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May 24, 2013
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Wilderness: Cone Snail Sting (cont.)

Medical Author:
Scott D. Fell, DO, FAAEM
Medical Editor:
Charles Patrick Davis, MD, PhD
Charles Patrick Davis, MD, PhD
Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Cone Snail Sting Treatment

  • If SCUBA diving, the diver stung should safely surface immediately accompanied by another diver.
  • There is no antivenom available for cone snail stings.
  • Use the pressure immobilization technique:
    • Use an elastic bandage (similar to ACE bandage) to wrap the limb starting at the distal end (fingers or toes) and wrap toward the body. It should be tight but the fingers and toes should remain pink so that the circulation is not cut off.
    • The extremity should also be immobilized with a splint or stick of some sort to prevent it from bending at the joints.
    • The elastic bandage should be removed for 90 seconds every 10 minutes and then reapplied for the first 4 to 6 hours. (Hopefully medical care can be received within this time period.)
  • Other treatment options that may help include:
    • Immerse the affected area in water as hot as is tolerable (water temperature not to exceed 140 F or 60 C).
    • Inject a local anesthetic into the wound area.
    • Some reports suggest that
    • Edrophonium (Enlon, Tensilon) 10 mg IV may be used as therapy for paralysis. A 2-mg test-dose should first be administered IV, and if effective, followed by an additional 8-mg dose IV. Atropine (Atreza, Sal-Tropine) 0.6 mg should be immediately available for intravenous administration in case of an adverse reaction to edrophonium.
    • A 2 to 4 mg dose naloxone (Narcan) given IV may help treat severe hypotension (low blood pressure).
    • Local excision (cutting out the area stung) by a health care professional (controversial and not widely recommended)
    • Incision and suction (controversial and not widely recommended)
  • Avoid excessive movement and keep the patient calm and warm.
  • CPR may be necessary. Artificial respiration may save the person's life.
  • Do not cut into the wound, apply suction, or use a tourniquet.

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