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>I was snorkeling in Bonaire over a patch of elkhorn coral and dove down to get a closer look at a sea fan. A dive boat zoomed by and I got shoved by the swell. My knee scraped against a horn of coral. I was surprised that it stung. Rubbing it didn't help. When I got back to the hotel, one of the cooks told me to rub it with meat tenderizer, but we didn't have any. Now it's been two weeks and the skin on my knee doesn't seem to be healing. What should I do?
>Coral scrapes are the most common injuries from marine life incurred by divers and snorkelers. The surface of coral is covered by soft living material, which is easily torn from the rigid (abrasive) structure underneath, and thus deposited into the scrape or cut. This greatly prolongs the wound-healing process by causing inflammation and, occasionally, initiating an infection. Cuts and scrapes from sharp-edged coral and barnacles tend to fester and take weeks or even months to heal.
- Scrub the cut vigorously with soap and water, and then flush the wound with large amounts of water.
- Flush the wound with a half-strength solution of hydrogen peroxide in water. Rinse again with water.
- Apply a thin layer of bacitracin, mupirocin (Bactroban), or other similar antiseptic ointment, and cover the wound with a dry, sterile, and non-adherent dressing. If no ointment or dressing is available, the wound can be left open. Thereafter, it should be cleaned and re-dressed twice a day.
>If the wound develops a pus-laden crust, you may use "wet-to-dry" dressing changes to remove the upper non-healing layer in order to expose healthy, healing tissue. This is done by putting a dry sterile gauze pad over the wound (without any underlying ointment), soaking the gauze pad with saline or a dilute antiseptic solution (such as 1- to 5-percent povidone-iodine in disinfected water), allowing the liquid to dry, and then "brutally" ripping the bandage off the wound. The dead and dying tissue adheres to the gauze and is lifted free. The pink (hopefully), slightly bleeding tissue underneath should be healthy and healing. Dressings are changed once or twice a day. Wet-to-dry dressings are used for a few days, or until they become non-adherent. At that point, switch back to #3 above.
- If the wound shows any sign of infection (extreme redness, pus, swollen lymph glands), the injured person (particularly one with impairment of his or her immune system) should be started by a qualified health professional on an antibiotic, taking into consideration the possibility of a Vibrio infection. Vibrio bacteria are found more often in the marine environment than on land, and can rapidly cause an overwhelming illness and even death in a human with an impaired immune system (e.g., someone with AIDS, diabetes or chronic liver disease).
>Coral poisoning occurs if coral abrasions or cuts are extensive or are from a particularly toxic species. Symptoms include a wound that heals poorly or continues to drain pus or cloudy fluid, swelling around the cut, swollen lymph glands, fever, chills and fatigue. If these symptoms are present, the injured person should see a physician, who may elect to treat the person with an antibiotic or corticosteroid medication.
>For more information on marine life injuries, see the complete article by Paul S. Auerbach, M.D., M.S. on Marine Life Trauma from the Jan/Feb 1998 issue of Alert Diver.