Difference between revisions of "Sea wasp sting"

(Background)
(Management)
 
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==Background==
 
==Background==
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[[File:Avispa marina cropped.png|thumb|Box jellyfish (Chironex fleckeri)]]
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[[File:Nematocyst discharge.png|thumb|Nematocyst stages of discharge]]
 
*''Chironex fleckeri'', commonly known as sea wasp
 
*''Chironex fleckeri'', commonly known as sea wasp
 
*Large form of [[box jellyfish]], found mostly off the coast of northern Australia to the Philippines
 
*Large form of [[box jellyfish]], found mostly off the coast of northern Australia to the Philippines
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==Clinical Features==
 
==Clinical Features==
 
*Sting is extremely painful, described as burning, and can cause death as quickly as 3-5 minutes
 
*Sting is extremely painful, described as burning, and can cause death as quickly as 3-5 minutes
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*Can cause significant [[hypotension]], [[hypertension]], cardiac [[arrhythmia]], and [[cardiac arrest]]
 
*Most stings are mild and are self-limiting
 
*Most stings are mild and are self-limiting
 
*Deaths most commonly occur in children  
 
*Deaths most commonly occur in children  
*Venom causes cells to become leaky, causing hyperkalemia
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*Venom causes cells to become porous and leaky, causing [[hyperkalemia]]
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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==Evaluation==
 
==Evaluation==
 
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*Assess/manage ABCs
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*[[ECG]] (look for arrhythmia, blocks, ischemia)
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*CXR
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*CBC, BMP, troponin/CK
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*Consider:
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**ABG, echo, nematocyst sampling
  
 
==Management==
 
==Management==
 
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*Address ABCs (e.g. [[CPR]], [[fluid resuscitation]], [[vasopressors]], [[intubation]] as needed)
 +
*Remove tentacles!!!
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**Nematocysts can continuing firing and delivering more venom if tentacles still attached
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**If available, pour lots of vinegar over tentacles first to inactivate
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*Do NOT apply pressure dressing/immobilization (triggers nematocysts to fire)
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*Box Jellyfish antivenom, if available
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**Cardiac arrest: 6 ampules IV push
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**Systemic envenomation with hypotension, collapse, or significant arrhythmia: 3 ampules in 100mL NS over 20m
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**Pain refractory to opioids: 1 ampule in 100mL NS over 20m
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*[[Magnesium sulfate]]: 10 mmol (~2-3g) IV if hemodynamically unstable
  
 
==Disposition==
 
==Disposition==
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==See Also==
 
==See Also==
 
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*[[Marine toxins and envenomations]]
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*[[Box jellyfish]]
  
 
==References==
 
==References==
 
<references/>
 
<references/>
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https://lifeinthefastlane.com/toxicology-conundrum-010/
  
 
[[Category:Environmental]]
 
[[Category:Environmental]]
 
[[Category:Toxicology]]
 
[[Category:Toxicology]]

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/