Scuba Diving: Starfish (Sea Star) and Crown of Thorns Puncture Wounds

• Starfish, crown of thorns, and sea stars are marine animals of the class Asteroidea, and live throughout the subtropics and tropics.
• They are bottom dwellers, so any contact with a diver is usually accidental.
• Injury occurs from the spine and the venom in a gelatinous form from around the spine areas.
• It can be injected into the skin and even through gloves as some star fish have long spines.
• Crown of thorns have as many as 13 to 16 short, sharp spines that are up to 6 cm (over 2 inches) long.
• Starfish (also termed sea stars) vary from about 1 inch to about 3 ft. in diameter.

• After the skin puncture, the victim experiences severe and immediate pain, significant bleeding and swelling at the site.
• Symptoms are usually limited, lasting from 30 minutes to 3 hours and then resolving.
• More severe reactions or envenomations can include numbness, tingling, weakness, nausea, vomiting, joint aches, headaches, cough, and in rare cases paralysis.

If medical attention is not readily available, the following guidelines are recommended in treating a puncture wound:

• Immerse the affected area in water as hot as the person can tolerate for 30 to 90 minutes. Repeat as necessary to control pain (water temperature should not exceed 140 F or 60 C).
• Some stings may require an injected local anesthetic for pain relief.
• Use tweezers to remove any spines in the wound because symptoms may not resolve until all spines have been removed. Occasionally the spines may remain in the wound, and will require a health care professional to remove them. Scrub the wound with soap and water followed by extensive rinsing with fresh water.
• Do not cover the wound with tape or any other type of occlusive dressing as it may increase the risk of an infection. A tetanus booster is often recommended for patients with these types of wounds.
• Apply hydrocortisone cream 2 to 3 times daily as needed for itching. Discontinue immediately if any signs of infection appear.
• Oral antibiotics are usually recommended to treat an infection.

• Seek medical treatment as soon as possible.
• Consult a doctor about treatment with available medications.