I was always taught that in the event of a puncture wound, the best thing to do is leave it in. In this case, the barb was poisoned. Might he have lived, if he had left the barb in?
I have not read the articles of the actual path of the stab but if you have an impaled object that will continue to do damage leaving it in will not always be the best course of action. It would be easier to deal with an open chest wound than remove venom that may still be infusing into his system from that barb.
Several reports on the news stated that the sting ray barb penetrated the heart!
Same difference, near instant death, although it was said he pulled it out immediately.
I don’t know about the stingray’s anatomy, aside from a radio report saying the sting detaches from the tail. Unlike a honeybee’s stinger, which leaves the bee dying, the ray will grow a new one. It is best to remove a bee’s stinger, because the venom sac keeps pumping after the bee has gone. Pull it out with a fingernail, don’t grasp the sac. That would squirt all the venom into the victim. :eek: Rays aren’t insects, of course, so that might not apply.
Don’t know for sure, but it’s a good question.
The stinger from a ray is long, and covered along the full length with nasty, back-wards slanted barbs. It’s easy to guess that pulling it out would cause a great deal of extra damage.
Yes, it’s actually a barbed barb. Pic. (WARNING: crikey factor.)
IANAD but I would think that pulling it out would be a bad move. Granted, Steve prolly didn’t think at the time that pulling it out would leave a gaping hole in his heart and that, given that they were offshore and not within easy reach of medical facilities, it would have mattered anyhow.
As far as I know, the stingray doesn’t lose its barb. In fact, according to Wikipedia, it’s growing out of their tail. It mentions part of the stinger being left in the wound sometimes but not the whole thing. Since noone’s seen the video and they’re obviously not going into too much detail when describing it, we can’t know for sure that it had detached from the stingray when it hit him. For all we know, it was still attached and if he didn’t pull it out, the stingray would have.
I’ve been thinking about this and believe it should have been left in (obviously, the reflex and natural thing would be to remove it, so I’m not “blaming”).
By leaving it in, the wound is plugged and additional trauma is reduced. I wonder whether the cause of death wasn’t a direct wound to the heart so much as a puncture of the sac around the heart (the pericardium). Removal of the barb might have led to bleeding in the sac to the point that the heart could no longer fill after each beat (since the space it would normally enlarge into by filling after each beat would have been filled with blood). This is called pericardial tamponade for those who are interested.
Even if it did enter the heart itself, and maybe even moreso, the same reasoning applies. If you unplug the heart wound, there will be bleeding directly out from the heart into the pericardial sac and the same problem (pericardial tamponade) would develop.
Dealing with something poisonous he actually made the correct call to yank it out promptly. If I was there I would have done the same and deal with the remaining hemo/pneumothorax as it develops. If the barb had just hit lung my slightly less than WAG is he would have survived. This isn’t a basic first aid scenario, when you have experienced EMT’s, paramedics and or emergency specialty RN’s around the rules get alot more grey and better solutions can be applied based on narrower circumstances. Out in the real world, like this situation, you run into the exceptions to the basic first aid rules.
Excellent GQ.
Drach, Ex EMT.
The damage to the sac would help mitigate a tamponade by allowing the blood to leak back out. Tamponade is far more of a concern under heavy blunt trauma situations like long falls and car accidents where the pericardial sac is not breached but impact has ruptured blood vessels on the heart.
There are several cases of huge cardiac trauma being survived when the object has been left in place. I cared for one person with a two foot by three inch piece of sliding door glass through the ventricle, who survived.
The nearness of a major trauma center, with cardio-pulmonary by-pass capability is essential. My patient arrived to us, went straight to OR within 10 minutes of the accident, much longer, would have had a different outcome.
There is no way to know how much damage the barb did going in, but it seems like he was too far from the required help to have had a positive outcome.
Assuming that Joe Normal isn’t going to know if a stingray barb hit the heart, the pericardium, the lung or simply the intercostal muscles, isn’t it a question of which is more likely to kill you - bleeding from the wound or the venom? I mean, if we’re trying to make policy here, not working with 20/20 hindsight on just this case.
A few years ago, the Big Parenting Scare of the Month was kids jamming toothbrushes through the soft palate or the back of the throat. All the parenting magazines (“Sixteen Ways Your Child Will Die Unless You Hermetically Seal Them in Bubblewrap and Cotton Balls! also Fun School Lunches!”) warned that if your kid jams a toothbrush down his throat, you should NOT remove it, as he would then bleed to death before the paramedics could get there. You should leave the brush in place to act as a cork and call 911 for help.
Of course, a toothbrush isn’t venomous. But most of the reports I’m hearing is that neither is a string ray really all that venomous, generally causing discomfort and sickness, but rarely killing anyone due to the venom.
Is the toothbrush advice still true? Is it different because the throat is nowhere near the heart?
I read that his manager stated that he didn’t pull the barb out of his heart. What’s the truth here?
One possible reason to leave it in - besides the acting-as-a-plug aspect:
Looking at a picture of a stingray barb shows that it’s not just “a” barb. It’s a long string, covered along it’s length by sharp, backwards facing barbs. It’s certainly going to cause a lot more damage coming out than going in.
My first concern for something like your toothbrush situation would be aspiration pnemonia from aspirating blood in the childs airway. Positioning said child on their side and or slightly facing down could allow at least some of the blood to drain out the mouth rather than pooling in the upper airway.
Many things in medicine do not follow common sense guidelines.
The standard of care, is to leave the impalling object in place until the patient is in surgery, no matter where in the body it penetrated.
Depending on the object, much more damage can be inflicted pulling it out. Leaving it, may help tamponade the wound, adding a little needed time, as well as leaving further damage to the controlled environment of the OR.
If the object goes into, or through the heart, the chances of sustaining adequate circulation for more than a few minutes are small, but definitely more than if the object is removed, leaving a gaping wound.
A funny story. When I was doing my CERT training, an EMT taught us the general rule of leaving impaled objects in place. Then, she also told us about a call she had gone on where a man had pierced his thigh with a ski pole. Someone trying to help him pulled it out of his thigh. A third person who had “some first aid training” said that he knew the pole should not have been pulled out. So he took the pole and stabbed it back in! Poor skier.
So not that anyone reading this would need to hear it, but: once an impaled object has been pulled out, leave it out! 
He was dead either way, and probably just as quickly either way. Neurotoxin directly into that particular organ? Yikes…