Wound Management

Initial Wound Care

The Infectious Diseases Society of America recommends against using iodine- or antibiotic-containing solutions for initial cleansing of wounds, and suggests hand wounds require special attention as they are often more serious than wounds to fleshy parts of the body 1
For deeper wounds, the Infectious Diseases Society of America recommends approximation of margins using Steri-Strips and subsequent closure by delayed primary or secondary intent, but advises that infected wounds should not be closed 1
Elevation of the injured body part, especially if swollen, is recommended to accelerate healing, and outpatients should be followed up within 24 hours either by phone or during an office visit 1
Ensuring tetanus prophylaxis status is current, and administering tetanus toxoid (0.5 mL intramuscularly) if outdated or unknown, is suggested by the Infectious Diseases Society of America 1

Doxycycline is a recommended option for oral broad-spectrum antibiotics covering water-associated organisms, according to the Infectious Diseases Society of America 2
Amoxicillin-clavulanate is considered a treatment option for more severe wounds by the Infectious Diseases Society of America 1
Broad-spectrum antibiotics covering water-associated organisms are essential for treating marine sting wounds, according to the Infectious Diseases Society of America 3

Thorough irrigation of the wound with warm potable water with or without soap until all foreign matter is removed is recommended by the American Heart Association 4, 5
Debridement of any necrotic tissue and removal of visible foreign bodies or spine fragments is essential for proper wound care, as recommended by the American Heart Association 3

Immersing the affected area in hot water (as hot as tolerated, approximately 40°C/104°F) for 20-30 minutes is suggested for pain management, with alternatives including dry hot packs or topical lidocaine cream/gel (4-5% or 10-15% formulations) if hot water is unavailable, as per the American Heart Association 4, 3, 6
Topical lidocaine (4-5% or 10-15% formulation) can help with localized pain, as recommended by the American College of Cardiology 3
Applying antibiotic ointment or cream to the wound, and covering with a clean occlusive dressing to promote healing and reduce infection risk, is recommended by the American Heart Association 4, 5

Monitoring for infection and managing hypertrophic scarring according to general wound care guidelines to prevent scarring is recommended by the American Heart Association and American Red Cross 4, 5
For mild to moderate scarring, applying silicone-based scar sheets or gel daily for at least 12 hours per day for 2-3 months, using sunscreen (SPF 30+) on the scarred area, and considering topical vitamin E or moisturizers to keep the scar hydrated may be beneficial 3
Monitoring for systemic reactions requiring emergency services, including difficulty breathing, signs of shock, and severe pain, which can occur soon after envenomation, is recommended by the American Heart Association and American Red Cross 3

The American Heart Association recommends against using pressure immobilization bandages, fresh water, alcohol, methylated spirits, aluminum sulfate, meat tenderizer, or folk remedies like urine, as these can trigger additional nematocyst discharge or cause harm 5, 4, 3, 6
Avoiding scraping the area is also advised, as it can trigger additional nematocyst discharge, as per the American Heart Association 4, 5, 3, 6
Surgical exploration and debridement may be necessary if there is evidence of abscess formation, foreign body suspicion, significant tissue necrosis, or nerve compression, as suggested by the American College of Surgeons 3