View source for Sea wasp sting

==Background==
[[File:Avispa marina cropped.png|thumb|Box jellyfish (Chironex fleckeri)]]
[[File:Nematocyst discharge.png|thumb|Nematocyst stages of discharge]]
*''Chironex fleckeri'', commonly known as sea wasp
*Large form of [[box jellyfish]], found mostly off the coast of northern Australia to the Philippines
*Extremely deadly, often considered one of the most poisonous jellyfish
*Identification: Often difficult to distinguish in environment, as animal is transparent. Pale blue bell, often the size of a basketball, with 15 tentacles emerging from lower corners up to 3 meters in length. Has been described as having an eerie similarity to a human skull
*Tentacles contain millions of stinging cells known as cnidocytes

==Clinical Features==
*Sting is extremely painful, described as burning, and can cause death as quickly as 3-5 minutes
*Can cause significant [[hypotension]], [[hypertension]], cardiac [[arrhythmia]], and [[cardiac arrest]]
*Most stings are mild and are self-limiting
*Deaths most commonly occur in children 
*Venom causes cells to become porous and leaky, causing [[hyperkalemia]]

==Differential Diagnosis==
{{Marine envenomation DDX}}

==Evaluation==
*Assess/manage ABCs 
*[[ECG]] (look for arrhythmia, blocks, ischemia)
*CXR
*CBC, BMP, troponin/CK
*Consider:
**ABG, echo, nematocyst sampling

==Management==
*Address ABCs (e.g. [[CPR]], [[fluid resuscitation]], [[vasopressors]], [[intubation]] as needed)
*Remove tentacles!!!
**Nematocysts can continuing firing and delivering more venom if tentacles still attached
**If available, pour lots of vinegar over tentacles first to inactivate
*Do NOT apply pressure dressing/immobilization (triggers nematocysts to fire)
*Box Jellyfish antivenom, if available
**Cardiac arrest: 6 ampules IV push
**Systemic envenomation with hypotension, collapse, or significant arrhythmia: 3 ampules in 100mL NS over 20m
**Pain refractory to opioids: 1 ampule in 100mL NS over 20m
*[[Magnesium sulfate]]: 10 mmol (~2-3g) IV if hemodynamically unstable

==Disposition==


==See Also==
*[[Marine toxins and envenomations]]
*[[Box jellyfish]]

==References==
<references/>
https://lifeinthefastlane.com/toxicology-conundrum-010/

[[Category:Environmental]]
[[Category:Toxicology]]