sand, plant debris, shark teeth, and shark mouth flora. After a clinical infection is recognized, wounds should
be cultured for aerobes and anaerobes by insertion of sterile swabs deeply into available lesions.
Proper operative intervention is mandatory. It is inappropriate to attempt emergency department
exploration of what often prove to be extensive and complicated wounds. In the operating room, devitalized
tissue should be widely debrided and the wound irrigated copiously to remove all foreign material. An x-ray
may reveal one or more shark teeth in the wound. Unless it is absolutely necessary to achieve tight closure,
the wound should be closed loosely around multiple drains (preferably closed systems) or packed open to
await delayed primary closure. Although there is debate about whether to use internal or external fixation of
grossly open and contaminated fractures, it seems logical to recommend surgical stabilization to facilitate
vascular and soft tissue repair. In the pediatric population, damage to the physis and future limb length
discrepancy should be anticipated.
The abrasion associated with a shark "bumping" should be managed like a second-degree burn, with
daily debridement and application of antiseptic ointment.
A reasonable "shark pack" should be available in emergency facilities and rescue vehicles near shark-
infested waters. This must be portable and should include items necessary to control hemorrhage and initiate
IV therapy.
Barracuda
To many divers the barracuda appears more sinister than the shark, and it is more highly feared.
Barracuda are distributed from Brazil north to Florida, and in the Indo-Pacific from the Red Sea to the
Hawaiian Islands. Of the 22 species of barracuda, only the great barracuda (Sphyraena barracuda) has been
implicated in human attacks.
The great barracuda is encountered in all tropical seas and can grow to 2.5 m and 50 kg, but is rarely
sighted at a length greater than 1.5 m. A solitary swimmer, the fish is extremely swift and swims in a
disconcerting darting fashion. The barracuda possesses an elongated narrow mouth filled with large knifelike
teeth, similar in appearance to those of canines. Smaller fish may be found in large schools.
Although great barracuda seldom attack divers, they do so rapidly and fiercely, often out of confusion
in murky waters. More commonly the fish charges through or leaps from shallow water to bite the dangling
legs of a boater, particularly if a shiny anklet (which resembles a fishing lure) is worn. Persons have been
bitten on the scalp while wearing a barrette or on the face when trying to feed a barracuda by holding a dead
fish bait in their mouths. Considering the great frequency with which barracuda are encountered and the low
number of reported attacks, they do not pose nearly the hazard of sharks.
Barracuda jaws contain two nearly parallel rows of teeth, which produce straight or V-shaped
lacerations, in counterdistinction to the crescent-shaped bite of the shark. Except for this difference and the
magnitude of injury, the surgical problems generated by the barracuda do not differ from those of the shark.
The clinician encounters tissue loss, moderate hemorrhage, and wound infections.
Barracuda bites are treated identically to shark bites. If a barracuda is captured, it should not be eaten
in ciguatera toxin endemic regions.
Moray Eels
Moray eels are found in tropical, subtropical, and some temperate waters. In the family Muraenidae,
some individuals of the larger species may attain lengths of 3.5 m and diameters of more than 35 cm. Morays
are muscular, powerful, and savage bottom dwellers, residing in holes or crevices or under rock and coral.
They have a snake-like appearance, and rarely have scales or pectoral fins. The distinguishing feature of the
morays is the small, round gill opening. The skin of the moray eel is leathery and mucus coated, not easily
lacerated with a knife. Fortunately, the eel usually evades confrontation unless cornered or provoked. Bites
occur when a diver intentionally probes into a coral bed or cave, or a fisherman reaches into a net and offers a
hand to a feeding eel. Aquarium-housed morays may strike when handled improperly. Most moray eels are
easily intimidated and avoid confrontation unless cornered. An aggressive eel may strike out in competition
for prey, particularly lobster. Elderly vision-impaired eels may attack without specific provocation, especially
at night. In U.S. coastal waters, the most prevalent species are the California, green, and spotted morays.
Morays are forceful and vicious biters that can inflict severe puncture wounds with their narrow and
viselike jaws, which are equipped with long, sharp, retrorse, and fanglike teeth. Molar-type teeth are present
in some species. A moray eel has the tenacity of a bulldog and will hold on to a victim, rather than strike and
