soaking, the wound should be reexplored, debrided again if necessary, and potentially closed, although delayed primary closure is preferred Imaging can be obtained to rule out retained spines Pain relief is best achieved with morphine, local anesthetic infiltration, or a nerve block Tetanus prophylaxis should be considered, but antibiotics are reserved for wounds that become secondarily infected Sharks Shark attacks may be preceded by one or more “bumps,” which may cause extensive abrasions from the rough denticles of the shark’s skin Two types of bite wounds are described: tangential injury and a definitive bite Tangential injury, caused by the slashing movement of the open mouth as the shark makes a close pass, causes severe lacerations, incised wounds, and loss of tissue Definitive bite wounds cause lacerations, loss of soft tissue, amputations, and comminuted fractures Most injuries involve only one or two bites and are confined to the extremities Hypovolemic shock is the immediate threat to life in shark attacks Bleeding should be controlled at the scene with direct compression, and intravascular volume should be replaced with crystalloid until blood products are available The victim should be kept warm and given oxygen when being transported to an ED Wounds should not be explored in the field Tetanus immunization should be considered, and prophylactic antibiotics with a third-generation cephalosporin or trimethoprim-sulfamethoxazole is recommended Scorpaenidae The 80 species found in the Scorpaenidae family include the zebra fish, scorpion fish proper, and stonefish In California, the sculpin is commonly involved Scorpaenidae are generally found in shallow water, around reefs, kelp beds, or coral They are nonmigratory, slow swimming, and often buried in sand The venom apparatus consists of a number of dorsal, anal, and pelvic spines covered by integumentary sheaths containing venom glands that lie within anterolateral grooves The venoms are unstable, heat-labile compounds Most often envenomation occurs when the fish are handled during fishing excursions Severe pain at the site of the wound is the first and primary clinical sign for all species The wound and surrounding area becomes ischemic and then cyanotic Paresthesia and paralysis of the extremity may occur Other clinical signs include nausea, vomiting, hypotension, tachypnea proceeding to apnea, and myocardial ischemia with electrocardiographic changes In cases of serious envenomation,