Envenenamiento por Rayas.pdf

Se presentan aspectos sobre el envenenamiento por rayas, con énfasis en México. Diferentes especies y distribución geográfica. Características anatómicas, forma y particularidades del aguijón. Composición del veneno y medicamentos utilizados para el tratamiento.

1. MC, MVZ Héctor Gabriel Ramos Rodriguez
ISSSTE-UNAM Julio, 2022

2. Table 1. Taxonomic classification of the stingray

Kingdom Animaña

Phy ‘Chordata

Class Chondichthyes

Subclass Elasmobranchi

Superorder Batoideo

Order Rajlomes

Families Anacanthobatidae Pesiobatdae
Dasyatidas Potamotygonidae
Gymnuidae Rajidae
Hoxatrygonidae hinobatidas
Mylobatidas Urolophidae

Ramos-Rodriguez HG, Cedilo Sanchez E, Méndez JD. Stingray poisoning, A careless aspect in México.
‘Advances in Environmental Biology. 20082(2): 54-62.

3. Craniata

(—Mytlobatformes™ à
Frames eo

Prstiomes 1
| Topsantornes |
‘—Pristiophoriformes !
-Squaniniformes |
[--Squaliformes. 1
| zrnertermes !
homes. |
naine!
H-Lamnitormes t
me
E etaroconttmes!

http://wwwibiologia.unam.mx/peces/evolucion_20CHONDRICHTHYES,html

4. Gus
Condes.
Shorts and Singrays

Figure Te current taxonomy of stingrays.
“Stingray amies most kel o nfic human injuries because of their long tis and more distally located dora tai

© 2008 international Society of Travel Meine, 1195-1982
Joumaof Travel Medicine, Volume 15, Iso 2, 2008, 102-109

5. Orden Nombre común

Rajiformes Rayas comunes

Myliobatiformes Mantra Rayas ds
agua dulce

Torpediniformes Rayas torpedo o Rayas
eléctricas

Rhinobatiformes | Peces guitarras

Pristiformes Peces sierra

https:/Ammwunimagdalena.edu.co/Content/Public/Docs/Entrada_Facultad3/adjunto_1029-20181004104939_919.pdf

6. VAE FZ

Esquema gencral de la anatomía de una raya (Vista
dorsal ariba - Vista ventral abajo). 1)espirdculo; 2)
jo; 3) aleta pectoral; 4) espinas; 5) aleta dorsal: 6) » _
aguijón; 7) aleta caudal; 8) aleta pélvica, 9) ano; 10) em tm ie
aberturas branquias; 11) fosa nasal; 12) boca. er
az?

|nttps://www.unimagdalena.edu.co/Content/Public/Docs/Entrada_Facultad3/adjunto_1029-20181004104939_919.pdf

7. eye

spiracle

pectoral
fin

stinger
pelvic fin } e tail

claspers

dorsal (parte superior) — — ventral (parte inferior) Anatomia externa
de una raya macho Mantarraya - https://es.abcdef wiki/miki/Stingray

https://es.abcdef.wiki/wiki/Stingray

4

6

Anatomía posterior de una raya. (1) Aletas pélvicas (2) Tubérculos
caudal (3) Aguijón (4) Aleta dorsal (5) Pinzas (6) Cola Mantarraya
- https://es.abcdet.wiki/wiki/Stingray

8. [snout

Fi. 2.Doravewat a pines rom afemae Dyas sabinas | |
Western North Atlantic, 1948) [21]

margin

Pectoral Meine Pelvic Caudal Tal Dorsal tal
fn tubercles in tubercles sting fniolé

C
|
|
|

‘Anterior Eye Spiracle Ventum Dorsum — Ciasper Ventral tail Caudal

(male only) finfold flament

Fig. 1. Body plan of a Whiptall Stingray (Family Dasyatidae) [21]

Ramos Rodríguez HG, Cedilo Sánchez E, Méndez JD. Stingray poisoning, A careless aspect in México.

‘Advances in Environmental Biology. 2008;2(2): 54-62,

9. resides pha hate amis ae

https://th-sites.imgix.net/sites/983/2019/02/07172254/Southern-*

ingray-Fact-Sheet.pdf

10. TAMAÑO RELATIVO A UN HOMBRE DE 6 PIES (1 PIE = 30.48 CM)

https: //www.nationalgeographic.com/animals/fish/facts/stingrays.

11. Mecanismo de ataque para picadura de raya

ht au.myindianshor: ner

12. Serrated spine ¿sino sono

FIGURE 4: Line diagram of the method of envenomation of a person treading on
a stingray. Pressure on the dorsal surface (for example, by a foot) will cause a reflex
“whip” of the tail, usually causing the serrated barb to be driven firmly into the
victim, (Diagram is reproduced with the kind permission of Mark Seidler, ©
National Geographic Society.)

‘THE MEDICAL JOURNAL OF AUSTRALIA Val 151 December 418, 1999

Diagrama lineal del método de envenenamiento de una persona que pisa una raya. La
presión sobre la superficie dorsal (por ejemplo, por un toque) causará un reflejo látigo”
de la cola, lo que generalmente hace que la púa dentada se introduzca firmemente en
la víctima. (El diagrama se reproduce con el amable permiso de Mark Seidler, ©
National Geographic Society)

13. Pectoral fin

Fig. 2 À fly aaa shelton of Urbs ja

Zoomorphology https://doi.org/10.1007/s00435-018-0404-0

14. Vista ampliada de la espina de la cola de la raya del Atlántico. Foto © Museo de Historia Natural de Florida

https//mmwfloridamuseum.ufl.edu/discover-fish/species-profiles/dasyatis-sabina/

15. Composición del veneno de rayas

SUBSTANCIAS FORMULA

Fosfodiesterasas
5' nucleotidasas 925 Amino ácidos
Serotonina Derivada del Triptófano
HO
a
M
Y
q
El
Hialuronidasa 425 Amino ácidos
Orpotrin HGGYKPTDK (1002 Da)

16. Algunos signos y sintomas por la picadura de una raya

+ Dolor inmediatoy severo que se radin hacia ariba dela extremidad y
dura hasta 48 horas

+ Hinchazón enel rea herida

+ Sangrado de la herida

+ Cambio de color en el área de la lesión: primero azul oscuro, luego rojo

+ Presión anerial baja
+ Desmayos, debilidad, marcos

+ Salivación, náuseas , vómitos díarea
+ Door de cabeza

+ Dificultad para respirar

+ Embargo

imbres musculares y dolor, parálisis

+ Irregularidades del ritmo cardíaco

+ La muerte, aunque rara, se ha informado por una punción en el corazón o

el abdomen y por la pérdida de sangre.

https://wwww.emedicinehealth.com/stingray injury/articie_em.htm

17. I 1L
Penetration
Local systemic
affectation manifestations Choc eiomen,
groin, neck)

Preservative Medical

management valuation DSRENCT
Complications HOSPITABLE

(necrosis, infections) MANAGEMENT

Fig. 3. Algorithm for the attention of a stingray poisoned patient

Ramos Rodríguez HG, Cedilo Sánchez E, Méndez JD. Stingray poisoning, A careless aspect in México.
‘Advances in Environmental Biology. 2008/22): 54-62.

18. Specific recommendations for stingray injury include:

(1) Washing the wound with clean tap water, or salt water
if clean fresh water is unavailable. Washing is advised
to remove toxin from the wound.

(2) Applying warms soaks to the injured body part, as hot
as can be tolerated without scalding, for 30-60 min,
‘Warm soaks are advised even if a patient's presentation
is delayed, especially if pain is still present.

(3) Adjunctive local and / or systemic anesthesia if needed.
Infiltration with lidocaine or bupivacaine, or adminis-
ration of parenteral or oral narcotics helps control pain.

(4) Irrigation of wounds with sterile saline to remove toxi
debridement of necrotic tissue. Many sources recom-
mend irrigation and debridement, although one author
with extensive clinical experience suggests that these
vigorous local measures are unnecessary [30]. Also,
emergency physicians along the coast of the southeast-
em United States vary in their use of irrigation and

6

10]

{u}

debridement, without obvious difference in clinical out-
come (16 physicians; written survey by the author,
1996).

Soft tissue radiographs to help exclude foreign body
(part of a ray's barb) remaining in the wound [4,7,31}
Magnetic resonance imaging (MRI) is reported to be an
excellent, albeit expensive, alternative to localize sting
ray spines (PS Auerbach, personal communication
Antibiotic treatment of acute wound infections should
include coverage of skin bacteria and Vibrio species.
Trimethoprim-sulfamethoxazole, tetracycline, and
ciprofloxin provide Vibrio coverage for wounds treated
‘with oral antibiotics. Aminoglycosides, third-generation
cephalosporins (cefotaxime, ceftazidime. moxalactam),
imipenem, or chloramphenicol provides intravenous
coverage for Vibrio bacteria [13). The same antibiotics
are recommended for injuries sustained in fresh water,
providing coverage of Aeromonas species [3].
‘Treatment of poorly healing wounds or chronic drai
dls ont iste supiste as ee
ment or cyst excision; such wounds respond poorly, if at
all, to antibiotics [9] (PS Auerbach, personal commu-
nication).

Wilderness and Environmental Medicine, 824-28 (1997)

19. Current management principles for stingray injuries’

= Immersion of the affected part in hot water for at least
80 minutes for pain relief (relief is generally only effective
while the affected part remains immersed).

= Radiography of the affected body part to exclude the
presence of cartilaginous barb remnants.

= Local infiltration of plain lignocaine (the use of lignocaine
with adrenalin is contraindicated, as it delays
microvascular clearance of venom from the wound
and thus further increases the risk of necrosis).

= Systemic analgesia.

= Careful wound examination, removal of foreign material,
irrigation and debridement.

m Heal by secondary intention; consider use of an
alginate-based dressing.

= Antibiotic cover using broad-spectrum antibiotics for
large or established wounds, or for penetrating wounds
(eg. doxycycline 100mg daily, or ciprofloxacin 500mg
twice daily, or as dictated by wound cultures). (NB: It
is important to specify seawater involvement when
submitting a swab or specimens for culture.)

= Tetanus prophylaxis."*

= Early referral of confirmed or suspected penetrating
injuries of chest or abdomen,

“Based on the mnowiedge o! the elects of venom and sequelae of
barb injury

MJA Vol 175 2 July 2001 (rnemsalounatot sat: 2001)

20. Surgery
Complete wound exploration

Through
‘Second bok at 48 hours + further dobridamont
Direct closure

Figure 6 A suggested algorithm for the management of stingray injuries to the hand.

Journal of Plastic, Reconstructive & Aesthetic Surgery (2009) 62, e270ee273

21. Cephalexin
Amoxicillin

M Ciprofloxacin
Ceftriaxone
Ml Clindamicina
Penicillin
Others

Figure 3 Characterization of antibiotics prescribed to people who were
traumatized by stingray stings treated at UPAs in the north and south
of Palmas, Tocantins State, Brazil, from 2018 to 2019

Rev Pon Amar Saude 2021:1210202100963 SN: 2176-6223

22. Figura 1. Distribución de casos por tipo de envenenamiento secundario causado por
‘animales ponzoñosos atendidos desde el centro toxicológico entre 2016 y 2018

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Rev. Salud Pública. 21(4): 1-5, 2019

23. Echa un vistazo a dónde viven las rayas.

lionalgeographic.com/animals/tish/tacts/sti

24. wow

Tors

pacts ocean

Pros

os

5] 0 m0 200

—
AAA AAA
Tru wor wor rv

Pura AP à Mergen Helen © Soracina

gue 3. Guen geographic dto ofthe fly Petamotygeiae (tape from Rosa and Lass 201. Map prepared by
Eine da Cob Se

TOXIN REVIEWS https:/doi.org/10.1080/15569543.2018.1542406

25. Map 2. Geographic distribution of rays of medical importance in the Mexican coasts. For the case
‘of the genus Urobatis, (sp) it involves other species like Urolophus maculatus, Urolophus
concentrieus and Urolophus jamaicensis. The last one predominates in the Gulf of Mexico and the
Caribbean. The population density for each species acquires knowledge

Ramos-Rodriguez HG, Cedilo Sánchez E, Méndez JD. Stingray poisoning, A careless aspect in México.
‘Advances in Environmental Biology. 2008:22): 54-62

26. [email protected]

psp deposit come mage nanas jos animados