfish near coral formation
Clinical ManifestationsIntense pain at site of contactEdema, Erythema, occasional skin NecrosisAdenopathyNausea, vomiting, diarrheaNeuromuscular effectsAgitation, malaise, sweatingCardiovascular – tachycardia & arrhythmias
Inflammatory & Vasoactive Effects of Marine Toxins & Venoms
Symptoms & Signs- LocalIntense pain -site of puncture on patient’s extremity.Erythema and edema also due to initial histamine-like allergic reaction to proteinaceous ichthyotoxin from Lionfish, Scorpionfish, Devil Firefish & StonefishSurrounding rings of bluish cyanotic tissue due to potent, potentially fatal Stonefish envenomationVesicle formation, especially in softer connective tissue and skin of hands, along with warmth which may spread to entire affected limbThereafter – rapid tissue Sloughing, - CellulitisSurrounding hypesthesia
Systemic EffectsNauseaMuscle weaknessDyspneaHypotension
Stonefish EnvenomationBradycardiaSyncopeCardiogenic ShockCongestive heart failurePulmonary Edema
Differential DiagnosisDecompression SicknessAnaphylaxisSerum SicknessEchinoderm envenomationsStingray envenomationsUrticarial eruptionsDysbarismSea snake envenomationsSpider bite
ImagingSoft tissue Radiographs with double marker UltrasoundCT Scanning & MRI imaging
Emergency Management & Therapeutic Modalities1. Pre-hospital Emergency Management-Proper diagnosisGentle removal of visible spines with gloved handsDirect pressure to control bleedingAdequate AnalgesiaAnti-emetic if necessary – for nauseaAlso – prompt recognition of serious potentially life-threatening systemic symptoms and signs, followed by immediate CPRTreatment of Anaphylaxis
Referral2. Appropriate Triage-Level 3 & 4 UCM Clinics ought to transfer to higher level of care, after initial stabilization and Tetanus ProphylaxisLevel 1 & 2 UCM Clinics may initiate primary care including – parenteral analgesia, antiemetic, I.V. fluids if necessary, antibiotics – only if indicated , wound debridement, Antihistamines, Corticosteroids
Immediate Treatment3. Hot Water Immersion Technique:Continuous immersion in non-scalding hot water of affected region of body (up to max 114 degree F, or 45 degree C) and up to 20 minutes, should inactivate heat-labile venom in Lionfish, Scorpionfish and devil fish. Pain relief in 97% of patients
4.Local, Regional Analgesic & SedationTordolOpiate analgesics – parenteral only in the absence of hypotensionBupivacaine – as local and / or regional block anesthesia for long-acting analgesia. Increases electrical excitation threshold slowing nerve impulse propagation, reduces action potential and prevents generation and conduction of nerve impulses.Lorazepam or Midazolam – for procedural sedation as needed.Intravenous fluids for hypotension.
Stonefish AntivenomIM / IV administration of hyperimmunized equine (Australian CSL) Antiserum With: pre-treatment subcutaneous epinephrine parenteral antihistamine, corticosteroidfor Intravenous Use: careful dilution – slow administration of: - 1 ampoule (2000 U) for every 1-2 punctures - 3 ampoules for more than 4 puncturesDilution: 50-100 mls – isotonic NaCl – slowly over 20 minutes on calibrated infusion pump.Wound debridement, irrigation and anti-sepsisPossible admission to hospital, possibly ICU
“If we can’t BEAT them, let’s EAT them”NOAA: 2007 promoted a Lionfish cookbook FDA: Discouraged this campaign – However, from tests conducted on more than 200 Lionfish, more than 25% exceed federal levels of ciguatera fish toxin; or more than 0.1 parts per billion. Nevertheless, other reports have dismissed these findings as “negligible and not clinically significant”.
ConclusionMoreover, rapidly evolving climate change and disruption of the delicate ocean Biome and fragile ecosystems necessitate growing awareness of this escalating biomedical challenge, with dire environmental consequences.http://nas.er.usgs.gov/sitingreport.aspxTracking and Cataloging Non-native Invasive Marine Species. Proactive conservation measures to protect delicate marine ecosystems.
Sea Orbiter
Toxin Venomous Toxin Stonefish
Yıl : 2020
Anahtar Kelimeler
Daha fazla görüntüle