Sea wasp sting: Difference between revisions

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== Background ==
==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


''Chironex fleckeri'', commonly known as sea wasp
==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]]


Large form of box jellyfish, found mostly off the coast of northern Australia to the Philippines
==Differential Diagnosis==
{{Marine envenomation DDX}}


Extremely deadly, often considered one of the most poisonous jellyfish
==Evaluation==
*Assess/manage ABCs
*[[ECG]] (look for arrhythmia, blocks, ischemia)
*CXR
*CBC, BMP, troponin/CK
*Consider:
**ABG, echo, nematocyst sampling


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
==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


Tentacles contain millions of stinging cells known as cnidocytes
==Disposition==


== Clinical Presentation ==


Sting is extremely painful, described as burning, and can cause death as quickly as 3-5 minutes
==See Also==
*[[Marine toxins and envenomations]]
*[[Box jellyfish]]


Most stings are mild and are self-limiting
==References==
<references/>
https://lifeinthefastlane.com/toxicology-conundrum-010/


Deaths most commonly occur in children
[[Category:Environmental]]
 
[[Category:Toxicology]]
Venom causes cells to become leaky, causing hyperkalemia
 
== Management ==
 
See Box Jellyfish - Management https://wikem.org/wiki/Box_jellyfish
 
== References ==
 
Fenner, P. J. (2000). Chironex fleckeri – the north Australian box-jellyfish. marine-medic.com
 
Fenner PJ, Williamson JA (1996). "Worldwide deaths and severe envenomation from jellyfish stings". The Medical Journal of Australia. 165(11–12): 658–61.
 
http://animals.howstuffworks.com/marine-life/jellyfish-venom2.htm
 
http://oceana.org/marine-life/corals-and-other-invertebrates/sea-wasp
 
--[[User:Jtheriot|Jonathan KDMC Theriot]] ([[User talk:Jtheriot|talk]]) 02:32, 6 August 2017 (UTC)

Latest revision as of 21:47, 28 September 2019

Background

Box jellyfish (Chironex fleckeri)
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 toxins, envenomations, and bites

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

References

https://lifeinthefastlane.com/toxicology-conundrum-010/

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