Thursday 17 December 2020

Stone fish envenomation

Stone Fish

Synanceia is actually a genus of fish on the loved ones Synanceiidae, the Stonefishes, whose members are venomous, unsafe, and in some cases deadly to individuals. It is amongst probably the most venomous fish presently recognized during the planet.[1][2] They are found inside the coastal locations of Indo-Pacific oceans at the same time as off the coast of Florida and in the Caribbean.Synanceia are largely maritime, however some species are recognised to are living in rivers. Its species have powerful neurotoxins secreted from glands on the base of their needle-like dorsal fin spines which adhere up when disturbed or threatened.[3] The vernacular identify with the species, the stonefish, derives from the stonefish's ability to camouflage alone using a gray and mottled colour comparable to the colour of a stone.[4] Swimmers might not recognize them, and may inadvertently move on them, triggering a sting. When the stonefish is disturbed, it could inject an level of venom proportional towards the amount of pressure applied to.Local reaction with swelling, severe pain and redness at puncture site.

Stone fish is the most dangerous venomous fish in the world

13 dorsal spine ,3 anal spines and 2 pelvic spines.

Most cause local reaction

•Severe pain, swelling,redness,celullitis, vesicle or bullae

Systemic reaction

•Pallor, diaphoresis,nausea,muscle weakness,dyspnoe,headahce,delirium, convulsion,hypotension,syncope

•**animal study = pulmonary hemorrhage,myotoxic,neurotoxic,hypotension primary cause of death in animal studies.


•Most of protein of venom are extremely labile and inactivated by heating

•Immerse the affected area in water as hot as is tolerable usually relieves pain from a sting.

•Spines should be removed

•The wound should be scrubbed and irrigated with fresh water.

•Oral antibiotics if infected.

•Suture if wound large lacerated

•Update anti tetanus


•Supportive treatment if systemic reaction occur


Sunday 12 April 2015

ENT Guidelines for the Medical Examination of Scuba Divers

Hi divers, today i will list out absolute and relative contraindication for Ear problem in Scuba Diving

Absolute Contraindications

  • Inability to equalize pressure in the middle ear by auto-inflation. This may be due to a correctable problem such as polyps, nasal septal deviation or coryza in which case the diver can be reevaluated after correction of the problem.
  • Perforation of the tympanic membrane. Until fully healed or successfully repaired with good Eustachian tube function, diving is contraindicated.
  • Open, nonhealed perforation of the TM.
  • Tympanoplasty, other than myringoplasty (Type I)
  • History of stapedectomy. * Recent studies have shown that this is not necessarily true. See this article:.
  • CONCLUSIONS: Stapedectomy does not appear to increase the risk of inner ear
    barotrauma in scuba and sky divers. These activities may be pursued with
    relative safety after stapes surgery, provided adequate eustachian tube
    function has been established.
  • History of inner ear surgery
  • Status post laryngectomy or partial laryngectomy
  • History of vestibular decompression sickness
  • Radical mastoidectomy (posterior) involving the external canal is disqualifying. (Closed childhood OK)
  • Meniere's disease is disqualifying
  • Labyrinthitis
  • Perilymphatic fistula
  • Cholesteatoma is disqualifying
  • Cerumen impactions -remove before allowing to dive.
  • Stenosis or atresia of the ear canal-disqualifying.
  • Facial paralysis secondary to barotrauma
  • Tracheostomy, tracheostoma
  • Incompetent larynx due to surgery (Cannot close for valsalva maneuver)
  • Laryngocoele  
Relative Contraindications
  • Recurrent otitis externa or media
  • Eustachian tube dysfunction
  • History of Tympanic Membrane perforation
  • Significant hearing loss in one ear
  • Midface fracture
  • Facial nerve paralysis
  • Full mouth prosthetic devices
  • Head and neck radiation
  • Migraine, severe (scotomata, CNS symptoms and stroke after diving)