What is the treatment for a stonefish sting?

Treatment for Stonefish Sting

The primary treatment for stonefish envenomation is immediate immersion of the affected area in hot water (40°C/104°F) for at least 20-30 minutes to relieve pain and inactivate the venom. 1

Immediate Management Algorithm

1. Hot Water Immersion/Irrigation

   • Immerse the affected area in hot (but not scalding) water at approximately 40°C (104°F) 1
   • Continue for at least 20-30 minutes or until pain subsides 1
   • If a thermometer is unavailable, water should be as hot as tolerable without burning the skin
   • CAUTION: Ensure water temperature is not too hot to avoid thermal burns 2

2. Pain Management

   • If hot water immersion is insufficient for pain control:
     • Apply topical lidocaine cream/gel (4-5% or 10-15% formulations) 1
     • Consider parenteral analgesics (opioids may be necessary for severe pain) 3
     • Regional anesthesia may be beneficial in hospital settings 4

3. Wound Care

   • Remove any visible spines or foreign material
   • Clean the wound thoroughly with water
   • Do not apply pressure immobilization bandages (may worsen envenomation) 1
   • Do not apply ice (may cause tissue injury) 1
   • Do not apply suction (ineffective and may cause tissue injury) 1

Secondary Management

1. Antibiotic Prophylaxis

   • Consider prophylactic antibiotics (amoxicillin/clavulanate is commonly used) 4
   • Particularly important for deep or contaminated wounds

2. Tetanus Prophylaxis

   • Ensure tetanus immunization is up to date 5

3. Antivenom Consideration

   • Stonefish antivenom is indicated for:
     • Severe systemic manifestations
     • Extreme pain unresponsive to other measures
     • Multiple puncture wounds 6, 5

4. Monitoring

   • Observe for systemic reactions including:
     • Difficulty breathing
     • Signs of shock
     • Severe or persistent pain 1
   • Monitor for cutaneous complications (necrosis, cellulitis, abscess) 6

Potential Complications

• Local tissue necrosis and ulceration
• Cellulitis and abscess formation
• Persistent pain and hyperalgesia
• Systemic manifestations (rare but can be life-threatening) 6, 3

Important Caveats

• Hot water immersion is effective but carries risk of iatrogenic thermal burns if water is too hot - never exceed 45°C 2
• Stonefish stings can cause extreme pain requiring multiple doses of analgesics 3
• Late complications like tissue necrosis are common but can be reduced with appropriate initial treatment 6
• Surgical intervention may be required for severe cases with tissue necrosis or persistent infection 6

Recent evidence suggests that regional anesthesia techniques in hospital settings may reduce cutaneous complications and shorten hospital stays for severe stonefish envenomation 4.