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Just a Day at the Beach: Sharks, Surf, Stingrays, Oh My
Lauren Altschuh, MD FAWMUCSD Wilderness Medicine
February 22, 2021
Why this lecture?
● Grew up at the beach○ My first wilderness environment
● Previous UCSD wilderness fellow○ Excellence in marine medicine
● Live at the beach○ Bella the beach dog
● I have no conflicts
What this lecture will not cover...
● Falling cliffs
● Dune buggy crashes
● Algae blooms
● Tsunamis
● Australian beaches
What we will cover...
● Sun & Sand○ Degrees of sunburn○ Sunscreen & SPF
● Swells○ Riptides○ Surf injuries
● Stings & Stabbings○ Marine envenomations
● Shark attacks
● Prevention○ Avoid 10a - 3p○ Reapply sunscreen every 90-120
mins or after water○ Wear SPF blocking clothes &
headwear● Treatment
○ Remove from environment○ Stop the burn○ Protect the skin○ Cold green tea bags
Sunburn
Does the SPF really matter?
Surf Zone Hazards
● Surf zone = from beach to breakers
● Drowning with or without morbidity
● Runout, rip current, or undertow○ Don’t fight, let it take you out○ Swim parallel
Wavesports injuries
● Most common mechanisms○ Hitting the sand or rocks or reef○ Hitting a board (yours or others)
● Most common injuries○ Laceration, MSK, head injury○ 40% head/face/neck
Marine Envenomations (Jellyfish)
1. Rinse with seawater, not freshwater2. Pull off any big tentacles, but don’t rub skin3. 5% acetic acid (vinegar) to neutralize4. Shave or sand paste for nematocyst removal5. Pain control with topical lidocaine, isopropyl ETOH, papain meat
tenderizer, topical steroids
If it stings, neutralize it.
Marine Envenomations (Stingray/Urchin)
1. Hot water for 30-90 minutes (sea or fresh)2. Remove spines if reachable3. Watch out for retained foreign bodies, xray or MRI to see4. Pain control local injection, nerve block or systemic narcotic
If it stabs, heat it up.
Shark attacks (and other big marine bites)● Rare → 65 attacks/year
○ Most common species: bull, great white, tiger○ Most due to mistaken identification, but can be territorial
● Cause of death usually hemorrhage or drowning○ Tourniquets save lives
● Treatment for big wounds○ Decontamination
■ Sharks mouths- are gross - remove foreign bodies○ Minimal wound closure - asking for infection○ Tetanus & antibiotic prophylaxis
■ Ensure vibrio & aeromonas coverage● Same treatment for sea lions, barracuda, moray eel
What’s the best marine antibiotic?
● Most common bugs → Staph, strep, vibrio● If healthy with minimal wound, no abx
prophylaxis needed● Large, deep, or unhealthy
○ Ciprofloxacin 500 mg BID○ Bactrim 160/800 mg BID○ Doxycycline 100 mg BID
● With sepsis or bullae, especially with underlying liver disease → Vibrio○ Imipenem-cilastatin○ Meropenem
Questions?
References● Auerbach, P, et al. Wilderness Medicine. Chapter 16, 55, 69, 73, 74, 75.● Cohen, P. “Beach Feet: A Sand-associated Thermal Injury to the Soles of the Feet and the Plantar Aspect of the Toe.” Cureus.
2019 Dec; 11(12): e6429.● Doelp, M, et al. “Characterizing surf zone injuries from the five most populated beaches on the Atlantic-fronting Delaware
coast.“The American Journal of Emergency Medicine. Aug 2018, 36(8), 1372-1379.● McArthur, K, et al. “Epidemiology of Acute Injuries in Surfing: Type, Location, Mechanism, Severity, and Incidence: A
Systematic Review.” Sports 2020, 8(2), 25.● Nathanson, A, et al.. “Surfing injuries” Am J Emerg Med. 2002 May;20(3):155-60● Other images
○ https://www.dailymail.co.uk/news/article-7237385/Beachgoer-suffers-horrific-burns-hot-sand-FOUR-HOURS-stopped-barbecuing.html
○ https://www.ksby.com/news/one-dead-four-injured-in-san-diego-cliff-collapse○ https://kmph.com/news/local/experts-believe-oceano-dunes-could-be-completely-closed-in-a-few-year○ https://www.wmbfnews.com/story/38954977/everything-you-need-to-know-about-the-florida-red-tide/○ https://www.sciencedirect.com/science/article/abs/pii/S0735675717310550○ https://www.youtube.com/watch?v=9pXMObfeOcE ○ https://www.grepmed.com/images/3034/vulnificus-clinical-bullae-vibrio-photo
