Crocodile Hunter: Pull it out or leave it in

Factual Questions
21

I don’t think that stingray toxin is neurotoxin; instead it just causes necrosis and a strong immune reaction:

http://www.aafp.org/afp/20040215/885.html

"Stingrays cause localized damage and a typically severe envenomation. The venom is deactivated by heat. The stingray spine, including the venom gland, typically is difficult to remove from the victim, and radiographs may be necessary to localize the spine or fragment. Surgical débridement occasionally is needed. "

Hmmmm… a really tough one. I think that removing the spine probably caused a great deal of trauma and probably killed him immediately. Leaving it in would definitely up the chances of eventual tissue necrosis in his heart (not a can of peaches either). However, I’m going to side with KarlGauss here and say he should have left it in.

Envenomation would have already occurred if it was going to happen at all, there’s a reasonable chance with stingrays that envenomation actaully won’t occur, but on the whole a stingray sting to the heart is just plain Bad News Bears. This is probably one of those injuries where getting stung in the heart by a stingray on a table in the middle of an OR in a top-level trauma center in Central Florida with doctors experienced with stingray stings wouldn’t have made a damn bit of difference in the end, but there might have been an ever so slight chance if he had left the barb in.

“tingrays have a spine at the base of their tail that contains a venom gland. The spine, including the venom gland, may be broken off in the attack and may remain in the wound. The venom has vasoconstrictive properties that can lead to cyanosis and necrosis, with poor wound healing and infection. Symptoms include immediate and intense pain, salivation, nausea, vomiting, diarrhea, muscle cramps, dyspnea, seizures, headaches, and cardiac arrhythmias. Fatalities are rare and usually a consequence of exsanguination at the scene or penetration of a vital organ.”

Oh yes, and this valuable tidbit:

“Shark attacks, although rare, require immediate attention.”

You hear that kids? If you’re bitten by a shark, tell an adult!

22

Note the wording used in the account:

It shows that Steve came over the top of the ray and the tail came up, and spiked him here (in the chest), and* he pulled it out and the next minute he’s gone**.*

It is not clear whether in his rapid paniced talk if “he pulled it out” refers to steve and “he’s gone” to his death, or if it refers to the stingray and it fleeing the scene.

It is also not clear whether the barb punctured the heart or the aorta. The latter being pretty much fatal no matter what as the barb is large enough to nearly sever it in two. I doubt Steve pulled out the barb, remember it is attached to the 3 foot long animal, which probably retracted the barb on it’s own.

The coroner’s report will be out soon.

23

I was operating under the assumption that in this case leaving it in could or would cause further damage regardless of immobilization due to the venom. If stingray venom is not as toxic as i initially believed (which seems to be the case) then it would be incorrect to remove it.

24

There was an interview on an Australian paper’s website (I think it was the Sydney Morning Herald?) where a doctor claimed that the venom of the stingray caused him to instantly suffer complete cardiac arrest, and that the actual wound wasn’t really the cause of death. I did wonder if he was just making crap up…

25

I suppose that’s the crux of it. I’ve spent a little while trying to sift through the literature. Everyone mentions immediate tissue necrosis due to changes in blood vessel constriction as well as a damaging immune reaction but no one seems to have fully characterized the venom. Everyone mentions cardiac arythmias and arrest as a possibility, but all of these references seem to be second hand and I can’t find anyone that can come out and say, “yes, this is a neurotoxin that directly affects the transmission of neural signals.” Color me doubtful on the neurotoxin angle.

Obviously, we’re gonna need some more stingrays. And another Timmy (Dinosaurs reference).

26

Well folks, apparently we have something approaching an answer:

http://www.cnn.com/2006/US/10/19/stingray.reut/index.html

This 81 year old man was stung in the chest and lived to tell the tale after leaving the barb in place.

Granted:

  1. We don’t know the species that stung either Irwin nor this man (Irwin’s ray might have been more toxic or have neurological effects this one didn’t)

  2. We don’t have a full pathologist’s report on exactly where the stinger went nor how it caused direct trauma or tissue necrosis

However, the point remains that you can get a sting-ray sting to the chest, near your heart, and still live. There isn’t some overwhelming neurotoxic effect that will lead to immediate death. Consequently, I think the generally accepted practice of leaving objects in deep penetrating injuries to sensitive areas in place. It’s possible that Irwin might have lived if he was lucky enough to have not been stung directly in the heart and received immediate medical attention.

In all likelihood I think he would have died anyway, but apparently leaving the barb in place is a slightly lower-risk option.

27

(Bolding mine)That is incorrect. In England several years ago studies were done to see if it is possible to squeeze in more venom depending on the method used to remove the stinger. It was found that the bee’s venom sac and stinger have valves in them that only open when the sac contracts. (Someone paid for an MRI of a bee’s stinger and venom sac)

The Lancet also has a documented study regarding bee stings and the best way to remove them. The found a few poor saps who agreed to be stung 10 times, 5 times on each arm. Each of the sets of 5 stings was left in for varying times. One set was removed using the scraping credit card technique; the other was just pulled out. They found that the removal method caused no change in the local inflammation or irritation, only longer times did.

28

Hmmmm… very interesting. I’ll use that for any future bee stings.

29

Couple of points in a very info-rich thread:

John Stainton (Irwin’s producer) said that the medical examiner told him Steve could have sustained the injury in a fully staffed operating theater, and he still would’ve died; that’s how serious the trauma to the heart was.

Jeff Corwin was stung by a stingray in the foot and said the pain was so searing it felt like he’d been struck by lightning. The pain Irwin felt may have been so intense he simply yanked the thing out completely by instinct, the way we pull our hand off a hot stove.

30

[Michael Scott]

That’s what she said!

[/Michael Scott]

31

Just this week a similar accident happened to an elderly man in Florida (? I think it was) and the barb broke off below the surface of the skin. Taken to hospital where barb was removed from the back of his heart and he survived.

The Dr. reccomended NOT pulling the barb out the way it went in as the barbs are like saw teeth, damage tissue and in the case of the heart would more likely result in death.

32

The venom doesn’t kick in instantly, at least not in the foot. I had time to walk to shore and sit on some rocks before my world went to shit. The initial stab feels like someone stabbing you with an ice pick, so it probably would be reflexive to try to pull it out from that, at least for that moment. But then you have a few minutes between that and the venom. So I don’t think the venom itself would have caused a reflex to pull it out. I am not a doctor, but I am a stingray stabbee (one who is stabbed, if it isn’t obvious).