Urgent Care Management of Common Marine Life Injuries and Envenomations (Trauma CME)

Publication Date: March 2026 (Volume 5, Number 3)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 03/01/2029.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 2 Trauma CME credits, subject to your state and institutional approval.

Authors

Nicholas Bird, MD, MMM, FAAFP, FUHM

Medical Director, Center for Hyperbaric Medicine, Virginia Mason Franciscan Health, Seattle, WA

Jamie Seymour, BSc, PhD, CF

Research Professor, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia

Peer Reviewer

Ivan Koay, MBChB, MRCS, FCUCM, FRNZCUC, MD

Urgent Care Physician; Medical Lead, Kings College Hospital Urgent Treatment Centre, London, United Kingdom; Convenor, Ireland and UK Faculty, Royal New Zealand College of Urgent Care; London Representative, Faculty of Pre-Hospital Care, Royal College of Surgeons, Edinburgh, Scotland, United Kingdom

Lyndsie Watkins, PA-C, FCUCM

Clinical Director, Northwell Health GoHealth Urgent Care, Manorville, NY

Abstract

Most presentations of marine life injuries and envenomations to the urgent care setting are non–life-threatening; they may include infections, retention of foreign material, systemic allergy symptoms, and skin irritation. However, patients may present with a wide spectrum of animal encounters, time since injury, and illness severity. Little has changed over the past 20 years related to marine life injuries and associated wound care, apart from first-aid guidelines for jellyfish stings, with an emphasis on the most lethal species. Because urgent care clinicians are often the first healthcare professionals to evaluate these patients, they play a pivotal role in early intervention, risk stratification, and timely escalation of care, when indicated. This issue of Evidence-Based Urgent Care provides practical guidance on the recognition, initial assessment, and management of marine life injuries, including recommendations for clinic-based treatment and clear criteria for referral to higher levels of care.

Case Presentations

CASE 1

A 14-year-old boy presents to urgent care with intense leg and foot pain…

He was playing in the surf on a North Carolina beach with his friends when he saw a jellyfish wrapped around his left leg and foot.
A bystander saw what happened and helped the boy wash off his legs and feet in saltwater.
His left leg and foot are red and inflamed.
On physical examination, he has no systemic symptoms but does have local erythema and itching.
You wonder what kind of jellyfish may have stung him…

CASE 2

A 17-year-old boy presents to urgent care with puncture wounds on his right ankle and Achilles tendon…

He reports that he was climbing over a rocky intertidal area, when he slipped and fell into the water. The patient was punctured by multiple sea urchin spines in his right ankle and Achilles tendon.
You wonder if he needs urgent referral for surgical evaluation ...

CASE 3

A 25-year-old woman presents to urgent care with pain in her right index finger…

Two days ago, she was scuba diving for invasive lionfish. She speared one, but punctured her right index finger with its spine while trying to remove it from her spear. She had immediate pain.
She washed the finger thoroughly with chlorhexidine and water, and then soaked her finger in hot water, which helped the pain.
She applied ice after she continued to have pain and swelling.
Two days after the injury, is she likely to develop significant systemic symptoms, and will she require urgent medical evaluation?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.