Division of Orthopedic Surgery, Department of Surgery, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (VAS, JK).
Department of Trauma, The Queen's Medical Center, Honolulu, HI (KN, SF, MSH).
Hawaii J Health Soc Welf. 2021 Nov;80(11 Suppl 3):31-37.
In a 5-month period in 2019, 3 long-distance swimmers sustained cookiecutter shark-related injuries while attempting to cross the Ka'iwi Channel between the Hawaiian Islands of O'ahu and Moloka'i. This report is the first case series of cookiecutter shark bites on live humans. A retrospective review of the State of Hawai'i Division of Aquatic Resources Shark Incidents List was conducted between March 1, 2019, and July 31, 2019. Trauma registry data and medical records were reviewed in patients treated for cookiecutter shark bites at The Queen's Medical Center in Honolulu, Hawai'i. All 3 patients sustained nonfatal cookiecutter shark bite circular wounds measuring between 8-13 cm in diameter. They were injured swimming over waters with depths of greater than 2000 feet at night. Patients had prolonged transport times to the emergency department (ED), averaging 73 minutes, due to their injuries occurring on the open water. All were hemodynamically stable upon ED arrival and did not require blood products. Tetanus toxoid was updated, and prophylactic antibiotic coverage, including doxycycline for Vibrio spp., was administered. Two of 3 patients were treated with operative management. Open water swimmers crossing the deep waters between the Hawaiian Islands at night are most at risk for cookiecutter shark bites. Wounds may penetrate down to and through the fascial level. Immediate life-saving hemorrhage control administered by personnel accompanying the swimmers on the open water is important for preventing morbidity and mortality. Antibiotic prophylaxis for marine bacteria is recommended.
在 2019 年的 5 个月期间，有 3 名长距离游泳者在试图穿越夏威夷群岛的瓦胡岛和莫洛凯岛之间的 Ka'iwi 海峡时遭受了与食人鱼相关的伤害。这是首例食人鱼咬伤活人的病例系列报告。对 2019 年 3 月 1 日至 7 月 31 日期间夏威夷州水产资源部鲨鱼事件清单进行了回顾性审查。在檀香山的皇后医疗中心治疗食人鱼咬伤的患者的创伤登记数据和医疗记录进行了审查。所有 3 名患者均遭受非致命性食人鱼咬伤的圆形伤口，直径在 8-13 厘米之间。他们在夜间游泳于水深超过 2000 英尺的水域受伤。由于他们的受伤发生在开阔水域，因此患者前往急诊部（ED）的运输时间延长，平均为 73 分钟。所有患者到达 ED 时血流动力学均稳定，不需要血液制品。破伤风类毒素得到了更新，并给予了预防性抗生素覆盖，包括多西环素治疗弧菌属。3 名患者中有 2 名接受了手术治疗。夜间在夏威夷群岛之间的开阔水域中横渡深水区的开放式游泳者最容易受到食人鱼咬伤。伤口可能穿透筋膜层。由在开阔水域陪伴游泳者的人员立即进行救生性出血控制，对于防止发病率和死亡率非常重要。建议使用抗生素预防海洋细菌。
