eMedicine Specialties > Emergency Medicine > Environmental

Conidae: Follow-up

Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine
Coauthor(s): William H Shoff, MD, DTM&H, Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania
Contributor Information and Disclosures

Updated: Apr 30, 2009

Follow-up

Further Inpatient Care

  • Intensive care unit monitoring is indicated for patients with conidae envenomation who are experiencing cardiopulmonary arrest and requiring mechanical ventilation.
  • Admit patients to a monitored bed for further observation if they exhibit hypoxia, significant muscular weakness, and/or cardiac ectopy.
  • Carefully monitor patients with persistent paresthesias and muscular weakness for signs of respiratory compromise.
  • Consider inpatient observation for patients with underlying cardiac, pulmonary, or neurologic disease.

Further Outpatient Care

  • Monitor the wound for evidence of infection. Patients whose wounds show any evidence of infection should return for evaluation and should inform the examining health care provider that the wound occurred in the marine environment because antibiotic choice will vary accordingly. The wound should be re-examined for foreign body.
  • The patient may require oral analgesics for pain control.

Deterrence/Prevention

  • Properly identify cone shells and handle them only with protective gloves.
  • Never carry a live cone in net bags next to skin, wet suits, or buoyancy control vests.
    • If a live cone must be carried, lift it at the large posterior end of the shell with protective gloves. This is not always adequate protection as the proboscis can extend the entire length of the shell. 
    • If the proboscis protrudes, immediately drop the cone.
  • Walk in intertidal areas wearing appropriate footwear. Do not reach blindly under corals or rocks.

Patient Education

  • To assist in preventing cone shell envenomation, give patients the following instructions:
    • Properly identify cone shells.
    • Handle cone shells only with proper gloves.
    • Do not carry a live cone in a perforated or thin bag near skin, wet suits, or buoyancy control vests.
    • If a live cone must be carried, lift at the large posterior end of the shell with protective gloves. Remember, this is not always adequate protection as the proboscis can extend the entire length of the shell.
    • If the proboscis protrudes, immediately drop the cone.
    • Walk in intertidal areas wearing appropriate footwear. Do not reach blindly under corals or rocks.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Stingray Injury.

Miscellaneous

Medicolegal Pitfalls

  • In most countries where cone shells are found, a permit is required for the collection of all species of Conidae.
  • Failure to make the diagnosis
  • Failure to consult an appropriate poison control center or toxicologist
  • Failure to examine the wound for a foreign body
  • Failure to inquire regarding the patient’s tetanus immunization status
  • Failure to monitor the patient with muscular weakness for evidence of respiratory failure
 


More on Conidae

Overview: Conidae
Differential Diagnoses & Workup: Conidae
Treatment & Medication: Conidae
Follow-up: Conidae
References
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References

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  3. Han TS, Teichert RW, Olivera BM, Bulaj G. Conus venoms- a rich source of peptide-based therapeutics. Current Pharmaceutical Design. 2008;14(24):2462-79. [Medline].

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  5. Atanassoff PG, Hartmannsgruber MW, Thrasher J, Wermeling D, Longton W, Gaeta R, et al. Ziconotide, a new N-type calcium channel blocker, administered intrathecally for acute postoperative pain. Reg Anesth Pain Med. May-Jun 2000;25(3):274-8. [Medline].

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  17. Livett BG, Sandall DW, Keays D, Down J, Gayler KR, Satkunanathan N, et al. Therapeutic applications of conotoxins that target the neuronal nicotinic acetylcholine receptor. Toxicon. Dec 1 2006;48(7):810-29. [Medline].

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  24. Rauck RL, Wallace MS, Leong MS, Minehart M, Webster LR, Charapata SG, et al. A randomized, double-blind, placebo-controlled study of intrathecal ziconotide in adults with severe chronic pain. J Pain Symptom Manage. May 2006;31(5):393-406. [Medline].

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  26. Teichert RW, Jacobsen R, Terlau H, Yoshikami D, Olivera BM. Discovery and characterization of the short kappaA-conotoxins: a novel subfamily of excitatory conotoxins. Toxicon. Mar 1 2007;49(3):318-28. [Medline].

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Further Reading

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Keywords

cone shell toxin, cone shell envenomation, cone shell sting, Conidae family, cone shell venom, conotoxin, conus, mollusca envenomation, conotoxin peptides, Conus geographicus, Conus geographus, C geographus, C geographicus, ziconotide, Conus aulicus, C aulicus, Conus gloria-maris, Conus gloriamaris, C gloriamaris, C gloria-maris, Conus marmoreus, C marmoreus, Conus omaria, C omaria, Conus striatus, C striatus, Conus tulipa, C tulipa, Conus textile, C textile, Mollusca, mollusk, mollusc, oligopeptide toxin, radula, radular sheath, cone shell poisoning

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Contributor Information and Disclosures

Author

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine
Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

William H Shoff, MD, DTM&H, Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania
William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Glaxo Smith Kline Consulting fee Consulting; Glaxo Smith Kline Honoraria Speaking and teaching

Medical Editor

Samuel M Keim, MD, Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine
Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

James Steven Walker, DO, MS, Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center
James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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